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HomeMy WebLinkAbout0010 STARLIGHT DRIVE - Health 10 STARLIGHT DR.! �✓ MARSTONS MILLS A = 100 042 I TOWN OF BARNSTABLE �' C- LOCATION /0 `3 � ��✓� SEWAGE # �-�' © � VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF�BEIDROOMS BUILDER OR O R PEILMITDATE: Ta� Q# t COMPLIANCE DATE: e , . _ _ _ . Separation Distance Between the: Maximum Adjusted Groundwater Table to e.Bot't"f_L-eaching 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 leachin faciii ) P Feet Furnished by 6 v O { A 1`41 Al- 54 BI - �9 � B3 ' '3-1 A &44T3, Z4 ; `� No. � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Application for Mitpool *pgtem Construction Vermtt Application for a Permit to Construct Repair ✓<U rade( )Abandon( ) El Complete System El Individual Components ( ) ( Pg P PP P Location Address or Lot No. 9 O slwL"6ttr DP, Owner's Name,Address and Tel.No. M A�.-rvNS M I LA,s T PEu.—'i e_ Assessor's Map/Parcel eW tDol P D qL Installer's Name,Address,and Tel.No. Lr� p��� Designer's Name,Address and Tel.No. "�c1t "loz 'Pows . MILL-Si ]vt Type of Building: 4- DwellingNo.of Bedrooms Lot Size 20I�� sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 3 y gallons per day. Calculated daily flow 340 gallons. Plan Date l ' 19- d 1 Number of sheets / Revision Date Title Size of Septic Tank / o0o Type of S.A.S. 2-K $SOP &Ai— ott3Q,6 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 issue by this Board olfealt . Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued TOWN OF BARNSTABLE Zill LOCATION /D `�� � ��� SEWAGE # 0� VILLAGErLLS ASSESSOR'S MAP & LOT 'INSTALLER'S NAME&PHONE 1NO. SEPTIC TANK CAPACITY 1�b I ) x j LEACHING FACILITY: type) (size) N!1 !lF RGT1R(1(1M.0 BUILDER OR 0 R DATE: • � PERI�IITDATE: COMPLIANCE Separation Distance Between the: Maximum Adjusted Groundwater Table to-the- ttem-of-Leaching Facility Feet l� Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility (If any wetlands exist Feet f et of leaching facility) w ithi 300 fee t Furnished by j ? �t h bh-! V i u No. j U " Fee ` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: <. Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 2pplication for Mizp $af *raem Cone;trurtton Permit Application for a Permit to Construct( )Repair( ✓j Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 10 S-Ma"60T Owner's Name,Address and Tel.No. n,rtJzs-rDNS -T-WrzEsA PELL�GT1 t-W Assessor's Map/Parcel 1'�n.A1P I DP o qZ Installer's Name,Address,and Tel.No. 4�`0 Zg/0 Designer's:Name,Address and Tel.No. J 1 rv� i t,Lk e7fL -p, 11J STq t t.E►e_ '50X 702- AAk95rrpWS EAILLS MN Type of Building: Dwelling No.of Bedrooms 3 Lot Size 20a ig-06 sq:ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures .Design Flow 3 3 o gallons per day. Calculated daily flow 3 4.0 gallons. Plan Date I 1 q ` 01 Number of sheets 1 Revision Date Title Size of Septic Tank I DDO Type of S.A.S. -D'X SAD 6�A-t. GNAnnp� Ls Description of Soil Nature of Repairs or Alterations(Answer when applicable) 45'ot) 5 Pr S .r f 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- date of Compliance has been issue by this Board of ealth. Signed ff 6 Date 1' 1`� ► O f Application Approved by v ����/l e II, .i Date ' Application Disapproved for the following reasons Permit No. ; r Date Issued 02 r ——————1—————— f———————— — —--'———— —— A THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS r Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( )Repaired ( )Upgraded( ) Abandoned( )by )l 1 CJ C? at if,e) C. j' 01- 1 �r, 1 t 1 > has been constructed in accordance with the provisions of�fitle 5 and the for Disposal System Construction ermit No. °,�l') .1 �' 'dated Installer Designer v v J c The issuance of this permit hall no be construed as a guarantee that the sy�ste/ �will functionasfdesig e'�l. Cl e Date Inspector -V`1 7��/�t _ ll� . )� -- ----w----—————————— -- -- � No. Fee V v THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS MigosW *pftem Con5tructton Permit Permission is hereby granted to Conte )Repair( (/ Upgrade-( )Aba don( ) System located at r =�—T I f ,1 a �a T- 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:Constructio//n/must be c mpleted within three years of the date of is�perm,itit./ f Date: d/ / / >7� A roved b / " / . / PP Y u �� . ___-_�-Tom'--_--i_�'t.�'-_•�-f-�'7-'_`. i 1 YI//'' �� t� ! 1 3 f� � i ' , Y i ''~---'�_ ��..- X $t> GAS C��PrititPJ�2S 13 +-� ' M I--�.--�- { --+ .,__ ;�� 5'rA�LZ 6E�T �12,-� �' _"6--- ._._i__ ! � -,-•� �-- � '_-.i_-�"�r�t !�.�_7�o, ►emu I vr ------t I I IvaA S"�o k+ �i 1 S r 1 _ 17, I I _ r ' 1. a ,._ � { _�. _ ♦.- ±_—_-- _�.__.4 _ � � _ a.�_ l_— ... �...,. +_. .1 _._.-1._ �,— r �_ -- - .a _ .. , . + r I I t , AL- r ! t i 7. I i. .i. J _ l. .. _.�. 1 1. + - i -- f + - .t. _1_.. L. it 4-1 41 IL ( t( l r I + t r , ' •. .i., !„�_t�:. .i—�.._._..L_--l..:f--.1..-_.r.� .. _«._. _.r .,... {._ 4. :«. .—.-.ti .«.r_ .{.. .i- .._^..#.. _.,..a .,7.1__ ..., __, ... -._ 1 s. 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) / AtU-er—.L A'wt ES ; hereby certify that the application for disposal works construction permit signed by me dated I / 0 ! concerning the property located at /D 6TA-a-LL&t4T /?—. meets all of the iwn t t tZ 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 plevation..[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) 78, t B) G.W. Elevation 2—� +the MAX. High G.W. Adjustment . S+3 DIFFERENCE BETWEEN A and B � SIGNED : DATE: [Please Sketc p oposed plan of system 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