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Home My WebLink About0048 OAK RIDGE ROAD - Health 48 Oak Ridge, Osterville A+ 142-003 1 i a I I, _ L TOWN OF BARNSTABLE LOCATION SEWAGE # / 7° VILLAGE ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. xu/ e SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) rt- NO.OF BEDROOMS BUILDER OR OWNER � rc. PERMITDATE: 7 COMPLIANCE DATE: 2, QL0 f ,Z_ Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 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 ✓c..{: .� �.i ' { �y e ,,_.. �` - - � i p a� �� r � �� f,v& �� .+.�i No. � � d Y ,� Fee 1/ S' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for �Die;po al *potem Construction 3dCrmit Application for a Permit to Construct( )Repair )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (t3 d AX- QL !!(( Ow is Name,Address and Tel.No. Assessor's Map/Parcel "� - Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �`� gallons per day. Calculated daily flow 7�3—C-) gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank S CTD PO � Type of S.A.S. ��'i �4T J r-. 0 Description of Soils � 1w/ Nature of Repairs or Alterations(Answer when applicable) fJ \ 54 C'Ct "IC 6\,, cc.:DGi'i L ` srGt—'— 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 is �hisf- alt _. Signed Date Application Approved by Date 3 / , Application Disapproved for the fol owing reasons Permit No. Date Issued • L ' TOWN OF BARNSTABLE q LOCATION _UrS,I C».k � SEWAGE # / Z, /9 VILLAGE ASSESSOR'S MAP & LOT -0 INSTALLER'S NAME&PHONE NO. f? 1 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) ( (size) NO.OF BEDROOMS BUILDER OR OWNER �.ct• %✓tom PERMTTDATE: 3 -1 � __COMPLIANCE DATE:�� O Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 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 rs Iq _-� !mow;, _. � .-�— -- -. .. •• ..4__ � .� _ �+- ! 1 No. Fee TIDE COMMONWEALTH OF MASSACHUSETTS Entered in computer:* PUBLIC HEALTH DIVISION —TOWN OF BARNSTABLES MASSACHUSETTS Yes ' 1pplication for ;Di!5po9;a1 *p9;tem Conotructi.on Permit !. Application for a Permit to Construct( )Repair(/Y)Upgrade( )Abandon( ) O Complete System El Individual Components Location Address or Lot No. A _Z, Owner's Name,Address and Tel.No, Assessor's Map/Parcel Gt Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. w Type of Building: -.Dwelling No.-of Bedrooms .3 L-oj Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow ��C') gallons. i Plan Date Number of sheets Revision Date f' Title Size of Septic Tank 1 `s on ( IOUM Type of S.A.S. t-V V k-i;� o f Description of Soil (\K.ID Svqv< ' { ( �3 . Nature of Repairs or Alterations(Answer when applicable) Z"U--S-�1-�\ \� �c � ✓c� v Ca G LT G.Z u r� STa�C-- /, Date last inspected: Agreement: F t „- f '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 irss_yad buy is Boar of i4ealth. Signed ,� ..� Date Application Approved by c. Date 3 / 9 S' Application Disapproved fore the following reasons ti Permit No. Date Issued ————— ————--——————————— — —— ——————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS F (Certificate of Complian' re THIS IS TO CERTIFY t thh 'On-site Sewage Disposal System Constructed( )Repaired ( ) Upgraded Abandoned( )by obit��lzr,Ar -A S at !A? t�kA'I(- �f e n i,2 V i I -{'r has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 97- dated FInstaller Designer The issuance of this permit shall not be constr ed as a guarantee that the system will function as designed. Date + ��{'J / Inspector -- --------------------------- No. � Fee 'f THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS ' a Zi5po5ar *pgtem Contruction Permit Permission is hereby granted to Construct( )Repair Abandon( ) System located at Saz~,U f1 y 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. F: Provided: Construction musstt/be cccompleted within three years of the date of this permit. Date: Approved by NOTICE: This Dorn, is to be used for the Repair of Failed Septic Systems Only 4 CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL NVORKS CONSTRUCTION PERMIT' (WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated -6� �I , concerning the property located at ` 0)0 -V—`�k� 06 meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system • "rile observed groundwater table is 14 feet or greater below the bottom of the leaching facility i There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED : DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. jxert i ��, v