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Home My WebLink About1692 SOUTH COUNTY ROAD - Health (2) 1692 SOUTH COUNTY i / TOWN OF BARNSTA_BJLE �+ LOCATION l0 �Z- 4/f 0�71 CAM f�, SEWAGE. # 7 VILLAGE �I�STD�IS A%6s ASSrESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. ®�T��/// SEPTIC TANK CAPACITY size LEACHING FACILITY: (type) ` (size) /`� 1 C: r,; / � NO.OF BEDROOMS 7 Y BUILDER O'C.� —� PERMTTDATE: 9"1 7,�_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 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 L i �� i EA f f Z Fee No. / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ,ate// s PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ! 01pphratton for Mt000al *pgtern Congtruction Permit Application for a Permit to Construct( )Repair(i%)Upgrade( )Abandon( ) LKComplete System ❑Individual Components Location Address or Lot C��/No. y l /'� , Owner' Name,,Address and Tel.No. Assessor's Map,,,��1 c ` �� Installer's N e,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 Agee_ o.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow &150 gallons per day. Calculated daily flow `� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1c.5-00 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 issued by s.Bo of ealth. Signed „ Date Application Approved by- r` Date r f Zi r Application Disapproved for the following reasons Permit No. Date Issued No. ! Fee��'THE COMMONWEALTH OF MASSACHUSETTS � Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS,; ' S ZIpprication for Migpogal *pgtem Congtruction Permit Application for a Permit to Construct( )Repair(Upgrade( )Abandon( ) M Complete System ❑Individual Components Location Address or Lot No. Owner's Name Address and Tel.No. Assessor's MaP el Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 39 „ `.` Type of Building: r Dwelling No.of Bedrooms L Lot Size �q.ft. Garbage Grinder( � Other Type of Building &eil'No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design,Flow ,/�/, gallons per day. Calculated daily flow �d gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /,6 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 0.)Al r� M1 1 of 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 is Board of tlealth. Signed Date / Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued --------------------- {{�� ----------r�------ THE COMMONWEALTH OF MCASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that thp,On-site Sewage Disposal System Constructed( )Repaired (Upgraded( ) Abandoned( )by ®/� at Z'" as been cons ted in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. '- 6 dated Installer Designer e The issuance of this errtt shall bec nstrued as a guarantee that the to w /I ' function as `e igne- { ') Date y L' Inspector THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mie;pogal bpgtem Cougtruction Permit Permission is hereby granted to Construct( )Re air( ✓)Upgrade( )Abando System located at u .0,�- � 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 Date: Approved a s� �n NOTICE: Ties Form B-To Be Used For the Repair=0f Failed 7 g 355 Sepfic Systems Only. e CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I, AlIkIll. r/ A`�OV'F hereb e 5th/at the application for disposal works construction permit signed by me.dated ��Q19� , concerning the property located at ��Z J'�OCl7`��pl�s?�y/� Dsj /� meets all of the following criteria: 1✓ The failed system is conne cted ecied to a residential dwelling only. There are no commercial or business es 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 W There are no wetlands within 100 feet of the proposed septic system V There are no private wells within 150 feet of the proposed septic system U There is no increase in flow and/or change in use proposed /Thereare 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] u /lIf 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) G.W.Elevation +the MAX High G.W.Adjustment. 70 _ DIFFERENCE BETWEEN A and B ` h SIGNED _ / q DATE: A, [Sketch PwPosed Plan of system on back]. ham haven an J 04/ C �wa� •� 9 �,A° ID ------------ Q 0 2 Germs:..ray /' �t�si c,.11r y B4p/r.�om 'e - CPJ TOWN OF BARNSTABLE f L LOCATION _LfI y 5,0GI / 4 41 1 SEWAGE # VILLAGE ,�9� �r1.5 ASSESSOR'S MAP & LOTTAM 4�1/3 `..INSTALLER'S NAME&PHONE NO. �®`T��/ Ce'xla1 7!7- SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS 7 BiJII DER O O PERMTTDATE: 7 "�✓� 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 site or within 200 feet of leaching facility) / Feet Edge of Wetland and Leaching Facility(If any wetlands exist ��ff within 300 feet of leaching facility) Feet Furnished by �l �B all 6e,Sn;fa✓ 6