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Home My WebLink About0082 COUNTRY CLUB DRIVE - Health tµ = 82 COUNTRY CLUB DR., BARNSTABLE q = f1 J a 0 : , T , a, 5.� 1 s ' .r , n ,x ,S W ° a F L . • : t! +i r • r : , ' is • k' R 4• ,t G r, H U ,1 , r r s v a,. w r ti� P ,r ' M1. TOWN OF BARNSTABLE LOCATION �� Cd �� 'YGICI�� SEWAGE # VILLAGE Oe42 4'0"/'P ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 64 (size) ��e�39"'>0,'2 NO.OF BEDROOMS p BUILDER O OWNE PERMTTDATE: ff 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 �� Feet within 300 feet of leaching facility) Furnished by �aray� � • O o )g 137- 3 ' i a TOWN OF/BARNSTABLE LOCATION �� Cd� YClll✓� •��• SEWAGE # 9�f,f1 VILLAGE �' >'�9 �L�lr D ASSESSOR'S MAP & LOT ✓S4 ozo INSTALLER'S NAME&PHONE NO. 6 ,rST SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 1L �� (size) NO.OF BEDROOMS BUILDER O OWNE PERMTTDATE: `� `�9 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility f 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 I ,/! within 300 feet of leaching facility) A Feet I Furnished byC7 i YAP '. �� t°Y ► i S L L° I s N L Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zippfication for Migogar *pgtem Con6truction Permit Application for a Permit to Construct( )Repair(' )Upgrade(✓)Abandon( ) ER/Complete System ❑Individual Components Location Address or Lot No.S Z covo,4eY la 6 4r, Owner's Name,Address and Tel.No. Assessor'sMap/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. el Type of Building: r� Dwelling No.of Bedrooms 9 Lot Size sq.ft. Garbage Grinder(� Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 11414 gallons per day. Calculated daily flow �53® 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) 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 b is Bo of Health. h Signed Date l Application Approved by Date 9'_17— 99 Application Disapproved for We foll&ng reasons Permit No. Date Issued — ------- — -- — -- - —————— r s73 No. Feet 5 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Y t ) r 01pprication for �Digpogal *pgtem Cbnttructiou Permit Application for a Permit to Construct( )Repair(' )Upgrade(✓)Abandon( ) R Complete System ❑Individual Components Location Address or Lot No. CD U0 f K/ L,la 46 4r- _j Owner's Name,Address and Tel.No. Assessor's Map/Parcel .47 °ww Installer's Name,Address,and Tel.NO. Designer's Name,Address and Tel.No.® 7 ?1-�13ff Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(y9 Other Type of Building ke 51011e'WCe No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow Pei gallons"per day. Calculated daily flow J?✓?0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /S`Dd Type of S.A.S. Description of Soil ld XV"K L Nature of Repairs or Alterations(Answer when applicable) Date last inspected: ' "� Agreement: The undersigned agrees to ensure the construon and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of-Title 5 of the dvironmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b =sB ealth. / Signed;= Date Application Approved by '4% * Date_f_•/7_ Sri .�, Application Disapproved for a fo wing reasons.... a; �{ ;�—! Permit No. 2 - ` � -�°'= Date Issued --------=----------------=—=---..—'------- THE COMMONWEALTH OF MASSACHUSETTS Ja Sao'`c�ZO " - BARNSTABLE, MASSACHUSETTS (tertificate of (Compliance THIS IS TO CER Y, that he On-site Se age Disposal System Constructed( )Repaired( ' )Upgraded Abandoned( )b D/?J �,r t` at 2- _ G( %i'� C !/ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 9!1-6// dated Installer Designer 1j C The issuance of this permi`shall n° nstrued as a guarantee that the st will ffunndon as'Vesign (. Date - Inspector /1 )D t No. 7 -----------------------=-T�a� Fee �S THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migogar I*pgtem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( V<Abandon( ) System located at g: 7 QUP 7`ee t/ C LZ112 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 . 7� Approved by -;., c..,i R u - n tr n.� =,e•'.ss,,,sv_. %�.t 'aa .:: ., .� ._ 4 sue..s' u,�y ''' 1vOTICE; This Form Is To Be Used For the Repair Of Failed _ z jSeptic Systeims Only v CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) hereby`ce Ythat the application for disposal works construction permit signed by me.dated 9�/��l/'� concerning the property located at (fe9af��l Clb4 dr G'*w*eX0*eets all of the following criteria: The failed system is connected to a residential dwellingonly. There are y no commercial or business uses associated with the dwelling. t✓/The soil is classified as CLASS I and the percolation rate is less than ore equal to 5 minutes r inch. ' / q 1� 4/ There are no wetlands within9-100 feet of the proposed septic system W. There are no private wells within 150 feet of the proposed septic system 6 There is no increase in flow and/or change in use proposed There are no variances requested or needed , The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor 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 ma..-dmum adjusted groundwater table elevation, Please complete the following:. . A) Top of Ground Surface Elevation(using GIS information) o B) G.W.Elevation l -` +the MAX.High G.W.Adjustment 7 DUTERENCE BETWEEN A and B 7 Z SIGNED DATE: 3' [Sketch Proposed plan of system on back]. y a r h s . bk� 3. Q - R � w a L I . I r