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HomeMy WebLinkAbout0009 WOODCREST ROAD - Health 9 Woodcrest %.c,;a ,Marstons Mills 1 A= 030-063 l J TOWN OF BARNSTABLE ' L%IOCATION. W C C SEWAGE .VILLAGE 1 Xn� S6v,- tl�\ks ASSES_SQR'IS,MAP& UC0,11 INSTALLER'S NAME&PHONE NO. p� SEPTIC TANK CAPACITY/O e-X19 I 4) GW OldY-l f n-,� LEACHING FACILITY: (size) �{ �f S w , ''� NO.OF BEDROOMS f q Tqr S U dlz-r BUILDER OR OWNER upckd � PERMTTDATE: ��l�lo COMPLIANCE DATE:.ff/Tg 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) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by -�� ��-� A � 06 gL ASSESSORS MAP NO' No. FARCELNO� ®tom j Fee C� 'STHE*60MMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,,. MASSACHUSETTS 01ppfication for Mizpozal *r5tem Construction Permit Application for a Permit to Construct( ,)Repair( 4-Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel �\ Installer's Name,Address,and Tel.No. 23—SvC1 1 Designer's Name,Address and Tel.No. k V_ Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(N 9 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /Q 0 O Type of S.A.S. q MKWc-I, lc Description of Soil Natpre of Repairs or Alterations(Answer when applicable) Add 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 this B and of He I� btS C Signed Date Application Approved by Date 144 Application Disapproved for the following reasons Permit No. 96 f/ Date Issued ��- ab 3 Fee 'T V-H 66MMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS ZippYication for Oigpotar *pgtem Construction 3permit Application for a Permit to Construct( )Repair( l/f Upgrade( )Abandon( ) ❑Complete System ❑Individual Components 4 Location Address or Lot No.(l Wood cci�rk ,Co ``Ow•,�ner's Name,Address and Tel.No. Assessor's Map/Parcel 11 ��� M` t W V / \'r"U', Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. j I Del ? QZ 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 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank / O U O Tyre of S.A.S. t r^ y Description of Soil { s 1 Nattire of Repairs or Alterations(Answer when applicable)—Add LA) 4 E+ 1 Date last inspected: i 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 this B and of He It . Signed �� Date k o Uv G c Application Approved by G 'r Date Application Disapproved for the following reasons Permit No. 9G Date Issued /6 - —2 6 ---------------------- -------------- 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 t•.�lt t✓l �7 "I,-V. NC_SJ at CI C -4-C-6 0-f 51 (21-) M . 1"1, a has been constructed in accordance with the provisions of Title 5 and••the for Disposal System Construction Permit No.96 SV1 dated Al a?Sf 6 Installer � (M \—h t✓i C`cDA Designer The issuance of this ermit Pall-not b�,con . ed as a guirantee that the systejWWlll unction as desi lied. Date Inspector No. _ �7/ Fee �U THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS MigpoeaY *p!tem Construction Permit Permission is hereby g anted to Construct( )Repair(V)Upgrade( )Abandon( ) System located at 'SA Pam) Mug.C"�n ,✓1r /t!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. Provided:Construction must be completed within three years of the date of this pprmit. Date: �© 'o?S" 1941 Approved by i F CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, ����� M \�c-P,ya� , hereby certify that the application for disposal works construction permit signed by me dated rcl, , concerning the property located at C� urax)ca--sV aA . meets all of the following criteria: ,There are no wetlands within 300 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system The observed groundwater table is 14 feet or greater below the bottom of the leaching facility There is no increase in flow and/or change in use proposed There are no variances,requested or needed. � I SIGNED : _` DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. 1060 �C(S� r (16000