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Home My WebLink About0037 OLD FALMOUTH ROAD - Health _ 37 Old Falmouth Road, Marstons A= 100-005 Mills I TOWN OF BARNSTABLE ?;I OCATION 37 0J ,61 ,B vd SEWAGE # VILLAGE 4 � M . M ASSESSOR'S MAP& LOT/00 INSTALLER'S NAME&PHONE NO. -�1,77--03Y4 �OJC�Ii �t lJiaH/�OS .:SEPTIC TANK CAPACITY /3,0 0 LEACHING FACILITY: (type) 2_ S�Q4 (size) /?X 2 S` NO.OF BEDROOMS I BUILDER OR OWNER cIo{iv� k�_4Tirh PERMITDATE: 7--5 — 97 COMPLIANCE DATE: 7— /F- 97 .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 `1~urrushed by L1 li/%Lrc�/ 9 TOVY'N OF BARNSTABLE LOCATION 4J SEWAGE # VILLAGE 406M=m M . III ASSESSOR'S MAP & LOT 20-arcs' INSTALLER'S NAME&PHONE NO. e177--o3Y9 Jo5g v4 SEPTIC TANK CAPACITY /SO D LEACHING FACILITY: (type) 2—.S'Oo Cll�o-o-rh�FrS (size) /?X 2S- NO.OF BEDROOMS 11 BUILDER OR OWNER Jd i 11C k s T�5 h PERMTTDATE: 7-8 —I-7 COMPLIANCE DATE: 7— /F— f 7 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 fac' 'ty) Feet Furnished by Ofi� ��`�rolrtli !2� :� � _ l3cd� � � �?, �s c s � 6% �, No. 3 L4 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Zipplication for Oizpooal *p5tem Con.5trurtton Permit Application for a Permit to Construct(L-TRepair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.37 0/ #1jN 1r4 R Owner's Name,Address and Tel.No. 1G�— Assessor's Map/Parcel Installer's Name,Address,and Tel.No. 4191 Designer's Name,Address and Tel.No. 1103epli 0-e13 s 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 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) '/� �x1�s1'��cr Gi_ iadt7� W,r Cal 1Qh / ! Ot3 ` tzs,, `S n 1 r a/: " 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 issu!9 by this Board o Health. Signed "e / Date 7 Application Approved by Date !::z —06-01 7 Application Disapproved for the fo owing reasons Permit No. Date Issued 4..I 00 No. 3 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 01pprication for ;Di2;poga1 *pgtem Congtruction Permit Application for a Permit to Construct(Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components w Location Address or Lot No. �`/ 0/ r4fiftYlr4 RW Owner's Name,Address and Tel.No!" S6.2— .1036 P".406ra%5 W/y/s Johot kl:-Jr6l Assessor's Map/Parcel r0-®os 0/J emlwoar4 Installer's Name,Address,and Tel.No. y7��a��19 Designer's Name,Address and Tel.No. ,/ost_-vl,, 91 G°ovw03 Type of Building: $" Dwelling No.of Bedrooms 2 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank / Type of S.A.S. Description of Soil Nature Qf Repairs or Alterations(Answer when applicable) i// I rswCz C/F_w J,00 "Sr,W// /SOO 6,#/Ar,1 Sad G.�/ GF.f:�r�,�. pH7b�i'S cc�i>Li y `S'/ar•�r #romnd 2,11 Pk'jw .S tyw er Date last inspected: J Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issweo by this J3 oard ofjHeal h. Signed `��+ Date 7—g4 7 rApplication Approved by Date Application Disapproved for the fo owing reasons Permit No. 3 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS ,e Certificate of Compliance THIS IS\TO CERTIFY, that the On-site Sewage Disposal System Constructed(.Repaired ( )Upgraded( ) Abandoned( )by ✓sAA yr, at has been constructed in accordance �,r !;with%the provisions of Title 5 and the for Disposal System Construction Permit No. 9y dated 1Installer y1t9l e104 ' 0,4 Designer 3a4V-.e, 1 e issuance of this permit shall not be construed as a guarantee that the system will function as designed. ` Date ~ /i '% f y ^� Inspector " {' f � ----�---------------------------- No: .Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migpogal &p$tem Congtruction Permit Permission is hereby granted to Construct( 40IRe p.air )Upgrade( )%'bandon( ) , System located at 37 D��l M��avr'�i /��/ t??,* H 5 �/��5 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: —7 - — 2 7 Approved by _J NOTICE, This forttt is to be used for the repair of failed septic systems Daly CERTIFICATION 01 SkETCH AND APPLICATION 1FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT IASIGNU PLANS) I, ,, z.,4 a, as"- , heteby rrertify that the application fot disposal works construction permit signed by the dated T f:.f., ; coticething the propetty located at ,�i /91,714 Aly,/�ozldv. theeN ell of the following criteria: i The " are Ho*ei dvaids VYlthif't A00 fm of the ot6odiod§60116 system �tved` no t►vate+dell§*lthlit I80 feet tithe ro osed§t tle s stein p p p p Y roundwatef table lg l4 feet tir rt;iltt'f beio�v the bottom of the leactiin factli g g ty 1. Ther 'o increase itt How attd%ot change ht it§@ prapd§ed There are no'variances recitiem6d of heeded. SIGNED; _ DATt; _1 LIC9NSED SEPTIC SYSTEM INSTALLER IN Tht tOWN OF BARNSTABLP,NUMBER [Attach a"sketch plat!of the ptoposed gystetii:Aho if the Ilcensed ltistallet pom§§es a certified plot plait, this plan should be subtititted]: q:health folder:cert LESS /foa Gp/ sj 4 I