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Home My WebLink About2800 MAIN ST./RTE 6A(BARN.) - Health p 2800 Main Street/Rte,6A(Barn) PF Barnstable z o i fNo. Fee G THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppfication for 0i5poear *T tent con.5truction 3perm�it Application for a Permit to Construct( )Repair( )Upgrade( bandon( ) [Complete System El Individual Components Location Address or Lot No. ac8cb VAS GA Owner's e,Address and Tel.No. Assessor's Map/Parcel 9 001 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms L 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) &&o (gv � 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 issu this Boa o lth. Signed P Date Application Approved by Date Application Disapproved for the following reason Permit No. 7iP/'U e"-Ile Date Issued 'Z— Z? — r No. � � dr, .R, - Fee Entered in computer: ✓� THE COMMONWEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVISION.=TOWN OF BARNSTABLE, MASSACHUSETTS 3ppricatiori#or Mop p t"M Construction Permit Application for a Permit to Construct( )Repair(- )Upgrade( )Abandon( ) EyComplete System ❑Individual Components Location Address or Lot No. _avcb 0W Owner's Na e,Address and Tel.No. Assessor's Map/Parcel Z 7 "/ — 001 ~ � Tom`,k "\:-.4.1-3�- Instaal^ller's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. CUv.-A Type of Building: Dwelling No.of Bedrooms L"� 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) S O� �� :.. 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 Boat. o .e th. Signed .,/ Date -2 Application Approved by Date 2—Z 7— Application Disapproved for the'following reasons Permit No. Date Issued Z` Z? - ---------------------------------------- - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE TIFY, that th On-site Sewa a Di osal S s�tt Co structed Re aired U graded g p G-� Govt) �, ( ) P ( ) P Abandoned( by d� �� or, Gv T v ' at 7i� l}� GX 4o( S fao, n E`eZ,41 has been construZe�n accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.UV/_ /(, dated Z 7 G Installer Designer The issuance of this pe tt hall not be construed as a guarantee that the sy will cti �%�s desigp�. Date �G/ G/ Inspector t� No. �I—/,� --------------------------Fee t THE COMMONWEALTH OF MASSACHUSETTS «� PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 1=i!6po!6a1 *pMem Constr"Aband,101r. " Permit Permission is herebyranted to Construct( )Repair( )Upgrade(g P ,r System located at ZO�" Qtin . T_(� _ 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 ,Date: �!/z ?/� Approved by € TOWN OF BARNSTABLE ' O—WA;?`"ON l go n/ (4- SEWAGE # 2001=1% VILLAGE w XAA ASSESSOR'S MAP & LOT 271-01 INSTALLER'S NAME&PHONE NO. A/r�ctL&CI Le-c�4.c j�y., .R,, 4/4ci. �� } SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 3 rC,-A-ykerl (size) NO. OF BEDROOMS BUILDER OR OWNER CJP �t��C kc,f& f PERMIT DATE: 7' COMPLIANCE DATE: 3!/ O 1 .Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 1 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 w chin 300 feet of leaching faciliry) !3 Feet Furnished by ka lor 1��r'l dLG, rIN v , �aae c. ss'4'' 0 - I I Ali' Vb�E '+4 ` ►� F �2; A"F �s c ii 144-0 fr i��o Ml q3 13 �A 'JA' TOWN OF BARNSTABLE WCATiON SEWAGE # 4' VILLAGE A ASSESSOR'S MAP & LOT 9- 1 INSTALLER'S NAME&PHONE NO.J.io+ �ecs-S� �5�.�RCb2 lw\�oLti.1 SEPTIC TANK CAPACITY 1 , _C o CAL• LEACHING FACILffY: (type) T 5eloGL. size) 33 e5 ( NO.OF BEDROOMS-- BUILDER OR OWNER bob Le`to kc,:�p� PERMIT DATE:(:2—62 7—0 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility. Z ' 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 facili ) Feet Furnished by je vJAZ 764 UL o8 c SS '6', �, �0►}0 D Ga V F �2` q}"F P's +G ` }o "►3`' p ,�� ' `i #mow � 0 fr0p e 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) 1, 1"1W1� ereby certify that the application for disposal works PP p construction permit signed by me dated . (X =��e , concerning the property located at meets all of the following criteria: ':'L—This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. L--e soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. -,—There are no wetlands within 100 feet of the proposed septic system C,--Th—e—re are no private wells within 150 feet of the proposed septic system here 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] • f 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) C) B) G.W. Elevation 1 +the MAX. High G.W. Adjustment . DIFFERENCE BETWEEN A and B SIGNED : , DATE: 7—/0111 [Please Sketch pr posed pla system on back]. NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert 1 LA Ll � 5 (- -l0 Ax- L 1 I ' '� i TOWN OF BARNSTABLE ATION. 0 SEWAGE # 200/ VII. IGE ASSESSOR'S MAP & LOT 27 —01 INSTALLE.� 'S NAME&PHONE NO: !Ur)rflw(�o�t� SEPTIC TANK CAPACITY I S®D LEACHING FACILITY: (type) - 3 -ems) r� ; �,p r, (size) 3 3 / NO. OF BEDROOMS BLUDER OR OWNER ae" e ke, PERMITDATE: ' 27- d 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 *w this300 feet of leaching facili ) // Feet Furnished by_ Ida�2r �v��dCln . I i 1 f 6s` �4 b bar t�A,(-o Gc `. W4 F a�F PIS %% C fr 6'+