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HomeMy WebLinkAbout0090 LAKESIDE DRIVE - Health y 94 LAKESIDE DRIVE, MAR$TONS MILLS A=102-015 1 TOWN OF BARNSTABLE LOCATION �® yl�es��� SEWAGE# VILLAGE /" 7�®`lJc /�/���5 ASSESSORS MAP&LOTI�2-d15 INSTALLER'S NAME&PHONE NO. ����J`/ ��c5 SEPTIC TANK CAPACITY IfOO 6; L LEACHING FACILITY: (type)�w�'Gfx (y� (size) 3L-T 4.2 NO. OF BEDROOMS 3 y BUILDER OR R ac JJ PERMTTDATE: JJ�O— b COMPLIANCE DATE: -7., Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist / on site or within 200 feet of leaching facility) /v Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feetAeachil_1aci Feetlity) Furnished by r eq r 27 ` t k l� _ No. l f� i . . : �® Fee o THE COMMONWEALTH OF MASSACHUSETTS f ° PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIpplitation for IBigw5al 6pelem�COtt$truction Permit Application is hereby made for a Permit to Construct( )or Repair(1/)an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. fo GQkesiae 01foe R"s�n-1 4eQG4,�Iy q lgal,5 >o705 ✓q/ s 7-6w i5p 'le-we- Installer's Name,Address,and Tel.No. 771—f aff Designer's Name,Address and Tel.No. 4601'/©4aJ�/� 1/ Type of Building: Dwelling No.of Bedrooms Garbage Grinder(.4P Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow J 1—ir0 gallons. Plan Date Number of sheets Revision Date Title Description of Soil Natu of Repairs orAlterations(Answer when 7plicable �- � eo 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 's Boar Health. Signed 8d, Date rbalft�' Application Approved by Application Disapproved for the following reasons Permit No. �6,'.�3 7 Date Issued ' d — 946 No. / r" R3 t ®� Fee i� � -41 OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS 01pplication for Miqu of *pgtem Con,5triuction Permit } Application is hereby made for a Permit to Construct( )or Repair(1/)an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. rs �o�s �fl s ��l QZByf� SoKr� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 1310/AP Ga,ei Ca7�5 9399 Type of Building: Dwelling No.of Bedrooms L Garbage Grinder(4v Other Type of Building ge f ,4dGC No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow /6/2 gallons per day. Calculated daily flow gallons. Plan Date Number,of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(An'swer when a plicable .�e5 all �. 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 s ard, Health. Signed Date 5IJ19h% Application Approved by Application Disapproved for the following reasons Permit No. / �`3 7 Date Issued -_--3 0 196 THE COMMONWEALTH OF MASSACHUSETTS IO2 �Q r—--^ PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( / )or repaired/replaced(1/)on by Ael for V as 90 GD . �rr O iG/i// has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 'o2 2 Y dated 1`-20- n Use of this system is conditioned on compliance with the provisions set forth b w: No. G �3 7 ` D ZFee O r THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Digoml *p.5tem Con5tructioin Permit Permission is hereby granted to construct( )repair( L11 an On-site Sewage System located at !! e5 C �. 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. All construction must be completed within two years of the date below. Date: Approved by ^G% � CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL 1YUItKS CONS'TItUCTION 11ER1111T (1V1THOUT DESIGNED PLANS) x4elm�I'l ereby certify that the application for disposal works construction permit signed by me dated 13011f� , concerning the property located at 11Q/61"`0,15 -41/// meets all of the following criteria: 'V T ere are no wetlands within 300 feet of the proposed septic system here arc no private wells within I5o feet of the proposed septic system The observed groundwater table is 14 feet or greater below the bottom of the leaching facility a There is no increase in flow and/or change in use proposed /There are no variances requested or needed. SIGNED: DATE: LICENSED SEPTIC SYSTEM INSTALLER-IN THE TOWN OF BARNSTABLE NUMBER (Attach a sketch plan of the proposed system. Also irthe licensed Installer posesses s certilkd plot plan, this plan should be submi((c:dl. ,.t.- -,�'�,.s' ��v�.4 t'". „� r•�`; ^`" rc•.._rr::,"'' �.,.:.r �''.'s�� ���wY� a�'H'�'!-��� .:Y...� .,$_.._„ , _. �� �' .,.ter>� . r � � h Q i W's l i Y.r6. Gn� -arJ S YV11 vl S 1 � � d °� o