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HomeMy WebLinkAbout0918 ROUTE 149 - Health 918 ROUTE 149t MARSTONS MILLS A = 102-048 ,\,'C>. 4210 1/3 RED �+ r v .� J L. ... A Fg No. —.3 8 Fee. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ,✓/ s PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Ye'/ 2pplitation for Oig ozat .5tem Congtruction Permit Application for a Permit to Construct( )Repair(ate)Upgrade( )Abandon( ) [!,Complete System ❑Individual Components Location Address or Lot No.�j� y Owner's Name,Xdress and Tel.No. Assessor's Map/Parcel Yl0,4.5 ���y ��e��' Q/#- _,�;,evl�Y Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. —,':;73 POP Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( © Other Type of Building /desiGe No.of Persons Showers( ) Cafeteria( ) Other Fixtures_ Design Flow gallons per day. Calculated daily flow gallons. gallons\' Plan Date Number of sheets Revision Date Title Size of Septic Tank %S®a Type of S.A.S. �"—✓�©��` ��/ Description of Soil 6_/o X 3® Xe , G� e�� Nature of Repairs or Alterations(Answer when applicable) /G. 19� 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 b this Boar of ealth. / — / Signed Date 6 aalQ� Application Approved by Date Application Disapproved for th follow' g reasons Permit No. Date Issued —————— TOWN F BARNSTABLE LOCATION •Q�"�`/� SEWAGE # VII.LAGE .�Q/J7'��'S ���s ASSESSOR'S MAP & LOT Id2-44/5 INSTALLER'S NAME&PHONE NO. ��oC� i SEPTIC TANK CAPACITY ilbo aaL LEACHING FACILITY: (type) S'00 Gs( Cw• t [ .S � (size) NO. OF BEDROOMS BUILDER OR OWNER PERMTTDATE:- L Z S— COMPLIANCE DATE: b 6 I Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility r t Feet Private Water Supply Well and LeachingFacility ty (If any wells exist on site or within 200 feet of leaching facility) �� Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by Feet OD .T I Ni i /Xy M 7- No. — t/ 1 Fee computer: THE COMMONWEALTH OF MASSACHUSETTS Entered in com p PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLES MASSACHUSETTS v 1 3pplication for Digo.5al *proem Con.5truction Permit Application for a Permit to Construct( )Repair(✓)Upgrade( )Abandon( ) L7 Complete System ❑Individual Components Location Address or Lot No.?IfOwn f�i�er's Name,Ydress and Tel.No. G®�-�/ram � - s Assessor's Map/Parcel �D�y���t>. /�if�! l' Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.Mo. 7/` 93Q� 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 gallons per day. Calculated daily flow ,33o gallons. Plan Date Number of sheets Revision Date Title Size of Septic TankType of S.A.S. Description of Soil +. '" �� �'r 3d X,7 Nature of Repairs or Alterations(Answer when applicable) t12,0-le JO Date last inspected: s'*: Agreement: ` The undersigned agrees to ens r the construction'and maintenance of h afore described on-site sewage disposal system in accordance with the provisions of1,T tle,5 of the Environmental Code and nbt-to place the system in operation until a Certifi- cate of Compliance has been issued'•b this Bo of,•ealth. Signed Date 612201�-V` Application Approved by � F Date 6, `�� -96 Application Disapprovedmfor the followg reasons �•. Permit No. DaF Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance ; THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(' )Upgraded( ) Abandoned( )by 4�Ae r COW at /� G6 f t�i�` r p/�f I9 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. - dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date /, 1� to - C7 K Inspector No. C?g _' �U� -------------------- �®G !/�?5 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS �Dfgpogal *proem Construction Permit Permission is hereby granted to Construct� )Repair(✓l"u'-pgrade( )Abandon( ) System located at y/f COT V17^ i W AW 61"?A1s Af/As 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: /! —,� --Approved by . 1� V ' �e A,: 101"7 NOTICE: This Form Is To Be Used For the Repair Of Failed rrz Septic Systems Only. CERTIFICATION OFS- KETCH AND APPLICATION FORA a DISPOSAL WORKS:CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) 4 ; 4 &/'MCPAI^ hereby certifythat the application for disposal works VV construction permit signed by me dated G �2�`Q� , concerning the u property located at //mees.all of the :. ioilowing criteria: V There are no wetlands located within '.00 lee:of:he proposed leac^ing `ac:iiry Xaere are no orivate wells within i:0 :ee:of:he proposed septic syste-rn There s no increase in low md/or_aange :n-ise_roposed X'nere are no variances requested or seeded. r`:::e oepse? euchina c:ii�y will _ !ocatec..vith; , fees ,r,nv wetlands. :he ecacrn or me _. ^.�. a proposed leachingaCi.it':'vill :e .ccatea ..ss:nan :UU1L -.1 - :�-:1Cudc me .^ as:mta :5 groundwa:er*=b.!-eievvinr, Please complete the following: A)Top of Ground Elevation(according:o the Engineering Division G.I.S. nao) a; B)Observed Groundwater;aoie Elevation(according to Health Division well mao) - DATE: SIGNED: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER . installer a a cetifled plot plan, (Attach a siceteh plan of the proposed system.Also 1f the licrased posers �cM�M1�_ S_ 1' 7y Y^�J� Y- 4N f z x T - }' �r5r-••�za ",i m.•�2 f s $ 'i, t"trd �i 10.1. I•5 f ;y ,+ a' •„ �' v v .. .+.., _.: •$":.` .<e_ .- ,X xAk]r` ,�•y.e:k.- r""'"`t r e.F .`t "T �" s '''-"n':k { ."w ter. x t r. �7,,3g'.r �a }� jj My t''qr r. n <. "} aRr.:?.'�'r .�-m.,'a.r x... ` `� '^-'t �B•�X.,r. �Y °3�_.._ .Gr =f`:4$?i` .__ .�:_ert_.. p a �11 �c 0 Joe,v O`er 1 s s U 0 jf O VKAW �n TOWNNPF BARNSTABLE Y✓ LOCATION Q/ eB��,r r�"' � .Qf/y� SEWAGE # — v� VILLAGE a/� �s �r/� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. /`7�L® � C4iP5�` 77/93 ' ' SEPTIC TANK CAPACITY IfW 6;4L LEACHING FACIL=: (type) S'200 Ge C 4wei e .L,., ( (size) /Z J" L/0 R NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: Z✓� COMPLIANCE DATE: b , Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility t 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 �y1 � ik eG s. 00 R 1 H ` s � e l