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Home My WebLink About2160 MAIN ST./RTE 6A(BARN.) - Health 2160 Main St. , Barnstable A= 237_008 I r J TOWN OF BARNSTABLE q LOCATIO 21 Qn ML I w S1- ��b� SEWAGE # / 7 r' Y` - VILLAGE J3 u42 r1-5Tr=tbL-0— ASSESSOR'S MAP & LOT bO S' INSTALLER'S NAME&PHONE NO. M il,� -( 64 _77 F-n6RX SEPTIC TANK CAPACITY 1 6 0 C 17 U ,-LEACHING FACILITY: (type) (size)z S:,r, Yam. NO.OF BEDROOMS BUILDER OR OWNER ✓S U S PERMIT DATE: COMPLIANCE DATE:V—f f— g Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 leaching facility) Feet Furnished by �� O �� i � `� � - - - - � ® - i s9 �C � _ � -�r 1 � fi _ -� � i .� � a � ® � , No. ° 2� �� _*Fee THE,COMMONWEALTH OF MASSACHUSETTS ::Entered in computer: V Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIpprication for �Digoml *potent CowAruction Permit Application for a Permit to Construct( )Repair(.,<Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No.a l '•`�}IV r)( �•i►^ Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. v Designer's Name,Address and Tel.No. 1-1-Z05 tiv-_�bol'b 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 33 D gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank / UU Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) U}� �w� Z.�.-,C `Tyc �✓If vci '-1' ai•— S�/Jc�' A 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 nvironmental Code nd not to place the system in operation until a Certifi- cate of Compliance has l -is is Signed Date Application Approved by Date 3 ,�� 7 Application Disapproved for the oliowing reasons Permit No. 7— Date Issued -3 9 TOWN OF BARNSTABLE q LOCATION -i f SEWAGE # VILLAGE_ LI y�2 SST- b�� ASSESSOR'S MAP & -III- INSTALLER'SR'S NAME&PHONE NO. M 1 _l �. -77 F-6(a SEPTIC TANK CAPACITY : . LEACHING FACILITY: (type) fc-• (size) NO.OF BEDROOMS / BUILDER OR OWNER A✓. PERMTTDATE: 3 -- h z� COMPLIANCE DATE:_ Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 leaching facility) Feet. Furnished by t I Uta`If; - - 4- Sod 1�otly '1`p 4 �j U7r N r�Fee 150 vt '." THE.COMMONWEALTH OF MASSACHUSETTS - d in computer: � Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE.,.MASSACHUSETTS ZIpprication for Migoml *patent Cougtructiou Permit Application for a Permit to Construct( )Repair(✓lpgrade( )Abandon( ) ❑Complete System ❑Individtial Components ~ Location Address or Lot No.a i � S 1 'lr Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 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 33 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1'~G�ZU Type of S.A.S. Y.ti- Tr a o t2 f ti. Description of Soil 1 Nature of Repairs or Alterations (And&er when applicable) ..Z-tA--`,T y1 - -/ G -vy'- y^,C LL-r - rz✓IS' , , S"✓lc-'_S d"47 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 nvironmental Code _. d not to place the system in operation until a Certifi--- cate of Compliance has is B -Meal Signed f t Date Application Approved by �` Date Application Disapproved for the fo lowin reasons511 t Permit No. Q 7" Date Issued -3 '" -2 92 --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERJIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by 5x J at c'Z. ,v has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Q ?- ,LG/2 dated Installer Designer The issuance oft this permit shall not be construed as a guarantee that the syst T will function a des' d. Date Ijspecfor No. � / �a -------------------------Fee �� I THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 'ig;pogar *pgtem Con5truction Permit Permission is hereby granted to Construct( )Repair( Upgrade( )Abandon( ) System located at j62 W, 1 A 1,w 74 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: 3 -.2 -5"-- 9 2 Approved by IV 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 `5-25S -5 concerning the property located at al tn.d � �- 5 Q� �-Si �c_ meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. `^ DATE: 3�-, 7 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 certified plot plan, this plan should be submitted]. j xert i 1 Oca