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Home My WebLink About0093 CAPTAIN BAKER ROAD - Health 93 Captain Baker Marstons Mills 1 1_ A= '125-029 l N - cw TOWN OF BARNSTABLE LOCATION dlyl<i=r SEWAGE # 97- .283 VI1.T.AGE GLlsersTo�s ll�Yls ASSESSOR'S MAP&LOT/.ZJ -OAK? INSTALLER'S NAME&PHONE NO. JW 1?10P_,r 5 W7-434i9 SEPTIC TANK CAPACITY Iwo LEACHING FACILITY: (type)(7)So0 4,al LEAc4 X l 3 NO.OF BEDROOMS 3 BUILDER OR OWNER �i,ahF `L1�rTi� PERMITDATE: 1.—9—97 COMPLIANCE DATE: 9 7 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 . 04410,*� Q r 3/, TOWN OFdARhSTABLE LOCATION 9 3 C/ pp71JW 9&Ek k,O SEWAGE # VILLAGE MngSTp/ys n/J ( .!� ASSESSOR'S MAP & LOT/E INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY . l 000 LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER /YI DATE PERMIT ISSUED: n DATE COMPLIANCE ISSUED: 9t c (, VARIANCE GRANTED: Yes No e�UV, Q li cl?pz lv /3/9 'eJg2 i� No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �7/_ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS application for �Digogal *pMem Cougtructiou Vertuit Application for a Permit to Construct(s epair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. f7j ��iQ/✓f 2ak/;, Owner's Name,Address and Tel.No. 4218" -1511 Assessor's Map/Parcel I g o' r� n� 644 — 1n' 4. Installer's Name,Address,and Tel.No. Ef`7 Designer's Name,Address and Tel.No. J05-EP4 O-e y'HOS F/ ce"",'o,"1--f &Z 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 .T; ,1 Na re of Repairs or Alterations(Answer when applicable), j'G�/� ( 1)�� .4 l 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. G Signed� i Date d1r_ ?— 917 Application Approved by ,1 r Date tS - 1% !7 1 Application Disapproved for the foll ing re sons Permit No. 77 - Date Issued No. —3 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ` Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYication for �Bfigpogar *p�gtem Congtruction Permit Application for a Permit to Construct(pair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 93 Cl4jdfl4/✓I 9,4k1_5r 9W Owner's Name,Address and Tel.No. 44 — :55 w Assessor's Map/Parcel� Installer's Name,Address;and Tel.No. 4`!q-4s�/9 Designer's Name,Address and Tel.No. t/OS>:o4 O-e 13a. OS Type of Building: ,I Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) f 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 ,�'�a na/s Nature of Repairs or Alterations(Answer when applicable), .ds 14` S 4/l rA 9 ' STo1l�, Oradn ar— 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 issu d by thi Board of H lth. G Signed � i Date dr— 1— 97 Application Approved by Date 6 - 9- 9 -1 Application Disapproved for the follo ing 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(4 paired( )Upgraded( ) Abandoned( )by ✓ /✓, �i 0., ��1"h6 S at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. a) dated Installer 1oS e X Q-e 110,t o-5 Designer 11463;;�i4 The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector ----t------------------------------------- No. / / " -�, ?, Fee 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS Oigpogal 6pgtem Congtruction Permit Permission is hereby granted to Construct( )Repair )U rade( Abandon( ) System located at —bra 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: -9 Approved by�,�i ��. 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, L'J'95-e'4 Ve dlarr0s ;hereby certify that the application for disposal works construction permit signed by me dated r _ y- 97 ; concerning the property located at y 3 �r�s T g d4k , 02a M,, meets all of the following criteria: + There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system j + The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances"requested or needed. SIGNED: DATE: _ `�- f 7 LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 9 [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 folder:cert i Or 0 I e ' e o01L P V, • f TOWN OF BARNSTABLE LOCATION 43 64isiyi SEWAGE # 97- 28S VII LA E_(�lsorsloHs «!.Y/ ASSESSOR'S MAP& LOTl.ZS-oA INSTALLER'S NAME&PHONE NO. Jo-,rfK Oc /�foaros y77-O 3 y q SEPTIC:TANK CAPACITY loOo / LEACHING FACILITY: (type)r 7�) rQa /,al Z241 d VM e) �9 X l 3 NO.OF BEDROOMS 3 BUILDER OR OWNER DianF_ f?7i�rTih PERMITDATE: -9-5?7 COMPLIANCE DATE: G -/I-97 Separation Distance Between the: i Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site orwithin 200 feet of leaching facility) Feet Edge of site. and Leaching Facility(If any wetlands exist within 300 feet of leaching facility, Feet Furnished:by, CApf<lirl �,al��s�' � y � Se • vw so. 3/ J1p, v ,