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Home My WebLink About0092 MOUNTWOOD ROAD - Health 92MOUNTWOOD •• { MARSTON MILLS ="125 of TOWN OF BARNSTABLE ✓ LOCATION � SEWAGE #- Vpl'-qel VILLAGE ASSESSOR'S MAP & LOT,&-®iX INSTALLER'S NAME&PHONE NO. VY-7- 01<1 9 �x�� ! •, �' SEPTIC TANK CAPACITY ROO LEACHING FACILITY: (type) NO.OF BEDROOMS BUILDER OR OWNER o0.`�`n�- C �� PW-1 PERMTTDATE: 5P7 COMPLIANa 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 fegg,t of leaching fac' 'ty) Feet Furnished by 1�� 'r v a I No. / f rlL1 Fee .�� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: YeV PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 0[pprication for Migozar *p!tem Comaruction Permit Application for a Permit to Construct(4-�'itepair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 9Q Iwcan Zveaal Owner's Name,Address and Tel.No. yy�j��S7'o�9S i21�'/�s' JO�N`'/-� .S�C7cIN'/✓' Assessor's Map/Parcel Installer's Name,Address,and Tel.No.y7/— 03 y Designer's,Name, Address and Tel.No. Ve- L3�9Hl�D f �QS�`�c/ C/G .iJi Jed 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 A Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answe when applicable). re-57"/oll Z- 5_00 6AO/ 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 aard of Health. Signed / ai2 Date 99 Application Approved by 444Date Application Disapproved for the llowin reasons Permit No. 9J`— ��j Date Issued No. 9'?-L- Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,� MASSACHUSETTS .� �V/ 0[ppricatiott for Migpo9;a1 *pgtem Congtruction ofirmit Application for a Permit to Construct(4�'Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components r Location Address or Lot No.9Q Hlad waa /2,,o Owner's Name,Address and Tel.No. Assessor'sMap/Pazcel 6.y�pyrgPOHS iffi��S Jp14sle-G .SjCJdl�'v' 125 1/9 rs G?/9 Installer's Name,Address,and Tel.No.4/'97- a 9 Designer's Name,Address and Tel.No. ,105,e,04 LG (.�s+roS ✓4S�i�i �c /�,Cvr,�djf"' oti A� f Type of Building: �r 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 s Type of S.A.S. Description of Soil �,assrA ,t Nature Jof Repairs or Alterations(Answe when applicable) ZHt2Zio0` L!/iY61 >d[9G lQl�D�it.>� 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,4 of Health. Signed aivta2r Date a-?- 491 Application Approved by 441 Date -- T_ Application Disapproved for the ollowi reasons -� Permit No. Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance G '"� THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed(4_�rRepaired( )Upgraded( ) Abandoned( )by ✓sfSA4 A25 at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 7% Y 4,/ dated Installer,1a%,4,!a4 RarrdS Designer .e a The issuance f this ermit s 1) be construed as a guarantee that the s w 11 function as designed. Inspect .�'Z� e No: /2s' 0/9 Fee _ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migpogaf *pgtem Congtruction Vermit Permission is hereby granted to Construct(4,. Repair( )Upgrade( )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 of this permit. Date: - c/ Approved by _ 116/99 NOTICE; 'This Form Is To Be Used For the Repair Of Failed _;Septic Systems Only. - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS COl`?'STRLCTTON PERMIT(WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction petinit signed by me dated 9— 1.-- Qy concerning the property locatei:l at 7 2 d3�my�f�i�dc.� ,r � ,G�j,,�yj%�� meets all of the following criteria: The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. E•'--The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. -! here are no wetlands within 100 feet of the proposed septic system �r There are no piivate wells within 150 feet of the proposed septic system ere is no increase in flow and/or change in use proposed There are no variances requested or needed • The bottom of the proposed leaching facility will pS t be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable} • If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching faciliry 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) L 8. B) G.W, Elevation 1/0 +the MAX.Nigh G.W. Adjustment. _ DUTEREI,iCE BETWEEN A and B SIGNED DATE;: / :zi® -,tr.