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Home My WebLink About0320 BRAGG'S LANE - Health 320 Braggs Lane, ' 2,ww off' r .,sa R a ,z M a , ' Sr._ , 4 . , E x i L a + ` t t rt r TOWN OF BARNSTABLE c LOCATION SEWAGE # :��,4.33 VILLAGE ASSESSOR'S MAP &LOT 299'/o$ INSTALLER'S NAME&PHONE NO. V1 Jo.�s°�i�di �7t stoHryS SEPTIC TANK CAPACITY /DOD LEACHING FACILITY: (type) NO.OF BEDROOMS S BUILDER OR OWNER PERMITDATE: 7, )7—i9 COMPLIANCE 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 fe t of leachi g,faacii'ty) Feet 2,0 Furnished by .!�-� 10*ZA.-y s x �1S •� No. ! / 3 3 Fee - � THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS I� 0[ppliLo.tion for IDiopoeat 6pe;tem Construction 3dermit Application for a Permit to Construct(v epair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. f,<j1� �L S' G`l�I9� Owner's Name,Adddress d Tel.No. Assessor's Map/Parcel S��'�� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 494- 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 11 Type of S.A.S. Description of Soil .]'/�rl�� Nature of Repairs orAltyrations(Answer when applicable) G�rA ` ,�`r®vl c s�Irrr�ply� 2 •• �Fa'.P1 �'Tv�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 E �. Date �-• ?7 s>� Application Approved by Date , Application Disapproved for the f owing easons Ili i Permit No. Date Issued No. / /` q 3 3 . � Fee s THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1/1 Yes .PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for Mi5pont 6pgtem Construction Pefm— it Application for a Permit to Construct(41Mepair( )Upgrade( )Abandon( ) El Complete System E Individual Components Location Address or Lot No. Y v 461".y S° G1rae. Owner's Name,Address d Tel.No. G' �lc�i�t� rl-e!r Assessor's Map/Parcel Z cel tea 161 Installer's Name, Address,and Tel.No.ey ry✓J•D Designer's Name,Address and Tel.No. ✓OS�'�i U->~1:�i4H.-'ps - ✓ds s;/v' h �� l�v'r^d'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) Dd ssl Z)eee W bk—,^ lu0T/J -5/ STOrIc Xea?d" '� f7LkJit.STyr1� 1 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 :7 .17- 9-9 Application Approved by 0104, ` Date �!k, 2-?- Application Disapproved for the f owing easons IQ Permit No. 3 Date Issued ------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( 4.4-Repaired( )Upgraded( ) Abandoned( )by Jos L2� S at 3 20 4"W'o-e- SAg4u.X04 has been constructed in accordance with the provisions of Tith- Sand the for Disposal System Construction Permit No. dated Installer, rrst.d�i �L .tri+�+� S Designer ✓os_T•f ��. The issuanc f this permit shall not be onstrued as a guarantee that the s will function as d }gned Date `^� _ Q Inspecto� ,-r.. �/�ta' --------------------------------------- el # /0 No. ^ � � �� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS- Miqu aY Opgtem Con5truction Permit Permission is hereby granted to Construct(&-) pair( )Upgrade( )Abandon 1: ) System located at .72 O _ r.a va S ZA A7 �e_ 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 - D 7_?p Approved by�r 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at 320 "'V .S' �d�r1 /�r�yT-��- 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. 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 � There are no private wells within 150 feet of the proposed septic system There is no increase in flow and/or change in use proposed tv There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than five feet above the ma.�dmum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor i method when applicable] • If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility 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) 2s B) G.W. Elevation JW the MAX. High G.W. Adjustment DIFFERENCE BETWEEN A and B SIGNED DATE: 7— [Sketch proposed plan of system on back]. q:health folder:cert 6AW S'T s i L/ syo . 6AOLl, Pry Gr//i/14 �. e o TOWN OF BARNSTABLE LOCATION 320 gza a,7 Lam., f SEWAGE # VILLAGE ASSESSOR'S MAP & LOT 29g-/0 E INSTALLER'S NAME&PHONE NO. y7 0 'J n SEPTIC TANK CAPACITY 10yre LEACHING FACILITY: (type) 5'-POLIPA/, ,&v �/��5 (size) NO.OF BEDROOMS S BUILDER OR OWNER PERMTTDATE: COMPLIANCE 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 feet of leachi g ffaacii4ty).. Feet Furnished by G`G i i y3 .7 I i O.lJ7 co ns 1 2.2, .RESERVE /5+3 6 30, 1 7 LEACHTEST POLE a 8 -l8_ �7 LOT Fvvc Mur P.AJ7 <<� d2 LniJu M[if+'�N£ In-F 0 'e4" LOAM NII] SoUVD