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Home My WebLink About0145 CAMMETT ROAD - Health 145 CAMMETT-RD.,MARST.MILLS Y A=078.044 rr 0'P I��IIO� TOWN OF BARNSTABLE LOCATION C~212oz r SEWAGE # VILLAGE A0,fa51Mllr Mi'llc ASSESSOR'S MAP & LOT Q7S INSTALLER'S NAME&PHONE NO. �/77 -0 3�f9 ✓oSYPLi D�/��r�o SEPTIC TANK CAPACITY /5-00 LEACHING FACILITY: (type) CP-,%d TrhncLi (size) NO.OF BEDROOMS 3 BUILDER OR OWNER PERMTTDATE: / !/- q 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 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 n " o �Y V ti r-O l No. 62 Fee = 5 , THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS 01pprication for ni$pozar Congtruction Permit Application for a Permit to Construct(c,- I epair( `)Upgrade( )'Abandon( ) El Complete System El Individual Components Location Address or Lot No./YS Copffk Owner's Name,Address and Tel.No. Assessor's Map/Parcel �' �o�7S !°!/S �sCr 1C0�1^41�`t Installer's Name,Address,and Tel.No. q,7 p j Designer's Name,Address and el.No. Jas c,pG 17c l3io,",mA S/ ` ✓vs'��li �L / tav►�"d S 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 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 epairs or Alterations(Answer when applicable) fl fl OAI: T i�d �!=S s,�l�a l W1 T� Cli�i ej Ls rill !.S'dv G..f .�7, za VCl ^rr�,� �i -0 X y x 2 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 this Board f Health. Signed Date Application Approved byA.*_99- Date Application Disapproved for the ollowt g reasons Permit No. Date Issued No. Fee %�� i THE C_ OMMONWEALTH OF MASSACHUSETTS Entered in computer: t Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSA,CHUSETTS 01pprication for niob!5al 6pssnim, ton!5truction Permit Y Application for a Permit to Construct(4, 4repair( )Upgrade( ):Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No./cyS' j,,1dM,All s/r /Z/ Owner's Name,Address and Tel.No. I,0f*0ronS' ryi•i/s X'SCKr/" kek-4c7' Assessor's Map/Parcel � W.140 U ' 8 Installer's Name,Address,and Tel.No. 1/.17 p1 fj f Designer's Name,Address and el.No. ✓61SCR4� 47-c /�ssrr/S �/os1�g U-` /4rr0S Type of Building':. Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures A Design Flow gallons per day' Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title % Size of Septic Tank h.. Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 4=�ir,riH4; <:Zes5 S gga W/r.4 .47 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 this Board of Health. Signed Date Application Approved by _ Date.._r . Application Disapproved for the low g 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( impaired ( )Upgraded( ) Abandoned( )by �,�ol� /�� zTelAn'*y : at /y /'m ,, � Vs: has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer -_ —.' ' �,_„�� Designer - a) - The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date / •T 1911 Inspector sz\ t No. Fee _ THE COMMONWEALTH OF MASSACHUSETTS 0? PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS I=igpogar 6potem Cow6tructiou Permit Permission is hereby granted to Construct( .Repair( )Upgrade( )Abandon( ) System located atc�� , 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: I _ C - 9 Approved by��'�] 10/9197 NOTICE: This Form Is To Be Used For the Repair Of Failed Styptic Systems Only: CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) I, hereby certify that the application for disposal works construction pern1it signed by me dated /— // 99 ,concerning the property located a,t / g-f efH nzi /-7'— /e/ 10'7, Zk/// meets all of the following criteria.., There are no wetlands located within 100 feet of the proposed leaching facility There areno private wells within 1-50 feet of the proposed septic system A,'-There is no increase in flow and/or change in use proposed ere are no variiances requested or needed: if the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will W be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) B)Observed Groundwater Table Elevation(according to Health Division well map) SIGNED: .c DATE: J-/ - LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER (Attach a sketch plan.of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be:submitted). q:health foldtr.cart F_SS- o Ison ��,1 57 a � e - J _ U ' o Y A 1 ' P�� l��g Widow► � c � � S,�- x;/s�. 0 r C c V1 Z 9J 1 rh ®3 0o R . � a c 1v z 23=0`` ---.r ! f `I UP I� i -- k i Bt�otb-- cA , 7 b 1v . l A, Oqq w;8 L. I a LI) L . "e L-'s _ OD W � a