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HomeMy WebLinkAbout0185 SETH GOODSPEED'S WAY - Health 185 SETH Grx��c �s x A=122-078,, 4 7 F o 9 TOWN-OF BARNSTABLE -C- . LOCATION SEWAGE # 16✓ 12 VILLAGE > + © ASSESSOR'S MAP & LOT-. Z-O U INSTALLER'S NAME&PHONE NO._t .f SEPTIC TANK CAPAC= ..aZ�n4 l A o"q LEACHING FACILITY: (type) A.v./f. ` (size) I q u zl ��n�:ddl5 NO. OF BEDROOMS BUILDER OR OWNER �fr9%,��M-�? PERMTTDATE: '�- --cT�i COMPLIANCE DATE:�� Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 r V , 'V V A ,2 3 /� No. Fee ,` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0ppYication for ai5poml *p6tem construction permit Application for a Permit to Construct( )Repair(grade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.` S�OS�E Owner's Name,Address and Tel.No. psrl:�.v�l�� Assessor's Map/Parcel C�a Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 0--cw-9-p-Se-pV\ �o 19�rE 9- O dY I Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow _Z _3 0 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title 1 Size of Septic Tank Type of S.A.S. �L- Description of Soil y S Nature of Repairs or Alterations(Answer when applicable) A��� j�r- �,�-t b(�. C��G�T-, Y��r L✓T r4.roYl S �� �-!�S 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 b this B Signe Date C Y Application Approved by Date4—i r' Application Disapproved for the folf(Aving reasons Permit No. ,5 Date Issued TOWN OF BARNSTABLE LOCATION I '� 04. di „ SEWAGE #' VII>LAGE (3 ASSESSOR'S MAP &LOT 11 a-0 7 R TAL LER S NAME&PHONE NO. INS SEPTIC TANK CAPACITY ,p x I A A-I o � t—Am%, rI'Y: 14 (size) I q"a%W,114A0' LEA IL (type) NO:OF BEDROOMS B.UOER OR OWNER ?ca, adde 2_ PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Ivlaxirrium Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private:Water Supply Well and Leaching Facility (If any wells exist site or within 200 feet of leaching facility) Feet Edge.of Wetland and Leaching Facility(If any wetlands exist Feet wiiliin 300 feet of leaching facility) Furnished b y � cf.. 17 No. Fee . 0"/ / \� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for Migogaf *p6tem Conotruction Permit Application for a Permit to Construct( )Repair(grade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.`T5 SS TIV C_ spE Owner's Name,Address and Tel.No. QBT E 2 (� Assessor's Map/Parcel _1_0 Yv\� _ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. f \'(()-c w P-e- se PM 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 33 gallons per day. Calculated daily flow 3 gallons. Plan Date Number of sheets Revision Date Title l mil` .o Size of Septic Tank I -S-t 2�- \CYM ch la rfl_-' Type of S.A.S. {4'%c�V C 106 i t!q ,3" - I C- Description of Soil ' 1nI�C� S►4`� a Ei Nature,of Repairs or Alterations(Answer when applicable) 1,A 1 L S T-Ule—, ri 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 this Signed Date Application Approved by Date Application Disapproved for the folf ing reasons t ( Permit No. Date Issued I ✓ \ THE COMMONWEALTH OF MASSACHUSETTS C- / " BARNSTABLE, MASSACHUSETTS Certificate of Compliatice THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired ( )Upgraded( y Abandoned( )by O--CIA-pF ram-• C-7- P-r\C.. at S 5 G-T 1-\-C (Doo S?F_.E-IL5 Q ST: has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date C _ /. �� Inspector ; v No. 7q Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS Digpo-5af *pfstem Cons&action Permit Permission is hereby granted to Construct( )Repair( pgrade( )Abandon( ) System located at ► j SET(+G de Abandon 0 C= 5i 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:Construction must be completed within three years of the date of this permit. Date: Approved by f. • To Be Used For the Rep air.Of Failed TICE: This NO Form Is • Septic Systems Only j E � f OF SKETCH AND APPLICATION�FOR A CERTIFICATIONMIT OUT DISPOSAL WORKS CONSTRUCTION PERMIT (W ENGINEERED PLANS) ! at the application for disposal works j �--� herebycertify that pp • concerning the construction permit signed b y me dated *p�Y located at 1 S meets all of the following edtidr. ' There am no wetlands located within 100 feet of the proposed leeching fkility I • is�� _to wells within I50 feet of the proposed� (/•. There we no p� j ( , Marease In now endfor change In use proposed • There is no (/. There we no variancesteque�ed or"Wed. • of any wetlands,the botto if the prop�d leaching facility will be located within 250 feet bottom of the ximu facility will no be located less than fourteen(14)feet above the mam adjusted proposedd Inching y ! groundwater table elevation. ! i'iesse eempleh the follawMg: A) 10 Top of Ground Elevatlon eccordIng to the Engineering Division O.I.So roap) ..!.1 ter,Table Elevation(according ro Health Division wre11 Wrap) B)Observed Oronndwe c f" E DATE: 31t3NED t C gYSTEM MSTA LLER IN THE TOWN O F BAItNSTABLE NUMBER LSED SEPTf .. I ItrEN l Int stdM d systm.Also Irtm lleresed Inrtsller pas@ •StlAed plot plan, tAtueh•rltrtr*p this plan should be submitted). ' . �kft how.an't ( s E N _ S i 2p.,-. , c..✓� v .�, *� a ,., 1