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HomeMy WebLinkAbout0047 WILLOW STREET - Health H Willow47 • • 1 Barnstable �— 0 TOWN OF BARNSTABLE I G;—ATION 4l 7 ///© c�T� SEWAGE VILLAGE (4> > 1�GY/ �e- /�ASS��ESSSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) y -Z/��`"/!f/l9�'f�/'✓� (size) NO.OF BEDROOMS BUILDER O O PERMTTDATE: 0 i — 14^I -9 r COMPLIANCE DATE: Separation Distance Between the: _ Maximum Adjusted Groundwater Table and Bottom of Leaching Facility s f Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) 160 t Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) 4111, Feet Furnished by fear 33 b ,o b �3 a o yy b 0 .51 No. Fee _570 TME COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE. MASSACHUSETTS Zipprication for Di5p0ar 6VOtem Construction Permit Application for a Permit to Construct( )Repair( 4Upgrade(/)Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. �fa /, Andy A'vkler's Owner's Name,Address and Tel.No. I Assessor's Map/Parcel IV i Adm',xa/j ✓ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ldllfr��AI - 9 Type of Building: � �l� Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(4 Other Type of Building Z5) e�Ge- No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow Jf D gallons per day. Calculated daily flow Ave gallons. Plan Date Number of sheets Revision Date Title i Size of Septic Tank 1 *e 00. Type of S.A.S. -Zh %/����� ! d Z Description of Soil Nature of Repairs or Alterations(Answer when applicable) Q/���T� — �� Qe/� ),fief /I`AI X 33 `�XZ 'D 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 - l Signed Date 140��`�`�� Application Approved by Date Tie' Application Disapproved for the following reasons Permit No. - Date Issued — +1. \. pia h so No. O Fee T�E�GNMONWEALTH OF MASSACHUSETTS,;,!.'-1',+ Entered in computer: Yvs PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSA`CHUSETTS Zipprication for-Di.5po.5ar *p!5tem Construction Permit Application for a Permit to Construct( )Repair( Upgrade(�)Abandon( -;) ❑Complete System ❑Individual Components Location Address or Lot No. 7 7 i//4 hl S T Owner's Name,Address and Tel.No. (( A)7.41y,-,f�od�i�i'S r Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Naine,`Addre and Tel.No. If Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. .' _ Garbage Grinder GZO �p Other Type of Building 6:6. lfe e- No. of Person , s. Ll ,Showers( , ) Cafeteria( ) Other Fixtures +� Design Flow///l gallons per day. Calculated daily flow 3,6 gallons. Plan Date Number of sheets Revision Date " Title Size of Septic Tank /,S`l>09a� 1;ofle Type of S.A.S. V.-re 1111/4 D S ',yZ1 Description of Soil Nature of Repairs or Alterations(Answer when applicable) oil/// /�-,egu'awe/ T,� '; l 4L2 t4G ;A 9 J `A� ,r 33 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 • t ' a d o alth..___. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded(� Abandoned( )by at !V:Z 444/&4Z 9 �` "G✓. &//l.S7'M41,/ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.9(-(p(L�dated Installer 4D6, ; /�4� c�`idh Designer. The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector s ——————————————————————————————————————— No. le - D .1 Fee SQL THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS r Mi5po$al *pWm (Con$truction Permit Permission is hereby granted to Construct( )Repair( )Upgrade(Abandon( ) System located at !y U4 l�k1 46 r ol. &A—ZeA5 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. t Date: Approved by �\ \ i 5.i J III CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL 1VORKS CONSTRUCTION i E1011-I'(1VI THOUI' DESIGNED PLANS) 1, j jo,,fr�,�Dr 1141 , hereby certify that the application for disposal works construction permit signed by me dated 1f/5'191 , concerning the property located at I1 A/i//D,v g,` �, V /e meets all of the following criteria: /71ncre arc no -,vctlands within ?no fcci of!hc proposed seplic system Y ncrc arc no P riIviie wcils within i 0 feet f the proposed seatic system Xlic nbse-vcd arenndn•nicr 'nbie �s i A fcc- areatcr beioly the bottom of the Ienchin¢ facility / � l y "ic-e is no inr.case in 'lo%v .ana/cr:ian¢e'n 'lse proposed �;;icre are no•:arianccs rcaneve+or needed. SIGNED : o DATE: LICENSED SEPTIC SYSTEM INSTALLER IN 174E 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]. v` V I DSO y� 1 / 0 V,, AJ KV7 11 AEef dam' ASSESSORS MAP N0: PARCEL NO: f ------------ --- Fee--.--------- --- -...