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HomeMy WebLinkAbout0060 MAIN STREET (OST.) - Health 60 Main Street, Osterville = 185 - 003 0 J , _ o Avrl TOWN OF BARNSTABLE LOCATION „' � 5 SEWAGE # 7 ©� VILLAGE ®,� �'yi'/�� ASSESSOR'S MAP& LOT 6 r��03 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 4;V c � (size) as NO. OF BEDROOMS BUILDER OR OWNER Ile �} 7'D11 PERMTTDATE: — 6 COMPLIANCE DATE: -tat jqrl Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Sr Feet Private Water Supply Well and Leaching Facility (If any'wells exist on site or within 200 feet of leaching facility) Ap Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by II��i Avrl 3 TOWN OF BARNSTABLE LOCATION P ge)ll 5 T SEWAGE # 9 7 Sod VILLAGE D,�7�Z'�l�/l�� ASSESSOR'S MAP & LOT ���✓� INSTALLER'S NAME&PHONE NO. /' ors`/C©�lcST. 7 7/ SEPTIC TANK CAPACITY ®O L/- / LEACHING FACILITY: (type) /�/�'dr/S (size)J,?S X �(� �Xa? NO.OF BEDROOMS S BUILDER OR OWNER 7°6rI PERMTTDATE: COMPLIANCE DATE: 101 N Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility S> Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet'. Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 42-9Y d 614, Fee THE CO?0NWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLEs MASSACHUSETTS Zlppltration for &9;pool *pttem Com5tructiou 3permit Application for a Permit to Construct( )Repair( )Upgrade(/)Abandon( ) �,Complete System ❑Individual Components Location Address or Lot No,�p �lt Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ��1�oGr�n`1 Corry'717—pPW Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( � Other Type of Building O, No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow /49 gallons per day. Calculated daily flow ,��� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ��✓dl� Type of S.A.S. /z •5-X Description of Soil CIf 20q $-© Nature of Repairs or Alterations(Answer when applicable) ) <e_ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued thi B rd of Health. h Signed Date7 Application Approved by 2 Date Application Disapproved for the following reasons Permit No. Date Issued `� v No. 7 Fee THE COM' ONWEALTH OF MASSACHUSETTS Entered in computer: M ' Yes PUBLIC HEALTH DIVISION;- TOWN OF BARNSTABLE., MASSACHUSETTS s { Rpplication for Oigpozal *p�tem Cow6tructiou Vermit Apphcati n,for a Permit to Construct( )Repair( )Upgrade Abandon( ) CrTComplete System ❑Individual Components Location Address or Lot No.[yI Owner's Nape,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. / i Designer's Name,Address and Tel.No. 77/-fP,3 Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( L� Other Type of Building Pf_'�h��No. of Persons Showers( Cafeteria( ) t Other Fixtures 4- Design Flow gallons per day. Calculated daily flow -51�� gallons. Plan Date Number of sheets Revision Date ` Title Size of Septic Tank Type of S.A.S. Z- 3-X L)Z X L Description of Soil �ZU�� ✓��,���a¢' �POG�G B°�s��,"� F Nature of Repairs or Alterations(Answer when applicable) Date last inspected: s Agreement: ---,a The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system�in opeation until a Certifi- cate of Compliance has been issued,b thi B . d Health. E. Signed Date9_� Application Approved by �Date 1" � 17 Application Disapproved for the following reasons ' Permit No. d�' Date Issued A— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS 1cS —cam" j Certificate of Compliance THIS IS TO CE TIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded(� Abandoned( )by Ae;, Zwz1 / �'.�/• at t� °rY// G has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated .9— /�; 7 Installer Designer / n/ I The issuance of this permit shal not re co strued as a guarantee that the s 'erra- 11 furialolp ej/M Date Inspector THE COMMONWEALTH OF MASSACHUSETTS 5�55 PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mf6ponl *pztem Cou6tr7)Abandon tfon Vermit Permission is hereby granted to Construct( )Repair( )U gr ( ( ) System located at Ile as 7?ryi Ile and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. -� Provided: Constrvct�ion must completed within three years of the date of thi/ � it. Date: Approved /` " n NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH kND APPLIC ATION FOR A DISPOS �L WORKS CONSTRUCTION PE MIIT (WITHOUT DESIGNED PL kN ) T that the auviication ±or iisnosai wor�s ConsirLictiCn permit siQnecl o ' me sated rore-.Vr 'ocated at ci:o«-inQ cteria: `i0NEL _ iATE: LICENSED SEPTIC SYSTEM INSTALLER 1N IHE TOWN OF BARNSTABLE N-LtiIBER [attach a sketch plan of the proposed system. Also if the licensed installer posesses.a certified plot plan. this plan should be submitted]. q:6eaith fol Side: Rear. 15' r, b Cb l Old S ` �\ ` Job. :.rl Li t ate) 1,) 1 % �4 c� : � /iW ,�, � v '`f,, ,•;'" 1 i�. i I.Ch , � 3 , 77 }. eOt F or Septic ° '. ��i { 8i 1 ��� 4�� �a P�oximote) P IM Iva } inn 1 L u or 0 o N :, to k co K `- - CH DH / Fnd C Oe T t+><-'?qi >.:•k / .k,: _ .C :-!/tie. V PLAN. SH WING f PREPARED BY.• - � ��4,�> } 3 �t Er EXISTING CON", TION ',r v # f a A �MA .��rr�llS�TRjr, E=T; r ..s ' (�I. 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