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HomeMy WebLinkAbout0070 CHOPTEAGUE LANE - Health 70 CHOPTEAGUE LANE,t A=028-076 2 C� No. 0 aq Fee----- A BOARD OF HEALTH TOWN OF BARNSTABLE ApplicationforlVell Con0tructioll Permit Application hereby made for a permit to Construct Alter or Repair (/")an individual Well at: , *26? o- --Address Assessors Map and Parcel Owner Address ----—-----------—--------------—-------—---—- Installer Driller Address Type of Building Dwelling Other - Type of Building No. of Persons-------------------- Type of Well Purpose of Well Agreement: The undersigned agrees to install the aforidescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Sig date Application Approved By— date Application Disapproved for the following reasons: date es Permit No. Issued —------ date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate Of COMPhan(C THIS IS TO CERTIFY, at the Individual Well Constructed ( ), Altered ( ), or Repaired —-----------------—------------ nst.1ler at —----- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No.t&GP-0-5-12a�1)ated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---------- Inspector—------—------------------------ No.— _ Q Fee---- --- BOARD OF HEALTH : TOWN OF BARNSTABLE Zipplication forlVell Con$truction3offmit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (✓an individual Well at: F —fo4fon Address Assessors Map and Parcel -- �=�---- ,-- -- -------------Owner Address -- _----___— S(p ��/C /--—— ---—------ -- ----—---------------------------—------- -- —— — -- — Installer — Driller Address Type of Building Dwelling-- ------ -- --- -- Other - Type of Building------ ---- - No. of Persons------------------- Type of Well y — Purpose of Well ------ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. a SignedIle- ,-G�J _ ,: --------- — - -11 ---- date Application Approved By -- -----— 1 _�7 date Application Disapproved for the following reasons:--� ----------___—________—__--_--_ date Permit No. � q — Issued--- --�\ -- ----- -- BOARD OF HEALTH TOWN OF BARNSTABLE C ertif irate ®f COMPU nre R HI IS TO CER TIFY, or Repaired That the Individual Well Constructed ( ), Altered ( ), ep d ( ) by-- r/ g� �------------------------- - -- -- --- ---- -- Installer -- �/r _-----has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No.l&-m-_5_As3�4Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------- -- -- - Inspector-- - --- - ----- —- -- BOARD OF HEALTH TOWN OF BARNSTABLE Veil conWructionAermit No. '_S d am' Fee A Permission is hereby granted ----- to Construct ( ), Alter ( ), or Repair (4/) an Individual.Well at: L�ug _f�✓ ��,i N—�"tt Sly -- ------ —------ --------------- -------- ---- No. — C-2 11�r1 Street as shown on the application for a Well Construction Permit NO. - ` S Oda- —^--__ to --- -i I - Board of Health DATE—� � 1 -- ----- TOWN OF BARNSTABLE G� LOCATION 7 SEWAGE # VILLAGE , �5����//1!l-% s ASSESSOR'S MAP &c LOT INSTALLER'S NAME&PHONE NO. � � � Ca/c�` SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 2 `3-2pOi Iehholye4 (size) 14 5i�Z�X NO.OF BEDROOMS 3 BUILDER O OWNE PERMITDATE: 315-AY 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-siie 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 78 i gall W W pc-)i 9 f V oZS--C 76 i No. / V Fee y". THE COMMONW6L'TH OF MASSACHUSETTS Entered in computer: Yes I PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZIpplication for ;Di,5po!5a[ *pgtem Construction Permit Application for a Permit to Construct( )Repair( *)Upgrade( )Abandon( ) ❑Complete System PIttdividual Components Location Address or Lot No. 70 & O / Owner's Name`,Address and Tel No Assessor's Map/Parcel r `� Le.�/fe ��i- 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(1410 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 33e gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank I AW Ael 49 )C�g Type of S.A.S. Zi 62 ZS.e 7— Description of Soil Nature of Repairs or Alterations(Answer when applicable) Z'/-,,L`e Je7� Jr 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 Boar of Health. Signed Date 7/2 r Application Approved by Date Application Disapproved for the following reasons Permit No. —1 Date Issued S No. / �' U 0 FVe �• `THE COMMONAE'AC N OF MASSACHUSETTS Entered inromputer: 1 Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSE*S Zipplication for Oi5po5al *pgtem Construction Permit Application for a Permit to Construct.( )Repair( /)Upgrade( ' )Abandon( ) El Complete System iKlividual Components Location Address or Lot No. 70 © ,--egfv& / Owner's Name`,Address and Tel,No. Assessor'sMap/Parcel q e`5//e � t ­eI1 11s ZO-- 7 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 771-93,O Type of Building: Dwelling No.of Bedrooms ✓� Lot Size sq.ft. Garbage Grinder(.41a w Other Type of Building ,C��S% ��lC� No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow /40 gallons per day. Calculated daily flow ✓�3O gallons. Plan Date Number of sheets Revision Date Title ~ Size of°Septic Tank ?�W 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 issuedWoarA,of Health. / Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. � Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS az-g—©76 BARNSTABLE, MASSACHUSETTS Certifi4ii� of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) _ Abandoned( )/byO/�Gl1llff% C0�1 ST at 6 G�lOAV-CwC -ell//S` has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. l— /00 dated 3 � Installer Designer i The issuance of this permit-shall not benco trued as a guarantee that the syst &Gviilll unction as d!ig e .�, Date. 'l f I Inspector Il/(%/ !/%�l �� ifY? Uii�j�� No. / / -------------------- 6' 24� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mfi6po$ar *p$tem Construction Permit Permission is hereby granted to Col}struct( )Repair(✓)Upgradgq�,( )Abandon( ) System located at 7D G ���Q(/P ./J, AA 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 a .t. Date: -3�5 / Approved by 4;Z : � �, 14" NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. .. R I CE TIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) L hereby certify that the application for disposal works construction permit signed by me dated 2/4�Y , concerning the property located at 70 c/o �QYs�� meets all of the following criteria: 4/The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. V/There are no wetlands within 100 feet of the proposed septic system Y 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 v 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 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 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) B) Groundwater Table Elevation "/ max,adjusted g.w. DIFFERENCE D ' SIGNED : DATE: [Sketch proposed plan of system on back]. a S 0 Ak\- -C_S l> TOWN OF BARNSTABLE LOCATION 7� G�1D 7�L� ale SEWAGE # VILLAGE ; 'lST4•�IS/�ji'tl� J o ASSESSOR'S MAP & LOT G 7-s1'--G�ib� INSTALLER'S NAME&PHONE.NO._ ���(:�� � CQ�, �` 77/—p SEPTIC TANK CAPACITY A 5G"G'' LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BOLDER 0 OWE /11'4- PERMITDATE: —COMPLIANCE DATE: Separation Distance Between the: _ Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 5 Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) 1SC� T Feet Edge of Wedand and Leaching Facility(If any wetlands exist �,A,// ' within 300 feet of leaching facility) rU�� Feet Furnished by - —-----(((---OL e"S-SESOOR'S MAP NO. PARCEL —76 LOCiATIOLN � �� SEWAGE� PERM JTQN�� VILLAGE (pp Im I INSTA LLER'S NAME _i ADDRESS BUILDER OR OWM DATE PERMIT ISSUED I DAT E COMPLIANCE ISSUED 54 � .�� _ 6 ~ 9 ��� � � � � � , � '� i I i `+ 1 � .,,� JY