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Home My WebLink About0558 CEDAR STREET - Health _ 558 CEDAR�;W. ARZTI ABLE A = 109 048 a 1 II � { 1 a o , TOWN OF BARNSTABLE i LOCATION SEWAGE # r 1 VILLAGE h/ U �r ASSESSOR'S MAP &.LOT/ 'D " INSTALLER'S NAME&PHONE NO. =-a�'"''s c�►�-rl ems' SEPTIC.TANK CAPACITY rf� LEACHING FACILITY: (type) c�}""Z4 (size) NO.OF BEDROOMS BUILDER OR OWNER Z,4r,✓,:, ,o V PERMITDATE: 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 i t � w� o s I *r �r TOWN OF BA/RNSTABLE �3 u & LOCATION f Cend' �Z SEWAGE # 1 VILLAGE tv A ASSESSOR'S MAP & LOT/pp� 'D INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) -3 C/0 " (size) NO.OF BEDROOMS BUILDER OR OWNER v°:— t h V PERMITDATE: 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 Fu�rushed by � I r , �\ s � � f No. /� � / O r Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYicatton for Mtgool *patent Con0truction permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. S L,,/ Owner's Name,Address and Tel.No. Asses or's ap/Parc149, 0-2 d p}rt S Installer's bame,Address,and el.No. Designer's Name,Address and Tel.No. Type of Building: L/ Dwelling No.of Bedrooms ` Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 6.P 10 gallons per day. Calculated daily flow Wd gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /0-op Type of S.A.S. Description of Soil Nature epai or Alterations jAnswer when applicable) ��- ��' C .- 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 Envir nmental Code and not to place the system in operation until 'Certifi- cate of Compliance has been issued byhpo 'ealth. Signed Date (� Application Approved Application Disapproved for the following reasons Permit No. L7,Lf4— Date Issued d'z3Z' is No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYication for Migpool *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No. s ST / l Owner's Name,Ad/)dress and Tel.No. Asses is ap l Ce /a✓j. S Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ;t7 (-OnJ Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other jype of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures nn ('�j C! Design Flow r �'I V" I gallons per day. Calculated daily flow T � gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /t>&o jr Type of S.A.S. Description of Soil Nature f epai 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 Envipnmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued hhi ABoa d o b� . ealth. Signed .l _G Date 4%7 d ` t Application Approved _ Cam'' > :-� � Date 0, - ! Application Disapproved for the following reasons ti Permit No. Date Issued •� d --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS ,, Certificate"of Compliance THIS IS TO CER ,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) AbandoY e )by �' t>Ifs Z.? ? ,- . has been constructed in accordance with the provisions,of Title 5 and the for Disposal System Construction Permit No. dated Installer -' 10� �� , Designer N The issuance of 'p6rmi, hall 1 of b construed as a guarantee that the syst ° wlt i .nc�ti n as designed. r j Date � // Inspector t/pl No. � ��'� ---- --------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS ig ogaY *p!Wnt Construction Permit Permission is hereby granted to' )Repair(�)U grade( Abandon System located at ' � 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 offtthi, e t. Date: ''" % �' Approved bys� ' � 9'' v • 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) I, �,c --L'q��1r,- , hereby certify that the application for disposal works construction permit signed by me dated��r,�,�i ,� � i , concerning the property located at rS—S7" Cc d S w ,(��,� � meets all of the following criteria: 61/ This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. 1/• 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 V" 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 V• There are no variances requested or needed. Ll 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] V ' 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) B) G.W.Elevation +the MAX.High G.W.Adjustment DIFFERENCE BETWEEN A and B 7O SIGNED : DATE: 114, [Please Sketch rK2010an of sys em 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