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Home My WebLink About0081 COUNTRY CLUB DRIVE - Health 81 Country Club Drive,Barnstable o M r r �h No. � �� ..a Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Migozar Opgtem Congtruction Vertnit Application for a Permit to Construct( )Repair( )Upgrade(/Abandon( ) e Complete System ❑Individual Components Location Address or Lot No. D / CowN/-//C lv,� O,.„ Owner's Name,Addr;ss and Tel.No. Assessor's Map/Parcel • CG 4(loxfam1Q9 Installer's Name,Address,and Tel.No. �f Designer's Name,Address and Tel.No. 7l Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder(14V Other Type of Building keu !! ^o.of Persons Showers( ) Cafeteria( ) Other Fixtures >>�� Design Flow gallons per day. Calculated daily flow `T`�® gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank f c�D'O Type of S.A.S. 6_Ra1O1W ,7_e-5 Description of Soil /0X4O Nature of Repairs or Alterations(Answer when applicable) 7 rle V—r 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 is d o ealth. Signed Date Application Approved by Date Application Disapproved for the WllowiVg reasons Permit No. 57, 7 — G6- Date Issued `�— Cr7No. to 7 , .1. as 1 / Fee r' v/ THE COMMONWEALTH OF MASSACHUSETTS Enteredin'bomputer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 21pprication for nigw6al *p5tem Construction Permit f Application for a Permit to Construct( )Repair( )Upgrade(Abandon( ) U Complete System El Individual Components Location Address or Lot No. �/ G�u�r=��C/�6 �,� Owner's Name,Address and Tel.No. 0-"*Ifty Assessor's Map/Parcel G Installer's Nam ,Address,and Tel.No. Designer's Name,Address and Tel.No. 7 7l-q 9 Type of Building: u Dwelling No.of Bedrooms ( Lot Size sq. ft. Garbage Grinder(_1610 Other Type of Building PS% g'NC^o. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow /Aa gallons per day. Calculated daily flow �O gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /S��O Type of S.A.S. ��Q�I�J/LG°'✓�.J Description of Soil /6)X 4W /x / Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: / f d22 j ~ 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 t is o ealth. Signed 9 Date I/1,�p/97 Application Approved by Date Application Disapproved for the o lowing reasons -7 r Permit No. / Date Issued —————————————— ———— ———————— ———— —— -t —— THE COMMONWEALTH OF MASSACHUSETTS 36-0 OL--IZ BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE TIFY, that the On-site Sewage Disposal System Constructed( ) Repaired ( )Upgraded Abandoned )by h1v`1?'//� eao,S ` at 60G/0,, G W I- 0ri C/ar41V4 'ui✓ has been constructed in accordance with the provisions of Ti le 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the.syste it functban a vde gned� �C Date Inspector t / --Q----�y--------------------------/-------- No. ! 7- lid ! 5�'D'7 Fee 667 THE COMMONWEALTH OF MASSACHUSETTS ' PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS k � 1=i!5po!9a16potem Construction Permit Permission is hereby granted to Construct( )Re r( )Up rade(Abandon( ) System located at CO(I�I tr y L��W b •fir'. C t,/M-love r 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: f/ - Approved by 10/9/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. I TON FOR A CERTIFICATION. OF' SK ETCH AND APPL ICATION DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) hereby certify that the application for disposal works I , db m e dated /1�le e7 ,-concerning the construction permit signed y Pro , ert located at '! W;10111"r- G`/4101 '4r meets all of the property following criteria: V There are no wetlands located within 100 feet of the proposed leaching facility W There are no private wells within 150 feet of the proposed septic system 1,/There is no increase in flow and/or change in use proposed ' ere are no variances requested.or needed. If the proposed leaching facility will be located within 250 feet of any 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 Elevation(according to the Engineering Division G.I•.S.map) B)Observed Groundwater Table Elevation(according to Health Division well map) DATE: /1�9� _ SIGNED : LICENSED.SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a ceitified plot plan, this plan should be submitted]. q:health folder:cert _- Lf X ' • � � �� pal � � � �, Ge6��y PlI oaf Mee--5 fi pq- to b� 4 'n oa y5 ' _, :{ ,.. � of r. r r_ v -1 a � - �... .. •- t OW I Otry c lyd Dr, r TOWN OF BARNST:4BLE ;�(i LOCATION l �� SEWAGE # —� VII;TAGE G e1 �1 .G+T!! ASSESSOR'S MAP &LOT 3S� lZ INSTALLER'S NAME&PHONE NO. SEpM:.TANK CAPACITY /Sd U C•z:L — LfiAHING FACILITY: (type) ,1-�- C fwtl -t �S`� (size) NO .&'9EDROOMS BU$I;D.ER O O PERIVirTDATE: I�''�l'1 Z COMPLIANCE DATE: Se �ariition Distance Between the: P. am Adj usted Gr oundwater Table and Bottom of Leaching Facility �r Feet M aia� 1 I Private Water Supply Well and Leaching Facility (If any wells exist Feet <vn:site or within 200 feet of leaching facility) E4`:..'Wetland and Leaching Facility(If any wetlands exist Feet ;.`within 300 feet of leaching facility) Furnished by �1b . .: ,b lei TOWN OF BARNSTABLE o LOCATION 47 62Vf�6 V Cl 6� ael", SEWAGE # 97 VILLAGE C t � ,aym - . ASSESSOR'S MAP&LOT 3.%7"z:5'ere INSTALLER'S NAME&PHONE NO. f �.�` SEPTIC TANK CAPACITY /3'do ca- LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER ORCOP 0; QWV PERMPTDATE: COMPLIANCE DATE: r. Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility s¢ 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) WIP Feet Furnished by .Ail y qo .r Y Y