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HomeMy WebLinkAbout0036 STARLIGHT DRIVE - Health 36 Starlight ice- Marstons"Mills A = 100-044 a .7 TOWN OF BARNSTABLE LOCATION3/j SEWAGE# 0Z<>- K-; VILLAG4*1Q4 71 , ASSESSOR'S MAP&PARCEL/00 INSTALLER'S NAME.&PHONE No5g&;fA(�a ; � SEPTIC TANK CAPACITY- /5Er_> 4/fO0:S r LEACHING FACILITY: (type), 1:a? C b;R_'?S (size) 3e /3 NO.OF BEDROOMS Z- ice: 3 des-;/o OWNER 1000e41v PERMIT DATE: /C 6 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 b_ a. TOWN OF BARNSTABLE LOCATION 3/ , %44IjG°,�/�j�.P;�i� SEWAGE# �—�-� VILLAGE/'r1�,�',5=��� ASSESSOR'S MAP&PARCEL/00 INSTALLER'S NAME&PHONE NO�Q,P�� t'C.U�dSJ� �/!1�" /? _ SEPTIC TANK CAPACITY /td > LEACHING FACILITY:(type)vS ,� /�, QS (size) NO.OF BEDROOMS L A OWNER G e1 A) PERMIT DATE: l/ 6 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 o i ' f. 73 /, i6 �? N, l � i TOWN OF BARNSTABLE P !dam O� i DADd9T�8L j on Ya,� BUILDING . INSPECTOR L APPLICATION FOR PERMIT TO ..... : :S.IJT'...C.1.C. :... .... ..4:�:l ?1.6.'............................ TYPE OF CONSTRUCTION ........... ,r /,c.. /,�c...................................... ................................................19........ TO THE INSPECTOR OF BUILDING The undersigned hereby applies fo a permit according to the following information: Location ..4.�.V.T... ..r ..:. .7`rf' /2...{�!4?(.�1.�. ............. Proposed Use s� !eU.. .4 !YE,............ ..1.^(�'..4: .... ..<.. ZoningDistrict ../..............................................................T......Fire District ................................................. ........................ Name of Owned.., ./1�.'�^'i�.�/,/....,, yk�.429..CA• IC,Address6... Name of Builder G3WJV-�)gjCJ>425S—LLl.KX...Address ............................................................. Nameof Architect ....... ..........................................Address ... ........................................................... Number of Rooms ...J .................................... ..................... 1�,.�.............D .............................. Exterior �`� d . ./..1./.!.Y.�:�.�::�J.....��.............................Roofing .,�.7.•��? GT Floors .................................... ............................Interior ..�14�.f�.�.r�...Y:..�..d.�'/.:��.T...12...o C;,f'�............ Heating /:(-/ ........ . ...l4../.. ........................................Plumbing ..�../Z.....�` !! �.... .............................. Fireplace ./ ... Approximate Cost .;,-)a /............ .............................. Definitive Plan Approved by Planning Board _________�_ Diagram of Lot and Building with Dimensions SUBJECT TO APPROVAL OF BOAARD .pF .H I Its. PHONU6!_U IVIL HUU UP t'K MOINU i-y' R SANITARY WAI ER CUPPI-.Y/�ISf-jE`;)&6SAL AND RAINAGE IS Fl~EtLI3 Ai=f i��r ED TOWN OF IBARNSTABLE. R0ARD OF HEALTH —77 i A 1CCfJSED INSTALLER Ml.-1S- 6JBTAIN SEWAGE �y F'E�NNT, AND INSTALL SY S �' 2,6 No._ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 9ppfiration for Disposal Opstem Construrtion prrmit Application for a Permit to Construct( ) Repair( ) Upgrade y( Abandon( ) Complete System ❑Individual Components Location Address or Lot No.s(----, Owner'sN �05_ Assessor's Map/Parcel c.�l Instals Name,FAddr ss,and fel.No. Desi Name A,dess, Tel Tq J Type of Building: Dwelling No.of Bedrooms Lot Size O VLC• sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Z_ILA Design Flow(min.require� gpd De7* ;flo)provided gpd Plan Date /d Z � �® Number of sheets Revision Date Title Size of Septic Tank 115co Type of S.A.S. c>co Description of Soil—S® _ Nature of Repairs or Alterations(Answer when applicable) PIT W ®� Z ` �APA 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 C rtificate of Compliance has been issued by thi and of eal SignedA /c." Date Application Approved by ✓ Date Application Disapproved by x.a;; Date for the following reasons Permit No. Date Issued ----------------------------- ------- ------------------------------------ --f • fr!°+±: � 'lit "' - r No. 0 Do Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:—� PUBLIC HEALTH DIVISION - TOWN OF bARNSTABLE, MASSACHUSETTS Yes 21ppIiration for Disposal .6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) Complete System ❑Individual Components Location Address or Lot No.�� ti (a('� Owner's Name,Address, Tel.No. Assessor's Map/Parcel /Do Zo7, rn Installer's Name,Address,and el.No. Designer's Name,Ajdddrress,an Tel. o. / /Jctj Type of Building: Dwelling ° No.of Bedrooms Lot Size Q 1� c,. sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) F Other Fixtures -.—Design Flow(min.require gpd Design flow provided gpd Plan Date Z(') Number of sheets .