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Home My WebLink About0040 SWIFT AVENUE - Health 40 SWIFT AVE., OSTERVILLE i o I i j �, TOWN OF BARNSTABLE �d ~ LOCATION C� o s�(,J�t'"1 As SEWAGE # VILLAG ASSESSOR'S MAP LOT INSTALLER'S -D i INSTALLER'S NAME&PHONE NO. 7-7 G/5 SEPTIC TANK CAPACITY Y44L 0 c� LEACHING FACILITY: (type) (size) f v4 �� S tV , NO.OF BEDROOMS BUILDER OR OWNER A^r i PERMITDATE: ,� �� COMPLIANCE DATE: Separation Distance Between the: iMaximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet j Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) No Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet - Furnished by i . I I . i C � 1 � f i _._ TOWN OFBARNSTABLE LOCATION T� C�e�`I Y�<J'� SEWAGE # VILLAGE " ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 7-7 S-- STI/ SEPTIC TANK CAPACITY I U Q Gal( . 0 C 0 X LEACHING FACILITY: (type) - -� (size) 4 Ff S fV %I NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: 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 /� A on site or within 200 feet of leaching facility) 0 o Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) S) Feet Furnished by V R cl: V ,Vti � � No. Fee J / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Miopooar *pgtem Cougtructiou Permit Application for a Permit to Construct( )Repair(i,-J'Upgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel L V,_� J\o % y Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ,s a$� 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/1� G-� �. Type of S.A.S. Description of Soil Nature oiRepairs or Alterations(Ans er when applicable) lZe c;-cz 5 t CSC lub Q `, Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the�afo.—r-e�described on-site sewage disposal system in accordance with the provisions of Title 5 of the En �Pnral Cn&L:�-�o to place the system in operation until a Certifi- cate of Compliance has been i u d by this B d of H 1 Signed Date Application Approved by _ Date Z Z Application Disapproved for the following reasons Permit No. Date Issued No. r �� O Fee / 1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes✓ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS 01pprication for �Ngpooar 6pgtem (Construction Permit Application for a Permit to Construct( )Repair(l/f Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 1s�� Owner's Name,Address and Tel.No. Assessor's Map/Parcel �.1'J\i -" ."�� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms_!�Z Lot Size sq.ft. Garbage Grinder(O 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 f GG ( _ Type of S.A.S. Description of Soil Nature o Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of�t��he—to-place described on-site sewage disposal system in accordance with the provisions of Title 5 of the En ante�P-end-ifo.to place the system in operation until a Certifi- cate of Compliance has been i u d by this B 6 d of H 1 Signed �—'� ~ Date '�a7 � Application Approved by Date Z Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS` (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(�pgraded( ) Abandoned( )by L- U I S r i C at L I U �t ! Q wQ 6 c��2 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer SL.3}1 1, r~r .. Designer f The issuance this `eat shall�not b n� arantee that the sys i 1 fu ction dries gt(ed � Date C r� J T L Inspector u- %�� — ® { r� No. / ( �9 �. � --------------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS ;Di!5po.5a1 *p.5tem Construction Permit Permission is hereby granted to Construct( Repair(114 Upgrade( )Abandon( ) System located at L-I 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:Con-s9truction must be completed within three years of the date of thi lit. 2, Date: Approved by 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, C�C> t"\�'CT'A- Hereby certify that the application for disposal works construction permit signed by me dated f /O hi concerning the property located at 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 t •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 maodmum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S. will be located with 2.50 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maxdmum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) 60 B) G.W. Elevation +the MA.X. High G.W. Adjustment . _ DIFFERENCE BETWEEN A and B SIGNED : DATE: WOW [Sketch proposed plan of system on back]. q:health folder.cert ' ' f� r �.�� J "_ - 1 t � , 4