The URL can be used to link to this page

Home My WebLink About0240 TOWER HILL ROAD - Health 240 TOWER HILL;' 142.044 J TOWN OF BARNSTABLE CA CI LOCATION t�U -1�wed Wi ( . SEWAGE VILLAGE .Y S ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. 9/-(Z -e .S2P C .. ..... . . . SEPTIC TANK CAPACITY LEACHING FACILITY: ( pe) a i l v 0. i: 1Z (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE:_ Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Y 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 oz ' No. ` � yr .- Fee • THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: • , VYJ PUBLIC�HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS • ZlppYication for Mi.5pogal *p!tem Construction i3ertnit Application for a Penn it•to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot NoP40-owe(."A ' fla Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �U gallons per day. Calculated daily flow ::S�Ns, gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. -)-_ � Description of Soil S� Nature of Repairs or Alterations(Answer when applicable) ti~ �_ k Ovs_ �1 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 Enviro_Wnental Code and no place the system in operation until a Certifi- cate of Compliance has been issue all Signed Date Application Approved by Date Application Disapproved for the followi reasons Permit No. Date Issued No. e/ " Fee J"Vs THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0[ppYication for XBigpoga[ *pgtem Construction Permit Application for�Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot Nopg0-- O-o Je-l/'` Owner's Name,Address and Tel.No. Assessor's Map/Parcel (44 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. O ��W� Type of Building: I� 411 Dwelling No.of Bedrooms Lot Size sq.ft. r�'Garbage Grinder( ) Other Type of Building No. of Persons `.- ;`,.c �iShowers( ) Cafeteria( ) Other Fixtures Design Flow U gallons per day. Calculated daily t ow'-lf. �:S ', gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank (. Type of S.A.S. L, rc (n Description of SoilQ- S� f Nature of Repairs or Alterations-(Answer when applicable) i r� S. I . 1�" 'T i 4-.i c;a S Lkl _o 51 S,n,-- f —f- 4 t 1 I t )l��•� ,�v-�t�-t L, Date last inspected: Agreement: / r 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 Envies ental Code and no place the system in operation until a Certifi- cate of Compliance has been issued czar. alth Signed Date (v Application Approved by r Date Z_— 5-- Application Disapproved for the followin�reasons - - i 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 ( )Upgraded'(v-r Abandoned( )by —L A Ol- S t=& i (-- at G V C�j t has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 7 5 _S' dated Z -S — Installer Designer The issuance of this permit shall n t be >o strued as a guarantee that the sy em illii'^ctio s designed. Date Inspector (/ /V 61 --------------------------------------- NO. ( /— 5 Fee . �— THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migogar *pgtem Construction Permit ✓) Permission is hereby granted to Construct( )Repair( )Upgrade( Ab radon System located at 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 Pqmt. Date: Z ' ' / / Approved by ✓� i. + 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) hereby certify that the application for disposal works construction permit signed by me dated off' �`�� , concerning the property located at c�`�D—�O��rL— �� 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 • 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 able 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) t B) G.W.Elevation 7 +the MAX.High G.W. Adjustment.7Z, 7 DIFFERENCE BETWEEN A and B SIGNED : DATE: `�O` J [Sketch proposed plan of system on back]. q:health folder.cert trod - -: — ---- ------------------- TOWN OF BARNSTABLE LOCATION �� y o ,�; z,, , , SEWAGE # J VILLAGE O y s �� i v ./lr ASSESSOR'S MAP & LOT [Y n INSTALLER'S NAME&PHONE NO. �. c: SEPTIC TANK CAPACITY LEACHING FACILITY: ( pe) _2 )% a k Y C,+ S (size) jNO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility -.._... g (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 i !i i cr I i i