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HomeMy WebLinkAbout0044 MAYFLOWER LANE - Health Mayflower Lane, Osterville Yix ;, '0 'Ar Ay'r A= 140-121 Sum AM A, Mhoo c it %K' all "Tg=nWj" G WIR_r - V DOW KENN 'J'A W; A Boom$ Dli� Nvum Imp ILI" vim Ora XR, I!t k,?,Ati�4 T2 4"Alt up W11, ------ CHIM 4,age 411 p", -14 C maw NOW 47,; POW. imp g ar Trv��v ,XNAn'A W-owl 1�ke`� Rl v gpl 110 a 'W"Al Iffi iQYVN�T 1W.1 "M tt R 9H?0,11�5?4411 A$Wil py fomvn) ­w Nr X ff" kV W..1 "y 4 51 q i�vgk­ ?Oiid OWN to ''M Omsk Tv Nu AT 7"Am"M 1®R 'x 4 , ,I", My 4 YAM, ksw a M9 lot mte MY qr,*ti, A NOW" On D iAIN Still WN 1 ifill, v '14,M All k pt g. Ib N�, HEMS OWE= I l AA". who QW25 i, w Uli P-m- NJ g,� 'K 4f,-q"S"P 05,-1 �,UIN; Mi v vuw 1�z I � 1 OWN X;j T 1J P X TNU IVA INS El Owe- R ANN-" No. ` 6 P ` Fee THE COMMONWEALTH OF MASSACHUSETTS '- r-j--iLL ntered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZIPPYicatton for Migaal 6p5tem Comaruction Vermtt Application for a Permit to Construct( )Repair( t�Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's N ime,Aldress and Tel.No. Yq Assessor's Map/Parcel 0,�*rel///e xO ly wQ elmD �All Installer's N�f'e,Address,and Tel.No. 6 lY Designer's Name, ddrles`sland Tel.No. 7l- , Type of Building: Dwelling No.of Bedrooms —3 Lot Size f sq.ft. Garbage Grinder4-_e� Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow //, gallons per day. Calculated daily flow 'y gallons. Plan Date 2— D—77 Number of sheets / Revision Date Title Size of Septic Tank /zy ®wl Type of S.A.S. f®"7— Description of Soil Nature of pairs J or Alterations(Answer when applicable) �i7�7��/ zeev go,/ /_Oenl .l✓��` let- Date last inspected: Agreement: The undersigned agrees to ensure the construction iWof 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 issue o ealth. / Signed Date Application Approved by Date 0016 Application Disapproved for the following reasons Permit No. Date Issued ter., 9 - S �v No. � � Fee - THE�C4MMONWEALTH OF MASSACHUSETTS e, �-,'_Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pprication for Migaal *pztem Cow5truction Permit Application for a Permit to Construct( )Repair( /upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. *, r Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name, ddress and Tel.No. /_ K Type of Building: a Dwelling No.of Bedrooms -3 Lot Size 3 84 sq.ft. Garbage GrinderS C,)'� Other Type of Building geneNo. of P—Aieo<IV ersons Showers( Cafeteria( ) . Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date SS— 77 Number of sheets Revision Date Title Size of Septic Tank /(�� � ,Type of S.A.S. 1/60_- A,2 7- Description of Soil Nature of Repairs or Alterations(Answer when applicable) T4 5_A I� // �l/4i7/ Date last inspected: Agreement: , The undersigned agrees to ensure the construction ud..-�a ��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 issue y t B/kd o- ealth. Signed �'""�. Date �&_ Application Approved by 1�', i Ax Date //I —. 2 V' owi i Application Disapproved for the fo ng reasons �� Permit No. =ryr-) Date Issued .1 THE COMMONWEALTH OF MASSACHUSETTS 1 LI&I—17 BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired (v4pgraded( ) Abandoned( )by /}/' lwl o�l) l' at ' _' has been constructed in accordance with the proof Title 5 and the for Disposal System Construction Permit No. L//L "S ��t) dated 10— Installer ra� /� � Designer The issuance of this permit shall not be constr d as a guarantee that the_,sy,.sst 11 function as designed. Date R,,7 Q2 Inspectgf ,�`�7 No. �i to �`�(� ------------------�/C/ �i-�---Fee--THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS lwigogal *p.5tem onotruction Permit Permission is hereby granted to Construct( )Repair( V<Upgrade( )Abandon( ) System located at_T�aV)4 j.ze- �% aS r 11,- 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. j Provided: Construction must be completed within three years of the date of this permit. Date: U ' .�G( mil/ Approved by v S ` CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PER511T OVITHOUT DESIGNED PLANS) (, 4-T, OrGo �; hereby certify that the application for disposal works construction permit signed by me dated . concerning the property located at qY 4a �/l4e� `°� 1��U11lle meets all of the P Y I, following criteria: _ ?here arc no wetlands within 3,00 feet of the oronosed septic system v T'i • r n rivale«ells within : o 1'c^_t f the ro sed septic system /7.1icobsc'. 'cd , c.ca a op P P�arenndm—ter il rcc ,r?_renter xioiv the bcitom of the.leac.�in¢facility Xicre is no increase in 'low andi�r=7an¢e :n use nrovosed r✓ i�icre are no variances rcaneste^^r need SIGNED : DATE: HE LICENSED SEPTIC SYSTEM INSTALLER IN T TOWN OF BARNSTAnE NUMBER (AUach a sketch plan of the proposed system. Also jr the licensed Installer posesses n certified plot plan, this plan should be submilledl. -e owle nV P/T - 9 -- /avUC�t 1 7-AOkj C oo ,,.x...,� - T y .'^�•.,.:,;��` LOCATiOt-4 C V,k TI V= T W rmFAY N PA K' ,v1-J ptA►.1 R�FERreNGfc W iTP TWE- StD�.l.1►-1� A ti.lr_" 'ETt3t•C1-! lVrOU(QEMEuT'S OP TNe �- ' G PL)S, ' • RcGISr�Z�ca 't_AI-tp 5u2vm`fo�Zg 'T141% pLAl-A 1's L OT 15A'e>rnV C)W A" OSTE2Vil..l.6s a I{XASS• Ir_1.__� r:'�;.•,�,["Wi -".U:�/[-�{ �; T1t�_ U[-��:-rS ,rioww APPUCA,"1T z 3 ! 13 1 ,A TOWN OF BA.RNSTABLE LOCATION y�`�� `® � !�� SEWAGE # ?V/"��D VILLAGE aJ 1��`y� '�'� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. �dr C©ns 7 7%�✓�9p SEPTIC TANK CAPACITY. 4000 LEACHING FACILITY: (type) �r¢ ( (size) NO.OF BEDROOMS 3 BUILDER OR OWNER /CPiJ��e PERMIT DATE: ��`'.Z � COMPLIANCE DATE:" eO Separation Distance Between the: kMaximum Adjusted Groundwater Table and Bottom of Leaching Facility �f Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) 11J Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by G' w_ w I 7Ci 6 GP