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Home My WebLink About0040 CAPE COD LANE - Health 40 CAPE COD LANE BARN TABLE - 002 A 298 y r r n , .. s o c , 't , ,1 r y •ice F w •. •- - , TOWN OF BARNSTABL'-E 5/ o L:0CATION `I® G t�V ��e/ �` 'b SEWAGE # 66 Z VILLAGE '3 2/%' ► J ASSESSOR'S MAP& LOT INATALLER'S NAME&PHONE NO. 6 1 -7 SEPTIC TANK CAPACITY LEACHING FACILITY: (type (size) NO.OF BEDROOMS '7 BUILDER OR OWNER C Q �6 + PERMITDATE: rL`16-y"U - -COMPLIANCE DATE: s, Separation Distance Between the: Maximum Adjusted Groundwater Table to e Bottom of Leaching Facility Feet Private Water Supply Well and Leac g Facility (If any wells exist on site or within 200 feet of leac ng facility). Feet Edge of Wetland and Leaching cility(If any wetlands exist within 300 feet of leaching acility) Feet Furnished by . . r r� a @i s •rvlr'� i•'�' w ate �\`��,,� 1 ��,. � way. -AA t ASSESSOR'S MAP NO. PARCEL C'�Cb2 LOCAL ON SEWAGE PERMIT NO. ,.ram � VILLAGE I N S T A LLER'S NAME i ADDRESS S U#IDER OR 0W�1ER v � P,C� -P sae Ce �iI j plan _ ' A r Y �d SAL w4nfelzlfelz�f � �- 00 No.� � � _ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION —TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYication for Mi5poot bpztem Com5tructton Vertnit 'Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components • ocation Address or Lot No. Owner's Name,Address and Tel.No. • V Cape Cod. Lane , Barnstable Bill Cobb Assessor's Map/Parcel Z2 O_ �v — 0 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm l;. Robinson Septic Service P 0 Box 1089, Centerville Type of Building: Dwelling No.of Bedrooms 3 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 S and. Nature of Repairs or Alterations(Answer when applicable) Title-5 septic system consisting of a tank, T)—hnx and 2 l e2_ch cb2-mber2 Wi tiq 2t8jqe @]-I 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 iss ed by t s B and of Health. Signed A. I� ' Date Application Approved by n 16fi A&' - Date J-1ef'—U'P-v Application Disapproved for the following reasons Permit No. Date Issued TOWN OF BARNSTA.BLE _. LOCATION `�'O "'J' 4 '6 SEWAGE # 6ri-6 L VILLAGE -C ASSESSOR'S MAP & LOT aw INSTALLER'S NAME&PHONE NO.�6 I �%�6 '� �Z 7 �'7'7 L SEPTIC TANK CAPACITY LEACHING FACILITY: (type) a- ;L C (size) J i NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: ''—J0v6-66 Separation Distance Between the: Maximum Adjusted Groundwater Table to e Bottom of Leaching Facility Feet Private Water Supply Well an/acitity) g Facility (If any wells exist on site or within 200 feet o facility) Feet Edge of Wetland and Leachin (If any wetlands exist within 300 feet of leaching Feet Furnished by IL F i e L l q ✓ _ w l No. c'"p�/ — � � � Fee �� ✓/// THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes t PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 01pprication for Migool bpgtem Congtruction Permit Application for a Permit to Construct( . )Repair(X )Upgrade( )Abandon( ) O Complete System 0 Individual Components 0 o Address Lo N Owe ' Name, dress and Tel.No. rt' ape �0� sane , Barnstable B�1�. Co,Vt Assessor's Map/Parcel 0 G O Z" r Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm E. Robinson Septic Service P 0 Box 1089, Centerville Type of Building: Dwelling No.of Bedrooms 3 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 Sand. a — Nature of Repairs or Alterations(Answer when applicable) f septic . system C OriS 1S t lrig of a tank, D-box and. 2 leach chambers with stone all around . `. Date last inspected: r' 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 iss ed b s a`d of Heal Signed 6 Date Application Approved by *: Date Application Disapproved for the following reasons , Permit No. ;k Date Issued ---- t —� ------------------------- THE COMMONWEALTH'&MASSACHUSETTS Cobb BARNSTABLE, MASSACHUSETTS ` Certificate of Compliance THIS IS m. , *obh BOrie eewp e Disp�gsea�,S 1Ce Constructed( )Repaired(�' )Upgraded( ) Abandoned( )by at 40 ,Cape Cod Lane, Barnstable has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.`Z.ytw Y dated Wm. E. Robinson Sr. Installer Designer , n,`L r The issuance of this permitsIf o be ns.° a as a guarantee that th -s',st m�will function as�designe rr Date Inspector -----.---,f— '--------- Z q7 0 0 Z yTHE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Cobb ligpogal bpgtem Congtruction Permit Permission is hereby ranted to Construct( )Repair(X )Upgrade( )Abandon( ) System located at 40 Cape Cod Lane, Barnstable 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 pst be completed within three years of the date of this Date: Approved by , I a' n c ? 1/6/" 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, W i l l iatn E. R ob ins on.S%ereby certify that the application for disposal works construction permit signed by me dated ��' , concerning the property located at 4.0 Cape Cod. Lane , Barnstable meets all of the following criteria: • The failed system is connected to a residential dwelling only. There are no commercial or business uses ated with the dwelling. • The soi is classified as CLASS I and the percolation rate is less than or equal to 3 minutes per inch. There ar no wetlands within 100 feet of the proposed septic system — There ar no private wells within 150 feet of the proposed septic system There is no increase in flow and/or change in use proposed • There a no variances requested or needed. • The ttom of the proposed leaching facility will tat be located less than five feet above the tna ' um adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor me od when applicable) • 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) B) G.W.Elevation +the MAX High G.W. adjustment DIFFERENCE BETWEEN A and B 7 3 SIGNED : xv L/r DATE: i (Sketch proposed plan of system on backl. y:heaM folder:cen �/ 'v �'` v V �� J_ .�� .� Z� f �� . L� 4y