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Home My WebLink About0032 HIGHPOINT ROAD - Health 32 Highpoint Road, Marston Mills — A=028-039 6� �9--t>c3�' �f No. � '�� Fee`�v THE COMMONWEALTH OF MASSACHUSE S Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpprication for Otgonl *p5tem Con.5truction Perron Application for a Permit to Construct(/Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. YD� Assessor's Map/Parcel Installer's Name,Address,and Tel.No. / Designer's Name,Address and Tel.No. Type of Building: Dwelling, No.of Bedrooms Lot Size sq.ft. Garbage Grinder(40 Other Type of Building I t°AK-e No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow A01 gallons per day. Calculated daily flow `3� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. 00 le Description of Soil Nature of Repairs or Alterations( nswer x�rrhen applicable) 7Mk;/ Gl�oi��rzs w r'i u�^ e �' ✓ � 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 d Health. / Signed Date Application Approved b Date Z±44 Application Disapproved for the following reasons Permit No. Date Issued No. 9 Fee— ./ M`*HE COMMONWEALTH OF MASSACHUSE TS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppfication for 324.5pogal *pgtem Conotruction Permit Application for a Permit to Construct(Repair( j Upgrade( )Abandon( ) El Complete System . ❑Individual Components Location Address or Lot No. 4�Ni`�� Owner's Name,Address and Tel-No. 3Z Hy/' le Assessor's Map/Parcel _0A01 3 10 5- A V/,L ` i Installer's Name,Address,`and Tel.No. Designer's Name,Address and Tel.No. 13o�1�DGo�i C®�57T7 7l Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder(/ti�/.,� Other Type of Building ��L? No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 3`3a gallons. Plan Date Number of,sheets Revision Date Title Size of Septic Tank /S dGf Type of S.A.S. 2,-1,- �Z j. Description of Soil Nature of Repairs or Alterations(Answer when ap licable) I le7_ - S;4� %o 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 dperation until a Certifi- cate of Compliance has been issued b th' Board of Health. Signed elDate Application Approved b � Date Application Disapproved for the following reasons Permit No. /' Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS � 1 \ BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that On-site Sewage Disposal System Constructed( )Repaired ( ✓)Upgraded( ) Abandoned( )by at i / 7`O/1S 146 115. has been constructed in accordance with the provision of Title 5 and the for Disposal System Construction Permit N d-1 dated 4"" Installer 1D11�dLo1. ir��Ti"��''%`!�h' Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date 1 1 014 ! Inspector —`� ---------------------0 No ✓ 1 Fee w 9� i THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS wiOpo5al *pgtem Construction Permit Permission is hereby granted to Construct( )Re_p�' ( /Upgrade( )Abandon( ) System located at �7 %��i /J%z3) �', /�l�'y�`r?hs 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 com leted within three years of the date of this Q it. Date: � � Approveqjby__" C y, - Eft 4--e,4 Vie)^j i t 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, p�o��!'r t, �!�� ,hereby certify that the application for disposal works construction permit signed by me dated C6I7�� , concerning the property located at 3� /7��G j� PG�� /vl�/S��Jr % S meets all of the following criteria: �/ There are no wetlands within 300 feet of the proposed septic system r There are no private wells within 150 feet of the proposed septic stem P P P P Y The observed groundwater table is 14 feet or greater below the bottom of the leaching facility Y There is no increase in flow and/or change in use proposed There are no variances requested or needed. M SIGNED : - DATE: �ll h 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]. q:health folder:cert / TOWN OF BARNSTABLE G, G . LOCATION ?y' Z- �1�1�0%��1� SEWAGE # ! Z VILLAGE �a/�5��—S �/� �? ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. �A��LoII C®)Sl/fllG�`�B� 1�`�J7�� SEPTIC TANK CAPACITY LEACHING FACILITY: (type)Z"Le Y G�� /�S (size) /3 2.7 S�2 NO.OF BEDROOMS 1 BUILDER ORCWN�F�$ PERMTTDATE:1-17- 7 COMPLIANCE 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 All* Feet within 300 feet of leaching facility) Furnished by Li O O Q d3-87 by 3 -� TOWN OF BARNSTABLE LOCATION 57-- �1�1�d/��r� SEWAGE# VILLAGE Wa 51--Mf AIIAS ASSESSOR'S MAP & LOT:01Y--03,P INSTALLER'S NAME&PHONE NO. �/NCO// / CC�S�jfll��`%®/> �J�`�✓Z�� SEPTIC TANK CAPACITY LEACHING FACILITY: (type)Z -Leery C�Qs� �%fs (size) /3 (95-y`.t NO.OF BEDROOMS BUILDER OR� PERMITDATE:—1 —/Z j' COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility S 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 Ib-h9 -1 3h-h N 61 �B-eg P �