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Home My WebLink About0006 STURBRIDGE DRIVE - Health (2) c� STURBRIDGE OSTERVILLE A = 166 028 I i �l fi0 'OF BgRNSTABLEk � r w N. �° `S1 ry/L 2z'1] � /�a�D SEW G # VILLAGE ASSESSOR'S MAP & LOT 1w, b INSTALLER'S NAME & P.HONE:NO. A & B CLAIM 775-6264 U T SEPTIC. ANK CAPACITY ��. :a kl,- ` LEACHING FACILITY:(tgpe Z�o�Sl�//2,2{��LLS (size) 2S' K 3 : NO.;.-OF BEDROOMS PRIVATE WELL .OR PUBLIC WATER BUILDEROR OWNER � /L1i�-�la!✓ : DATE PERMIT ISSUED � '(E 1 6 `DATE 'COMPLIANCE ISSUED:' VARIANCE GRANTED Yes No k. s Z � P I 1fJ�0M��t`I No. A OOL003 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yication for joigool broetu Cougtruction Permit Applic 'on� rmit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No /Z 6 f of 7 C_ la Owner's Name, dre an ss d Tel. o. ��►;��r -rt Assessor's Map/Parcel j Installer's Name,Aft a o. Designer's Name,Address and Tel.No. n rest 1N. Yarmouth, MA 02673 Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder(/ t, 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.Sja� Sbc_-,C-s Description of Soil Na re of Repairs or Alterations(Answer whe applicable) ..4A1 (.4 t,�.00 S �✓ �� d 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. Signe Date h v f Application Approved by Date Application Disapproved for the following reaso Permit No. Date Issued ® . No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: VV Yes --PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS rication for 33i.5pool *p5tem Construction Permit Apphcakton Permit to Construct( )Repair(grade( )Abandon( ) El Complete System 0 Individual Components r ,Location Address or Lot No —7 iZ b r : 1� Z Owner's Name,)kldress and Tel.1yo. Assessor's Map/Parcel 1406 — O 8 v i SInstaller's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: f� Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder(A(p Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures /Design Flow gallons per day. Calculated daily flow gallons. Plan Dae Number of sheets Revision Date `Title 1 Size of Septic Tank <1(X_JC r Type of S.A.S. 1 ,(_x..C, Description of Soil x Z Na ure of Repairs or Alterations(Answer whe applicable) .,l Vl1 (,4 (( (. ' ('5 S �• W t 1) . / 7<,y �ict 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 AlL Date Application Approved by _ fl!_ U f r U �1L Dates Application Disapproved for the following reasoner , 1 ,r Permit No. j^ `�. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( <Upgraded ( ) Abandoned( )by _ d�/GU at U 2 bt I d S has bejou constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. r ' ated Ca `i 0 Installer Designer The issuance of this permit shall not be construed as a guarantee that the systemwill function as designed. Date Inspector No. — Fee -S THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS Mizpoar *ps�tem 50n9truction Permit Permission is hereby ranted to-Constru t( . ) epair( ade( )Abandon( System located at �J l G/` O/t z E s IL, rt t 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: Constructiodmust�erc�ompleted within three years of the date of ils Date: �/ l 1 A roved br'!s t PP Y 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) I, qM , hereby certify that the application for disposal works construction permit signed by me dated (i Lo ( , concerning the property located at �p S�(j D I GQG Dfrk, S meets all of the following criteria: /This failed system is connected to a residential dwelling only. There are no commercial or business ses 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 • There 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 maximum 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) B) G.W. Elevation, S +the MAX. High G.W. Adjustment.�• = v1 DIFFERENCE BETWEEN A and B a << SIGNED : l DATE: [Please Sketch proposed plan of system on back]. NOTICE Based upon the above information,a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert / � fit. I r �� a � '