Loading...
HomeMy WebLinkAbout0021 STONE HORSE ROAD - Health 21 STONE HORSE RD. OSTERVH.LE A = 142 115 p r i i 0 o a I i TOWN OF BARNSTABLE LOCATION Jf 4Tor�1h /i,�"S/i l � SEWAGE # F,7^ Vf VILLAGE _ � � OC 11 �� ASSESSOR'S MAP &LOT/112 7'/.,," INSTALLER'S NAME&PHONE NO 4/77^ D3'19 SEPTIC TANK CAPACITY LEACHING FACU ft`Y: (type) Pr/ cv, /l(size) NO.OF BEDROOMS BUILDER OR OWNER Sr6YZ- 14 Tr PERMTTDATE: 26 ^ Sgl COMPLIANCE DATE: 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 A feet of leaching facility) Feet Edge of Wetland andleaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �;—Ve4 ,. Frp�tT _ O A ` L4 o Fee No. r.= THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 3pprication for 0igpo9;ar *p!6tem Congtruction Permit Application for a Permit to Construct(vj Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.4 I 5-ime— HohsF 4W. Owner's Name,Address and Tel.No. o,rr�H�t;rt Assessor's MaMap/ParcelSrew 61411-rahs (Y2 !/S' r At 49 Installer's Name,Address,and Tel.No.Z{7'! D'.f 9 Designer's Name,Address and Tel.No. Jo s,JO* Qc. d o.~o 0 04. i /ti> �ls Type of Building: Dwelling No.of Bedrooms `Z' 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 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil $ash Natured Repairs or Alterations(Answer when applicable) 42" zs !af a oc�t'h' antetvr3! off N 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 by this BMY f Health. Signed u,[it.�i?r Date Application Approved by Date ^ Application Disapproved for the Mlowiny reasons Permit No. D Date Issued ---------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed(4-)-Repaired ( )Upgraded( ) Abandoned( )by /os f-0/1_o.e- S AM,*'o S- at 2! S tA.1 e- ymr 4-L 61 esrr_ryzY/: has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.�!-30 dated Installer rro Designer. v 0 The issuance of this permit of be const ed as a guarantee that the syste 1 nction as desigrld. Date I Inspector No. 2�—a.Z� s Fee Vs THE COMMONWEALTH OF MASSACHUSETTS-� Entered,in computer: "+4 `PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE.,MASSACHUSETTS Zipprfcatfon for bfgpogal *pgmem Cow5tructfon 'Permit m Application for a Permit to Construct(ems-)Repair( )Upgrade( )Abandon( ) ❑Complete.System . ❑Individual Components Location Address or Lot No. / 51,04 G H0e5's Owner's Name,Address and Tel.No. Assessor'sMap/Parcel /5'2 Installer's Name,Address,and Tel.No.4 71 —0141 9 Designer's Name,Address and Tel.No. �# ' ° k: 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 gallons per day: Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 5A4cr/ Nature of Repairs or Alterations(Answer when applicable) o X's Ay,:,/. cad-4 oa G S Mao6AV, u i_/ w,1A y ' SToH-c k4s1a4l.o ,y 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 by this Board of Health. Signed Date AS'-?G-9 ' Application Approved by Date Application Disapproved for the Wilowiny reasons a r 1 Permit No. O Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (tertfffcate of QCompliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed(4_),.Repaired( )Upgraded( ) Abandoned( )by "J0 at 2/ �?a 4 c_ Hoe.4 L �u>< /.I Srl;: ^j/i%//; has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. _50 c dated Installer ,/osr_,dX { Ave.-oS Designer n The issuance of this Permit sha not be onstrued g y as a guarantee that the s ste illAf nctlionn as desi ne Date / Inspector gl� VU f J \ to j� —�=���8---------------------1y2!/— ------- No. Fee 7 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Of 5pogal *pgtem Con mructfou Permit Permission is hereby granted to Construct(Repair( )Upgrade( )Abandon( ) System located at 2/ j ra i-e Hors. ' /2u� 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 N 7� 6A v N'A'be k 10 xr V ()o fU(') V-)A-1 Z7 t=- �S�T�rs L or Lo-T Zo 4 K id Sv to got-, A\(. 6A,L t 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) .L Js-,�AtiV-e 9,41n,4 S hereby certify that the application for disposal works construction permit signed by me dated Sr'^ G9 concerning the property located at -V {forSit /2� asr�r✓r/�� meets all of the following criteria: • The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. �There are no wetlands within 100 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system • ere is no increase in flow and/or change in use proposed There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than five feet above the mammum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14) feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) Jr B) G.W. Elevation +the MAX. High G.W. Adjustment .J W = DIFFERENCE BETWEEN A and B SIGNED : '& 'va-lam— DATE: [Sketch proposed plan of system on back]. q:health folder.cat TOWN OF BARNSTABLE LOCATION :Z/ STo h �/��S/= %� SEWAGE # VILLAGE �����V J ASSESSOR'S MAP &LOT /' 2 LL INSTALLER'S NAME&PHONE NO. 4r7 SEPTIC TANK CAPACITY LW LEACHING FACILITY: (type) 3,SA2 6µ i 4i-v (size) A' / NO.OF BEDROOMS BUILDER OR OWNER re a�S PERMITDATE: 5' ^ 91, COMPLIANCE DATE: 27-5; ? 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 540 � e i 1v�Aaj