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HomeMy WebLinkAbout0263 CHURCH STREET - Health J 263 CHURCH ST, W. BARNSTABLE A= 153-012 t, r t �i i� k, CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONS7'RUC"I'ION I'EItMI'I' (WFF1IOU'I' DESIGNED PLANS) 1, I=FF �ANoWA) , hereby certify that the application for disposal works construction permit signed by me dated 9`/3 °'r , concerning the property located at (a C/?URC, �[�. �Qa�ic/. 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. SIGNED: DATE: J� LICENSED SEPTIC SYS I E I TALLER 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]. 4 TOWN OF BARNSTABLE v LOCATION Cu a Ga U1 "r SEWAGE # VILLAGE, �1�A�'S`1'i�►ibLF ASSESSOR'S MAP&LOT 3-"'��Z INSTALLER'S NAME&PHONE NO. A r 6 6 4A)(.,,d �7 7,5 SEPTIC TANK CAPACITY /TOO LEACHING FACILUY: (type) tv td i f& pro A5 (size) to�O NO.OF BEDROOMS RLWmWR OR OWNER ( PERMTTDATE: 9OMPLIANCE DATE: 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 3© �` d_ a S i 4 1:♦ MA ls-3 No. • ° PC—`, a Fee 30 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Applichtion for Miqoal *pgtem Cun!5truction permit Application is hereby made for a Permit to Construct( )or Repair(&-'�an On-site Sewage Disposal System at: Location Address or Lot No. Owner's N Address and Tel.No. el, cy Installer's Name,Ak4h,®d ft fto Designer's Name,Address and Tel.No. `350 Main Street ?Y-asoo /VIA+ W.Yarmouth, MA 02673 Type of Building: Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 gallons per day. Calculated daily flow 33 L 9;_ gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer when applicable) I-IK'60 9,9/ 1i 11, 'Y e r D 136 yc O 'y X,7 PO P ¢o f S S , 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 Board of Health Signed Date Application Approved by A Application Disapproved for the f lowing asons Permit No. l.5 — I / ,9L Date Issued —————————————————— ———————————————————— y R V, C) No t Fee _THE'COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for M-igpogaf *p5tem Construction Permit- - Application is hereby made for a Permit to Construct( )or Repair(V/ an On-site Sewage Disposal System at: Location Address or Lot No. Owner's N ,Address and Tel.No. alo3 C' v!?cti. St. 3 J;4,% ya,AhJe. �. Sad+A e 36 a - (o Lt Installer's Name,Addre,A&BI-CAN O . Designer's Name,Address and Tel.No. % 35o Main Street AIA W.'Yarrriwh; MA 02,6; . Type of Building: Dwelling No.of Bedroom; 3 Garbage Grinder( ) Other Type of Building • No.of Persons Showers( ) Cafeteria Other Fixtures ' i Design''Flow gallons per day. Calculated daily flow 33 L _ gallons. Plan Date �r Number of sheets Revision Date Title Description-of Soil Nature of Repairs or Alterations(Answer when applicable) I n3 f l t e /-/z'o d 9-A 1 IA,,114 fo /`4 j- A?a a rmj,4 6r u /4"(Jr7 cF e r— c, 1 Date last inspected: t r Agreement: t�` The undersigned agrees to ensure the construction and mailillenance of the afore described on-site sewage disposal ystem. 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 Board of Healthnn ) Signed LDate +. �.3'9S `�. \ - I r Application Approved by Application Disapproved for the fvlowing; asons Permit No. !.S^ — 1 7.a' v Date Issued THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,t at`the On-site Sewage Disposal System installed( )o(repaired/replaced( )on by r C/�?/7 t for (�r rLt �_ e)vi A hue as - ,( TQ� 1r 1.✓a' f -x @D9r has been constructed in accordance with the provisions of Title 5 and the for Disposal Syste nstruction Permit No. dated Use of this system is conditioned on compliance with the provisions set forth below: No. t Fee 3a THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE. MASSACHUSETTS Migogar *pftem Construction Permit Permission is hereby granted to #f e eAn to construct( )repair(vol)an On-site Sewage System located at '?!n3 ehyeeA ��1=14c7/Af. 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. All construction must be completed within two years of the date below. Date: ~��' S Approved by �I c ' 350 Main St. • W. Yarmouth, MA 02673 • 775-6264 Division of Canco Energy Corporation Septic Services • Pumping • Installation 1J D 0 3 Y'-O' 1 9'-O 1/B" F 4'-4` ed-2I F D N i 6 N a N e' e rp of of \p o 0 0 r 0 p And......T'W904 Y 0 o ra.9'-9 7/6'»4'-4 7/B' 1 0 A I o i 1 i ® And......TWY 44e• . -------------------- A. ..n-rW Y 04 Y £ 1 a e 0 J P• s 8 � a � o � 0 0 - N e•'-I 1 1/4" S F " j.. ....................... 'Z 0 _ A.yr.... w: o. '-1 9/4'•♦-44 , l/a' ------------- :1 2 0 � ii , , 11 And.r..n.GN 9 4 1/9"s 4'-0 1/Y i � I - I ®® I I , , I +ie.eirr ' And.r..n.TWY 9 9 1 0 Cp f IS ---------------- a 0 0 s '+Q �ccad� $ o rd+ IIF � d f(�i� e+�iv ��(�+r i -0 3' { � e o Z 1 oo NE I A < _____________________ of dg1a �++ +- -------- --------' n P 6 i a 1 C " + A .D E p £ p Q J r 0 , s i �•_5„ F F �•_5„ 9 4'-O" t-opyrl0t02011 by EKSAd.lign.-gn..: q DRAWN BY: A These pla a we protectFederal PrQJeCt # 1..17 PROJECT: Addikion anal�enovakions for:mA y ews.The originer of thisTHt planto authorized to cons andoniyProfessional Bulldin Desl er Z one home uaing this platlon or g gn e, euse prohlb[ted . riitenJONN anJSUE TAN�EX ipermission of Lhe . O m "Q KSA design . Anydlerrepencles,error9 and/or omissions A a m LOCATION: In the notes.dl....lona.and/ar PROFE55IONAL BUILDING DESIGN drawings contalned on these dowments REVISIONS: shall be brought tot"attention of O - Pr.Ilmin.ry Pl..r pl.n. l0/19/I I COMMERCIAL•RE5IDENTIAL 2l0% Gh�rGh�kreek the ooeaigner prior to the comma ement F peal HHG p.vtaw I 1/9/1 I Cape God•Massachusetts const construction.Proceeding WIt" ruction constitutes the acceptance Gan.l'rud+tan P'11— I I/1 9/1 f Guanaea5te•Costa Rice of these err rsseand and any capecod.ksadesign...* "."design.cam Vti/es-I't�arnskable 1"(�. di bewame the responelblllty of theons P.O.BOX I 1 49•Nyannls,MA o7 a01•50..190.593] bullGing LOntrae Ldr.