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HomeMy WebLinkAbout0046 THIRD AVENUE (OST.) - Health 48 TIIIRI) AVE. OSTERVILLE A = 140 003 i t } :�yi Ni. Fee D THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIpprication for Migpoal *potem Construction 3pertnit Application for a Permit to Construct( )Repair(_Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 4'6 Tv, ,A V C, Owner's Name,Address and Tel.No.- f Us�e��lle �AMC's I�oWA%lt, Assessor's Map/Parcel 43TA�c Ts. y/G /Oa3 p�8—f 8j•�l/ kkc Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Br-tvCe, MACLCC Ql slc� e 1 fob 5k. 4a8-5-saq o sZc�..t1L Type of Building: Dwelling No.of Bedrooms_3 Lot Size sq.ft. Garbage Grinder(AA 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 Nature of Repairs or Alterations(Answer when applicable) J 50 /91 s o - gcx — /� 00 41 C l a o c 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 iss by this B azd of He h. Signed Date /1011. 00 Application Approved by 0ly fff Date Application Disapproved for the following reasons fi Permit No. r Date Issued TOWN OF BARNSTABLE LOCATION 7 �20 'AlC SEWAGE #j 00©' -&3 VILLAGE AS MAP & LOT INSTALLER'S NAME&PHONE NO. r')jI CA 11_sT SEPTIC TANK CAPACITY LEACHING FACILITY: (type) .5 y 0 G t4 4ic r 3�(size) %2 NO.OF BEDROOMS t Iid BUILDER OR OWNER \ 1 Z rLO Uj(�-\S h PERMITDATE: 1 6 D D COMPLIANCE DATE: Separation Distance Between the: j Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet it 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 we exist within 300 feet of leaching facility) Feet s Furnished by O i 00o I g XF� 9 �Iv?yrd� ,5/ � v p o (I t;16 701� No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS ZIPPUratton for 3Dtgpo!6a1 *pftem Con6tructton Vertntt Application for a Permit to Construct( )Repair(P15 Upgrade( )Abandon( ) ❑Complete System ❑Individual Components ` Location Address or Lot No. TV ,Ra R u Owner's N e,Address aid Tel.No. USier-;\te �lrl�es h0LAJ S�z, Assessor's Map/Parcel �yt �3 Th`If. (-\, Installer's N Address,and Tel.No. Designer's Name,Address and Tel.No. 4sr`vice 1tiac_Il',st�� Type of Building: Dwelling No.of-Bedrooms 3 Lot Size sq. ft. Garbage Grinder(,A/I Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow M 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 Nature f Repairs or Alterations(Answer when applicable) !��> ��`l Q - / Soo Sim /a - 36x iy 3 -..SDD�jO Cf/ilih$C� �f 3/ a S7a4t Date last inspected, Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system pay 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 issp9d by this , and of thy Signed �> G� /l r� Date /1011- Application Approved by �✓�� Date Application Disapproved for the following reasons r' Permit No. Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certtftcate of Coniphance THIS IS TO CERTIFY,that thg On-site Sgwage Disposal System Constructed( )Repaired(Upgraded( `) Abandoned )by h at ( � �" N vc. U s c r�,l h s constructed in accordance with the p-rto�visions of Title 5 and the for Disposal System Construction Permit N . dated j Installer .ur'ucc.�C�CeI�;s-1I�- , Designer yh i �� r' tj JC The issuance of this permit shall not ab-e�YCotns e s a guarantee that the sy�temd�l function as designed. Date E� ` J ID Inspector " t r N o D = =-----------------------Fee 57--- /`C THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mt6poal *pgteti Comaructton Vermtt Permission is hereby granted to Construct( )Repair Upgrade( Abandon( ) System located at 0 g r� and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5�nd the following local provisions or special conditions. Provided:Cons ti n ust be completed within three years of the date of this perm' Date: � 0 Approved by U6i99 NiOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. Ind/av3 . CER=CATION OF SI-aTCH A2+-D :APPLICATION FORA DISPOSAL WORKS CONSTRUCTIO' PERYCIT (—W=OUT DESIGNED PLa-NV'S) j, (`yCe l4CC_1 t 3 (C� he: by Cam'T.1'?/ E a2 &�e 20Glicai on 'Or C!sDOsal works r consmuc cn pernut sizlec oy —e uaCe-" conce...i:,c the t - proce:-y Iccate'd a: �( 5 ���� arc ©5lcr v.l�e rnl-e:s all or Cze tcllowzr.� c-ite�a: ' • i ne cane s;se^t is coa^e` e�;o a res;ce ea!c:e��in;oni-;. l—ze:e are no ccca merciz!Or bi:sLess uses asseciaced-,;nh the cwe:lins. • ! C s0ii is Classi eC as t SS !3 d u`.-ce:colaCOn-race is iess ^:, i or-q.=1 CC 5 rcunuCes pe:inch. • The:--a.*e no we:13res wiChin ICO er:of e`:e^proccse se:;ac s,se:z • T hne:c arc no on-,ace wells witt in Ifo e-,of tc orcccse-sc-.uc rse n • i fie:a is no i is e^se in haw anc1cr cla zt L- use orccosed • !a'rt nre ^_0 V3-^:ar.C= CCC.UCSe=or • s ze ccam of'fie preccsw lere .;n;iaclirr'.;rli act ce lccaEec less G`tan five -et, abcve Lhe .rila.'C,AIUrn adjus,, ?*Cund-NaCe:able ele'racn. (AdjLS u:C Q'CL^.Q V3Ce: i201e SiIl� u e i:uT,000C meutic,d whet applicable! • '' S._a..S. "nrU Ce lcc pea _fo . CCi CC i croccEet l� aCa. v will ncC _e icC :e.. .ess _�. :C�:.-.__. `Please Cornole:z i1e IOilowiu-: q '—- a • •J � Q1 O 10 r v o 0 5ooCAS, 3 llz2 11 weld r TOWN OF BARNSTABLE LOCATION y T�lRp 4Vic SEWAGE # cZ 00© VILLAGE 1057�2-Rk-folk— ASSESSOR'S MAP & LOT � INSTALLER'S NAME&PHONE NO. . nil it CA II YJ(-'? - SEPTIC TANK CAPACITY oZ" /S'd 0 G << LEACHING FACILITY: (type) .SHOO G9 �(at4JC1 4) (size)-167 �3/ NO.OF BEDROOMS 1_ BUILDER OR OWNER 2 RO r?-�5�� PERM TDATE: I� 6 L O 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 . e s I) i 33 19 %A�CgTn/tT �6 ,?3` a v7/c o24 000 �3 A, o