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Home My WebLink About0026 EBENEZER ROAD - Health 26 EBENEZE MARSTONS Mid . A = 147 075 1 I, TOWN OF BARNSTABLE ✓ LOCATION -o c-t e"�,r SEWAGE VILLAGE ASSESSOR'S MAP & LOTr%` ,l INSTALLER'S NAME&PHONE NO.r .1W to G&ie ` SEPTIC TANK CAPACITY _le e c� LEACHING FACILITY: (type) 1..1?1'7-17_/A/r0/Z,3 (size) NO.OF BEDROOMS R OR OWNER AV - , f1 PERMTTDATE: `'1�'Z L _Af&rEOMPLIANCE DATE: Separation Distance Between the: t; Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Welland Leaching Facility (If any wells exist a on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet o, eaching facili� ►, ` Feet Furnished_ by a �^ ' t ; 'j 3 . . 433 No. � ��_� Fee:� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for Migooar bpotem Congtrurtion Permit Application for a Permit to Construct( )Repair( )Upgrade(Abandon( ) El Complete System VIndividual Components Location Address or Lot No. Owner's Name,Address and Tel.No. r��dV19 LtS �- Assessor's Map/Parcel Ar�+SOtJ 1' �' ._07 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3c) gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank STo as.c,._Sate A y�` 1� Type of S.A.S. tiS� C�, dwC'�Tom► �� L. Description of Soil CZ 0_e ei Nature of Repairs or Alterations(Answer when applicable) SIN 54 Q\\ r=.V` - w, y" Ctc L1Kc C� t j�c U: r v-o LU\ LA,' 5Taae— 0o,,S-0, IS ut-. rve � 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 tlu' tasitn ental Code and not to place the system in operation until a Certifi- cate of Compliance hastbgg issued-by<thi Boar ealth. Signed Date -7-a, -00 Application Approved by Date T7 Application Disapproved fofAe fo wing reasons Permit No. 9= Date Issued _ r -sue - No. %. " ' Fee E'er THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:c es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for Digpogal *potem (fon!Aruction ,permit Application for a Permit to Construct( )Repair( )Upgrade(Abandon( ) O Complete System Q Individual Cott ponents Location Address or Lot No. ^ r7 Owner's Name,Address and Tel.No. Assessor's Map/Parcel •k Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. -�\ Type of Bu' ing: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow .-3:sf�_ gallons per day. Calculated daily flow '?s V gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank t ` Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) u r e Date last inspected: 4 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 Certify- cate of Copliance has been issued by this Board of�alLl"i'�-ter Signed Date ' Application Approved by Date _ Application Disapproved fo e o wi g reasons_ Permit No. Date Issued ————————————————----------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (tertificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded Abandoned( )by r:�� at has been constructed in accordance with the provisions of lritl'e"g and7the for Disposal System onstruction Permit No. _ datedT,, Installer Designer The issuance of this permit shall not be construed as a guarantee that the syste . ill function as des' ned. Date i Inspector ,� , k --------------------------------------- t, No. _ Fee.5: � THE COMMONWEALTH OF MASSACHUSETTS V PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS M.5pozar bpgtem (Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at � �w r~ 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: 4 _ Approved by 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 7'cY-o'Qy , concerning the property located at 91JO meets all of the following criteria: (This 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 table elevation. [Adjust the groundwater table using the Frimptor method when /af plicable] Qthe S.A.S.will be located with 250 feet of an vegetated e y � 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) U_� B) G.W. Elevation SO +the MAX.High G.W.Adjustment. I��_ O t DIFFERENCE BETWEEN A and B SIGNED : DATE: 0 [Please Sketch o an of s em on back). NOTICE Based upon the above information,a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert { . . -:: � . � � � . . 6 �- ,�_ '� r--- r � - �, TOWN OF BARNSTABLE j LOCATION � rE � ir1 t%"� J/` SEWAGE VILLAGES.. ./1 ,4 __ ASSESSOR'S MAP & LOT d INSTALLER'S NAME&PHONE NO. r SEPTIC TANK CAPACITY le �r✓ LEACHING FACU-ITY: (type) (size) NO.Of BEDROOMS R OR OWNER PERMITDATE: 'I � kk .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 ofleaching facili,. Feet i Furnished by FJ V TO ALL N W BUSINESS OWNERS DATE: /� bo , - :..... Fill in pleas : APPLICANT'S YOUR NAME: BUSINESS YOVR HOME ADDRESS: Z(o 2e_o5�on, ells su r� �te0- 3�2p TELEPHONE Tele hone Number Home NAME OF NEW$USINESS R.I , c en~E3 k A5 oe TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES N.O Have you been given approval from the build' g division? YESLE�j NO 0 ADDRESS OF BUSINESS ZtP 2aq . lam' Ma-rg MAPJPARCEL.NUMBER_ I �f "1 o-Ik�:) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall) or if you get the business certificate first you MUST go to the following office to make sure you have all the required permits and licenses.. GO TO 200 Main St: -(corner of Yarmouth Rd. & Main Street) and you will find the following offices: 1. BUILDING COMMISSIO ER'S OF ICE This individual has bee med of permit requirements that pertain.to this type of business. horized Sign Tt .- MUST COMPLY WITH HOME OCCUPATION COMMENTS: €� TIONS. FAILURE TO ULT IN FINES. 2.. BOARD F HEALTH This individual has been i rm d of the per it requirements that pertain to this type of business. A Iz ignature'* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature" COMMENTS: Business certificates (cost $30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. - it does not give you permission to operate -you must get that through completion of the processes from the various departments involved. . "SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY. Q:\CONSUMER\Lols\CA.Forms\newbusfrm.doc