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Home My WebLink About0095 STURBRIDGE DRIVE - Health 95 Sturbridge Drive, Osterville = 165 - 044 ! T a I i o I . a TOWN OF BARNSTABLE ; " LOCATION _15 y��r hr/ �(i /�. SEWAGE # �" 1 VILLAGE �bIil'/// /l1� ASSESSOR'S MAP & LOT S 4#-"�Y INSTALLER'S NAME&PHONE NO. 400,51, 7,7/'�31,0? SEPTIC TANK CAPACITY J o00 (x L LEACHING FACILITY: (type) (size) NO.OF BEDROOMS 3 / BUILDER O OWNER �4��r/�y PERMITDATE: /D.:S� 7 COMPLIANCE DATE: I 0 — r-- 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) /y�1� Feet Furnished by PAY �S O 10 .r No. Fee CJ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(pprication for &spool *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade(/)Abandon( ) D Complete System E Individual Components Location Address or Lot No.`� L y—�r�r� �, �j Own�r's`N/��A�ddrei��e . Assessor's Map/Parcel G`J ®3/relf w/ Ile �/ Installer's Name,Address,and Tel.No. (�` Designer's Name,Address and Tel.No. �Z/-4��e' Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder Other Type of Building v -lee No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow D gallons per day. Calculated daily flow 330 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /6 V 90 Type of S.A.S. /Z: XJ S—X T Description of Soil Z Nature of Repairs or Alterations(Answer when applicable) 2-12-le ✓.�9/'t4'�� 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 is o of lth. Signed Date Application Approved by Date Application Disapproved for t follo g reasons Permit No. 7 — 5:7 Z Date Issued '7 ��F �— No. — S /I Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for Migoml *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade(V)Abandon( ) O Complete System C1 Individual Components Location Address or Lot No. Own 'Si Name,Address and Tel.No. '> �g a �0�"• �i Assessor's Map/Parcel /��C,� V ;Ile Installer's Name,Address, d Tel.No. �7 Designer's Name,Address and Tel.No. 77/-9_3 <, Type of Building: je k Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( o Other Type of Building I�25f �N12 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 3 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 94 Type of S.A.S. Description of Soil Z Nature of Repairs or Alterations(Answer when applicable) 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 is o of Health - Signed Date Application Approved by Date c Application Disapproved for tWfollo g reasons Permit No. r S 7 / Date Issued —— —————— ————————— —————— --——————— - THE COMMONWEALTH OF MASSACHUSETTS 46 BARNSTABLE, MASSACHUSETTS ��- clCertificate of Compliance THIS IS TO CE TIFY, that tie On.,si��w ge Disposal System Constructed( ) Repaired( )Upgraded Abandoned( _)by L® / � at z;5 /'vi c- has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. - 5,71 dated Installer Designer The issuance of this peymit shall not be construed as a guarantee that the system willlfuncti, on as designed. Date - �� Inspector �t No. �J ✓ /� ------------------- 11�J '4% � Fee 115� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS lwizpozar *pgtem Construction Permit Permission is hereby granted to Construcl( )RppairUpgrade(✓)Abandon( ) System located at y3 Jr' 4111^ 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: /D ' 6 - 9 7 Approved by I aye 5 r `/� .STu/UC2,p EE NOTICE. This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH kND APPLIC aTION FOR A DISPOSAL WORKS CONSTRtiCTION PERUVQT (WITHOUT DESIGNED PL_k S) T ��T//7 / �• � gAl- -" )v C..-7ii?. Thai _Ile arri!Ca-don or is-mz31 -vork �Q^ST CLicr Dei?1nL igne, „ _i:e dai�Q !� l ��ilCeinl_-- e S1GNED 3A E. roly��7 . LICENScD SEPTIC SYSTEM.INSTALLER IN —HE TOWN OF BARNSTABLE NUNMER [attach a sketch plan of the proposed system.Also if ale !icensed installer posesses a certified plot pian. this plan should be submitted]. �1011 MOM" •' - .mot=- -- .�.::.� - . •� - ?� v' -.-. q:babb fo! TON, tOW-NDOF BARNSTABLE �3 SEWAGE # OCATION r / i6 �� / _�=ASSESSOR'S MAP &LOT VILI:AGE QD � CDa6l; �77�--�3�� R SN AME P HONE N0. INS�ALLE o00 (x L . SEPTIC TANK CAPACITY (size) LEACHING FACILITY: (type) Np;.,QF BEDROOMS 3 BUILDER O WNE D /�-'S Q 7 COMPLIANCE DATE: PERMITDATE: J Separation Distance Between the: Feet Iaiimum Adjusted Groundwater Table and Bottom of Leacezist Facility 1 Well and Leaching Facility (If any well q Feet :;private Water Supp Y on site of within 200 feet of leaching any facWetlands exist Feet :Edge of Wetland and Leaching Facility within 300 feet of leaching facility) Furnished by s- r' O