—I-Revision Date Title [� G Size of Septic Tank / Type of S.A.S. a v s Description of Soil Nature of Repairs or Alterations(Answer when applicable) �� 1 G� 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 Certificate of r Compliance has been issued by thi0oard of ea . Signed Date ©! Application Approved by P.,nk ICA L Date -� Application Disapproved by Date for the following reasons i Permit No. r1�r�f �j Date Issued } THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the ''On-site Sewage Disposal system Const ucted( ) Repaired( ) Upgraded Abandoned( )by CPyM W�� C_cw�) 1l l at Gj`( .�( _�y has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ated Installer (D1 W k , 6 0M�. Designer C y µ V C #bedrooms 2_ Approved design flow A encPgpd The.issuance of this permit sh 11 not be construed as a guarantee that the system will ctio 1esigned. Date -�-�L� '1 P Inspector r 4 1 -- --- -----.- - ------- ---- - - --- --- -- - - --- --- -- -- --- ---- ------ ---- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *pstem Constructiow3permit Permission is hereby 7ted to Construct( ) Repair( ) Upgrade(1-5 Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 / he Approved by /j w Town of Barnstable Inspectional Services : Public Health Division • him ,�a• 163 Thomas McKean,Director 9 �6� ++�°i 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Sewage Permit#�f -J s 5 Assessor's Map\Parcel Designer: t� 9/ �� Installer: Address: � � - Address: T 1 i ty(0a�C/`� On 11 16 1W was issued a permit to install a (date) (installer septic system at ��0� y based on a design drawn by (� ( dress) �J f0 �-yam.,l^ dated (designer) YllI certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was,inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I cert' that the system referenced above was constructed in compliance with the to rms of the approval letters(if applicable) OF A4�ss DAVID qcy� ler' B. 1UTASON an, No.1066 0.,�a Design ignature) (Affix. 4f -AV% Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. 1\wa\depts\HEALTH\SEW ER connec ASEPT{COesigner Certification Form Rev&14-13.DOC No �T__ 1; The installation SMU cam*with the state Environmental Cade Title V and Town off* ,.QQ Board of health Regulations. c p F�gL �' _._v` C7��.: G ;LO ID..'�1.�.LLf�' � � 2) septic stem as proposed on this�- L�' - system - phpt�shah not be installed until a ikertsed Lawn installer A Y „� receives approval,end an instWlation permit from the applicable town. = � ,!„ ' �,� ' ,�. t ( F ✓ 3! Prism-to Installation,the installer shall ver4 the location of utilities,sewer inverts,sewer lines and exisft septic cur panentt prier to Installation. 1 (Tot , r ) All grav,t�sewer piping is to be 4 Inch schedule AO PVC at iJ8"per foot. e first 2 feet out nt ' 114"' i - t:�sk bibution box shall ba level. All piping connections to be glued. 51 'Cftis septic design plar is not to he utilized for property lute determination or for any other r ss /Q 11 1C l i posed septic system+nstaatan.purpose other ftn the prc . Ail ride V cQ#1 por:E'nits-are to meet Tide V sMcifications. a �0 ll PatrMng shill be prohibited over i itle V components unler.rmnponents are H2O loaded. �Tt 1 t�l� 0 �'� g} N eneisting leaching or cesspoois shall be pumped and filled wifi material per T"rt(e V lj ✓' abandonment procedures leaching and cesspool(s)and contaminated soils within the Gt ltJ t I� proposed SAS shall be removed and replaced with dean sand per Title V specifications-9) SeA components are to be UY from a wattr service hne.Sewer Braes crossing a water line shad !0 be*eved w tie an appr,�pr:ately sized schedWe 40 PVC with ends grouted. The water Service << fine or the septic line rani he sleeved wlthti the sleeve being a distance of?V on both sides e# ►L crossirw the lime. - _- V)) if a garbage grinder exists in the structure,It is to be removed if the septic system Is not 20 ZZ4C:::� </ designed to accommodate a garbage grinder. �7Z j 1� The installer is responsible for care of excavation around all;utilities on the property and 0 `7 It '_ T '`.. protecting the structural integrity of all structures during the installation process of the septic system. - -� 12) This plan only represents that a septic system can be irutalled on the prop"meeting Title requirements_ lop 1'_, " The property QINrfEfi 5h331%review dt'si ;,criteria to approve t�e total number of bedrvcm5 and design flow.Installation of the Septic system as imposed and recelpt of.payment f6f the des' ± shall be deemed approval of the design criteria by the property owner or agent Of. X �„ JOL, !�{Trams validity of this play}stall expire with the expiration of the town installation permit issued foi fE this plan fire validity of this plan shall expire on the expiration of the Certificate of Compliance issued for the irist;;Uai-: r`of ilia pr cause a System cn:his plan. IED -�� -� _ lei ' � � �u�.1► _ t Z1 rT - { FIFIALTH >\ 549 4PI) N k-7— flu ,e)[ _ _ - TIG 2ftTIEN _ �g AT. rim SMI 3 u of ; s 7Dq OF 7 67` /AX-6 ma Vgl, r DAVI B. MWON V _ i .tors c -V ► A1..41 MA4E x 011/ AdA w <f0 � - :�: y VI ..