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Home My WebLink About3598 MAIN ST./RTE 6A(BARN.) - Health 3598 Main St./Rt.6 A, Barnstable A=317-016 0 E _ G No. � �` Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipplicatton for 30i!5pogaY *p!Aem Cone;trurtion VCrmtt Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System El Individual Components Location Address or Lot No. .35g?&U e q Own is Name,Address and Tel.No. Assessor's Map/Parcel /7 ` O 16 #44-'M� q�g" A0 Installer's Name,Address,and Te No. Designer's Name,Address and Tel.No. �E sus A -� Type of Building: Dwelling No.of Bedrooms 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 �J '® 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) `5iC 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 d by this Board of Health. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued f--— TOWN OF BARNSTABLE SEWAGE # LOCATION ASSESSOR'S MAP &LOT VILLAGE 3 INSTALLER'S NAME&PH ONE O NE NO SEpTI :TANK CAPACITY .�I�Z a LEi4dWgG FACILITY: (type 'S7l�Y (size) �C NO.:OF.BEDROOMS ` BiJII. ER OR OWNER PERIv1TTDATE: — COMPLIANCE DATE: Separation Distance Between the: /� Feet t Maxamdm Adjusted Groundwater Table to the Bottom of Leaching Facility RriwaEe Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) exist v Edgy of Wetland and Leaching Facility(If any ,�� Feet_ :;w.ithin 300 feet of leaching facility) F�rxushed by - s r.r. •' t f'� J TOWN OF BARNSTABLE LOCATION 26W424 464 zl�z SEWAGE # VILLAGE ASSESSOR'S MAP & LOT-3 t 6 INSTALLER'S NAME&PHONE NO . 4 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �&Ai �seC C�tG�y (size) NO.OF BEDROOMS64 BUILDER OR OWNER Gf�fO PERMTTDATE: JCOMPLIANCE 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 � i Feet within 300 feet of leaching facility) , Furnished by i ' 9 No. �� - Fee f,0-P Z' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC-HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS Zipprication for nigaal 6potem Construction permit, Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual`Components Location Address or Lot No. ;S98 Lp Owner's Name,Address and Tel.No. No. Assessor's Map/Parcel 3 1'7 Installer's Name,Address,and Te No. Designer's Name,Address and Tel.No. C ,C a! 6-17s *64e .. ��G�'" Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building, A:12 No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow //D gallons per day. Calculated daily flower 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) 5 02 QA1 Date last inspected: s Agreement:' The undersigned agrees to ensure the construction and maintenance of t�e 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 d by this Board of Health. t Signed 1 Date Application Approved by Date Application Disapproved for the following reasons J t Permit No. •� Date Issued -- _. . .. _ 01, -------- ----------- '—=-------- ^ -- THE COMMONWEALTH OF MASSACHUSETTS , BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired (k f Upgraded Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. "1 7"7 dated Installer Designer The issuance of t_'s pe t srhal a be construed as a guarantee that the system ill ction as designed. Date c �.7 Inspector No. Fee p-✓ r/� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS lwigozaf *pztem Construction Vermit Permission is hereby granted to Construct( )Repair( )Upgr de( bandon( ) System located at 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 pe 't. Date: '"' �•� �1� Approved by V 1019/97 NOT ICE : 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 ENGINEERED PLANS) 1, , hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at 3.5 �I�l meets all of the following criteria: e There are no wetlands located within 100 feet of the proposed leaching facility There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed e There 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 W 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)—Lk— SIGNED: DATE: y LICE ED EPTIC SYSTEM INST LER 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]. - q:health folder:cert