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Home My WebLink About127B WEST BAY ROAD - Health WEST BAY RD. , OS'1' RVY.LLE A = 116 034 0 mod i - -- TOWN OF BARNSTABLE LOCATION A w 'jam SEWAGE # o- — OS/ -VILLAGE �.1'¢ ASSESSOR'S MAP & LOT �� INSTALLER'S NAME&PHONE NO. C. SEPTIC TANK CAPACITY ��y - a LEACHING FACILITY: (type) %v,,s (size) //�X 3 y' X.0 ' NO.OFBEDROOMS 3 (ijb7gR R OWNER u ' ¢-S PERMTTDATE:- COMPLIANCE DATE: a _ 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 r Ak, 0 o n ' rc r / yy- y, 6--ol 6"1 No.� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in co Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for &.5pogal *p5tem Com5truction 3permit Application for a Permit to Con c ( r )Upgrade( )Abandon( ) 11 Complete System El Individual Components Location Address or Lot No. t� Owner's Name,Address and Tel.No. Assessor's Map/Parcel ltb-oGy�� 4/�0469/ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. � O Type o Building: _ Dwelling No.of Bedrooms Lot Size Ol�%i sq.ft. Garbage Grinder(B ) 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 /5WI Type of S.A.S. Description of Soil 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 issue y t Board Heal tPa Signe Date�K/ Application Approved by ate (./ Application Disapproved for the following reasons Permit No. Date Issued 11 X- 7mv No: ! Fee THE COMMONWEALTH OF MASSACHUSETTS' Entered in com"pauer: 4 Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS } 01pprication for Miopoal *pgtem Construction Permit Application for a Permit to Con t c ( ir )Upgrade( )Abandon( ) O Complete System O Individual Components Location Address or Lot No. Gj�C� Owner's Name,Address and Tel.No. Assessor's Map/Parcel 72 L/A/P`e/ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. // 44 G O Type o.Building: _ Dwelling No.of Bedrooms Lot Size ©w sq. ft. Garbage Grinder(B ) Other Type of Building b1- Z 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 , �.7`6111 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) :3 �� Date last inspected: It�a 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, ertifi- cate,of Compliance has been issue y t ' Board f Healt L�� ' Signe /)4Date��,� Application Approved by /�� v ate Application Disapproved for the following reasons(/f T Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CER -. Y,that the O�j-sit Sewage is osal System Constructed( )Repaired( )Upgraded( ) Abandoned by r� m 1~l at �� _ has been, tructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Note Installer Designer The issuance o this perrrt4t shall not be construed as a guarantee that t*ssg will, unction as de n d: i �� s�J j Date - Inspect � Ult'?!;"? --------------------------------------- No. Fee �- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS MisSpogar *p5tem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) 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 permit. Date: Approved by—T _ i TOWN OF BARNSTABLE - -- `-� -- LOCATION 1,31 Gv, A RV J f2 SEWAGE # n-D — OS/ j VILLAGE O:r'tL ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. � ! 4 SEPTIC TANK CAPACITY ��J - LEACHING FACILITY: (type) /01 7! Zlf:a {u,�S (size) NO. OF'BEDROOMS 3 CjKDEj `R OWNER o� a PERMITDATE: COMPLIANCE DATE: Ion 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 �. I :.. 7T, - -- r - 1i6i99 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 1 0 concerning the property located at ay 'pje; P,n 19-6A lam; meets all of the following criteria: F • 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 130 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 ma dmum 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 faclity w m ill not be located less than fourteen(14) feet above the maximu adjured zroundwater table elevation, Please complete the following: A) Top of Ground Surface "Elevation(using GIS information) B) G.W. Elevation the'vta'(. High G.W. Adjustment . _ D 97ERENCE BETWTBv A and B SIGNED : DATE: / AL (Sketch proposed plan of system on back]. q:i C11111 Calder.c-t �. ._ -> �yy � _ _ T I ` �� s� p �l� Gri , � S'�`�G- 25G.90' r t a 11 11 _--------� LF. -- I � 11 11 11 � i , k — • 12' 3�1 1 1 #I27A GZ j UNIT 1 I J ,N ;- � BUILDING A- j i I C71 ��o I 11 1�1 O 11 11 O y L----------�i--- t _ x - 11 ,`�I II - - - _• - - - .r _. - - - - - '_ - - - - - - - - -' —" -- - I 5-TONE DRIVE 1 �—� --------- to 1 I ---- 1 1 COMMON DRIVEWAY AND UTILITY AREA -- --------_ --- q.2•GO' 1 1903± 51. ----- 20,G.7 5' ti 1 U I 1 1 11 11 ; 1 1 - I 1 1 . 1 . . 1 ' 1 1 1