�. �.�! .r��. !��„— S [Sketch proposed plan of system on back]. q:health folder.cent • oAGII �JyttSlX� 111du!/TCvvo� 44 TOWN OF BARNSTABLE LOCATION VMLAGE SEWAGE # ASSESSOR'S INSTALLER'S N MAP LOT . AME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) NO. OF BEDROOMS_ BUILDER OR OWNER PERMITDATE: _ - e'''q MPL CO LANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility Feet on site or within 200 feet of leaching facility (�any wells exist Edge of Wetland and Leaching Facility(If any Feet within 300 feet of teaching face tyy Wetlands exist Furnished by ,n._X � s 3 i ;. TOWN OF BARNSTABLE �' A.�V e, -fAG UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS ASSESSORS MAP NO. Az PARCEL NO. ADDRESS; VILLAGE,' \ RK-_SJMS M \S NAME'.__ _- - �- Q_91& - _ CONTACT PERSON PHONE NUMBER -1 LOCATION OF TANKS.:. CAPACITY: ..TYPE- OF- FUEL AGE: TYPE: LEAK \ OR CHEMICAL: DETECTION oo F Z �'�\ ®lL \0\12- SYSTEM! OF PURCHASE OF EACH: 1. 2. 3. 4. 5. _ -DATE OF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS `PLEASE PROVIDE A SKETCH SHOWING THE LOCATION OF TANKS ON THE BACK OF THIS CARD. sc oDale� lv yt � 63 CENTERVILLE - OSTE +LLE FIRE DEPARTMENT ? t PERMIT FOR. ST i GE OF FUEL OIL In accordance with .,. provisiotls of Chapter 148, G.L:, and Regulations Y made under authority thereof. Name ..;TQ.s 4'..C.�...SI? .............. Name ...JAMOO.. (owner or occupant) s t (Installer) Address .92..�4Ui#.W.9Q Rd.•. M Addressg.! ..MA.:.. Burner �'' Storage Make .. BR..�HY.44tk�4m Type of,Tank Q� .....:iaund........ Manufacturer HydTOtheTm;�. InC, Ca aci 0„p ty.1 QQ.. gals. (or) Size............ Model No. or Size SQT.-1.4JQ..3HL..SRocation -xilidp.Z:grpurid ............. Type.....�'IM......... a�s(s. Approval No. ....1.4.?...... ' Permit issued .....! 7. 7 ......., ` .Jphn..M.• . axa' gt.p ................ ( ead of Pi ent •w /////'//_/� a .............................................................. By .. ..... (THIS PERMIT MUST BE CONSPICUOUSLY POSTED UPO E PREMISES) ,. JUL 05 '91 15:25 CENT.OST.FI . DEPT. - * wF'.2:•2 ,FORM F.P. 292 -r, (rev. 9/90) Department of Public Safety Division of Fire Prevention and Regulation AM=TM FOR PERMIT, AND PERMIT, FOR REMOVAL AND TRANSPORTATION TO APPROVED TANK YARD FDID# c.:) i5 Qc. Permit #_ -- Date 1Q 1911 TV i�z 5-I s-$-". t l S I Cny,Town or CHatriot s _.�1 C . 82 S . 4 6 H . C . L . N 7- DIG SAFE NUMBER Fee Paid:S l e •6c (:� I a 7 S3&,3 start date 1. 1 in accordance with the provisions of Chapter 148, Sec. 38A, M.G.L. , 527 CMR 9.00 application is hereby made by: 1LA,, a- - Street Address & City ax To n: 1 v ,� �� cct ? z. z Signature of applicant: Applicants name printed: o For permission to remove and transport one underground storage tank from. Owner: S,,a,z tZ Street Address: 'Jt Firm transporting waste: State Lic. Hazardous waste manifest # E.P.A. # Approved tank yard: Y. # (c G c� c �- Tank yard Address i_... Type of inert gast. _ - �� r- c.�� UL tank #: Tank capacity: Substance last stored: - Date of issue: �� Date of a pi on: '. I( Signature/Title of Officer granting permit.~ 6 -�477 01",9 KEEP ORIGINAL AS APPLICATION AND ISSUE DUPLICATE AS PERMIT �®F/10 r, L-0>CATION SEWAGE ',lPdERMIT NO. PILLAGE I N S T A LLER'S NAME & ADDRESS Ye A4 t3 j� 14 L- It lit P1 C e- r) 4 S ?" I/ 0, B U I'L D E R OR OWk ER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �_ ? ,,,.- :, �. ,� �� 1