- BOARD OF HEALTH TOWN OF BARNSTABLE ApplicationArVe[C Congtruction Permit Application is hereby made for a permit to Construct (Y ), Alter ( ), or Repair ( )an individual Well at: --4--1------- i+ C3 L?-- ''= —t Z' = -c1 c_tlti e6.�I - - -- ----------------------- - --- --------------------- Location — Address Assessors Map and Parcel r _____—Caz_.--i---t_�__-__«p_--__�----------- Owner Address F ------------------------------ =i - K-+ t 5 Installer — Driller Address Type of Building _ Dwelling-------'a c-&--(/------------------------------------ Other - Type of Building---------------------------------- No. of t� �-+cr Persons--------------------------------------------------------- Typeof Well -----------------------G------------------- Ca acitY------------------------------------------------------------- Purpose of Well----- -�-----� " Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Cert' i ate .of C lian as been issued by the Board of Health. Signed date Application Approved By -- --- ---- - ---- --- -— -- ---- - - da to Application Disapproved for the following reasons:----------------------------------------------------------—----------------------------- - ------------------------------------------------------------------------------------------------------------------------------ date Permit No. -� � ---------- -(�-f----------------- Issued---- ---------�_`�_�-_z----''.------ ---------------------- date BOARD OF HEALTH TOWN OF BARNSTABLE 1ertificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (,Altered ( ), or Repaired ( ) by ---------------------------------------------------------------------------------------------------------------------------------- Installer at- -- _`�-- �CLula----- n---z t 0'b e------- --------------------------------- has been installed in accordance with the provisions of the Town of Barnstable/Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--------- ---—--- -- ----— -- Inspector------------------------------------------------------------------------- Fee- -------------- '- BOARD OF HEALTH TOWN OF BARNSTABLE ���[icatio�t,�'or�e�[-�ongtruction_�ermit - }- " Application is hereby made'for a permit to Construct ( ), Alter (" j;''or Repair'( --)an•individual Well-at: ----------- - - -;- - - --- -- ------------ -- - - --- - - — -- - -- Location — Address � Assessors Map and Parcel C� . 'F ( k' t� Zn:i cep_`_ Address (` Ems- ..> �n,.,.1`t=. l �.t�a�' tj ._.�_ w:?_ty '_�_�_: I '� �"Z l_.7 c� fL'. \t"_--------------- Installer — Driller y, � �" Address - Type of Building Dwelling------- =' `-' =_ �=== ------------------ Other - Type ofBuildin ----------------- No. of Persons---------------------------------------------------- Type of Well— 'Capacity,'-- - _ - - - -- - ---- - Purpose of Well Agreement: The undersigned agrees. to install the"aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation untillrtificate .of C mpliance:rthas been issued by the Board of Health. Signed-- —, ° �; �L ' �" ----------- 7-- .. date Application Approved By ------ --- ---- —-- -— --- ------------------- date Application Disapproved for the following reasons - -- -- --- -- — ------—---- — date — — — ---- ---------— — — —-- — — — — -- — — —— — -- ----------- Issued -- - -- ------�—"------- ---------------------- Permit No. --� -------------;--------------- � -------- --- date BOARD OF HEALTH TOWN OF BARNSTABLE ertifirate Of.Compliance THIS IS TO CERTIFY, That the Individual Well'Constructed X-, Altered ( ), or Repaired(' ) by - ------ 1a N - -: �°r .liistaller r �� ------ -- ----------- - _ - _ _ -- - -------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection - -- Regulation as described in the application for Well Construction Permit Nc#'1%����^---Z�-- /ated------------------------ THE ISSUANCE OF TH-I:S CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. -, DATE --- --- =— —-- 'a -- - Inspector— - -- ------ - ---------------------------------------------- .:. �,,,,,,,;,sw,� � -- _ . _ '.� _ s�: ::w�r. :�ws�3+suw-wts•, ;, "'.» BOARD OF "HEALTH TOWN OF BARNSTABLE 4 e[t-Construct ion J)ermit No. Fee Permission•is,.hereby granted -------' = 1_!1 C- c -ff�'C c��2 ( ------ ------------ `-` to Constr'ucY( an'IndididuahWell at No: - y - = {' -------- ------- Street as shown on a plication for a Well Construction Permit No. - �' ` =•!- — �f ----------------- Dated `�'� `-" -�{7 1---- ------- ----- t. s Board of Health DATE---- -- — - I E