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HomeMy WebLinkAbout3705 MAIN ST./RTE 6A(BARN.) - Health 3 105 MAIN ST. RTE,6A BARNSTABLE :i' A = 317 033 l —�33 . No. !�" r® .A �. Fee / THE COMMONWEALTH OF.MASSACHUSETTS Entered in computer: s PUBLIC HEALTH DIVISION -TOWN OF BARNSTAB'LE., MASSACHUSETTS 2pplication for Miggool bpztem Construction Permit Application for a Permit to-Construct( )Repair(V )Upgrade( )Abandon( ) L�Complete System ❑Individual Components Location Address or Lot No. 3 7,45' R7- / /1_mQ10� Owner's Name,Addres$and Tel.No. Assessor's Map/Parcel �J/T �I'r✓I5reile Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 'e©!'tzpzoe 7 7/9✓�9 Type of Building: Dwelling No.of Bedrooms i Lot Size sq.ft. Garbage Grinder( © Other Type of Building ellw?No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 5 3&7 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /-5--e40 Type of S.A.S. Description of Soil �4 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 by,4iis Boar f Heal / Signed Date Application Approved by i Dated' Application Disapproved for the following reasons Permit No. p `�� Date Issued r■ TOWN OF BARNSTABLE . LOCATION • 7� �� nI4/�l VILLAGE /'�1S�Qale SEWAGE # Zee y6Z9 INSTALLER'S NAME&PHONE NO. ASSESSOR'S MAP& LOT 3/7 SEPTIC TANK CAPACITY C LEACB3NG FACILITY: / (type) .r'w X"I><ra NO. OF BEDROOMS 3 (size)—/— BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of LeachingFacilityS- Private Water Supply Well Leaching Facility f Feet on site or within 200 feet (If facility) many wells exist j Edge of Wetland and Leaching Facilityg tY) � within 300 feet of leaching facility (�any wetlands exist Feet Furnished by ,191 i ,b£ e OL.t.l� No. �6s! Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: r PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,, MASSACHUSETTS Zipphration for Misspo.5al *pztem Cow6truction i3ermit Application for a Permit to Construct( )Repair(1�)Upgrade( )Abandon( ) U Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Addres and Tel.No. _ r - Assessor's Map/Parcel y:�,y y����� V Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. /3or t-©�o�ti 771 93 Type of Building: t. I Dwelling No.of Bedrooms— .. Lot Size sq.ft. Garbage Grinder(-Iti'lo Other Type of Building 71G?�Ille No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow l/D gallons per day. Calculated daily flow 3 3i!57 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank �J'~OQ Type of S.A.S. lG'� icy Description of Soil Nature of Repairs or Alterations(Answer when applicable) �4o 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 Board f Hea . . / Signed C Date Application Approved by' � Date Application Disapproved for the following reasons Permit No. Date Issued /10 A�*'LT -------------------- -------------------- THE COMMONWEALTH OF MASSACHUSETTS 3 1 J BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that he On-site ewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by Kf-xr 111_1 at ? 7,!!L 6d! d�eI W J - e1,M;"1 14 e has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit P47~ !0 !Z ated l 1P, Installer Designer The issuance of this permit rsh}al snot/be c nQstrued�as a guarantee that the sysYe -w 1/ unction, esigned. r r1 111 Date �f / � t/; 1 ?J Inspector � U 1 No. `!yf'' ` � O �----------------- 3/2 3 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS 30i.5po0ar *pMem Com9truction 3dermit Permission is hereby granted to Construct( )Repair(V.)Upgrade( )A andon( ) System located at Y74,5-- le� �/� M IX eS�`�ale 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 rnit. Date: ��' ��~ J Approved byB-'�-G9 ff-.vw,sw..i '3y rlo�� own2i- -,ESSOR'S MAP NO. '?� r PARCEL 033 ;/ p J. C AT ION SEWAGE PERMIT NO. VILLAGE S 1 N S T A LLER S NAME a ADDRESS BUILDER OR . OWNER f / w-I We. Vols- DATE PERMIT IS UED � S DATE COMPLIANCE ISSUED A� REA K 17 7q�' � .C:o TOWN OF BARNSTABLE LOCATION 3 7D5-- 60 * 1J1:7/17 AS" SEWAGE # WV 42-,ff V .�II.I:�`AGE d?rn_-7Aa1.,1e ASSESSOR'S MAP & LOT 317-033 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /fad G SAG LEACHING FACILITY: ( lviC1,6444 C1 'size /d� Xo � � (type) _ (size) � NO OF BEDROOMS 3 BUILDER OR OWNER / / eo .M PERMITDATE: lollT/0® COMPLIANCE DATE: 0140C1 i .Separation Distance Between the: m Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 3 , " 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) 1 :,,`F. Feet Furnished by /6 eI 1 39 r /U, - 0 Q ; Tt I r a NOTICE: This Form Is To Betsed For the Repair Of Failed. Septic Systems. Only. - CERTIFICATION OF SEITCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) Agr�o, ,/ ere.by certify that the application for disposal works construction permit signed by me dated /Ol6AD concernins_t the property ylocated at J mee ts all of the followings criteria: L The failed system is connected to a residential.dwellingonly. There are no commercial or business uses associated with the dwelling. /The soil is classified as CLASS I and the Detcoiation rate is less than or_ ual :o minutes �, per tnca: . V"net e are no wetlands within 100 feet of:he proposed:septic system K -acre are no private wells within.I:0 -eet of the oromsed septic system i aer a is no incise in flow and/or change in use oroposea Y There are no variances.requested or needed. � The bottom of the proposed leaching facility will not be located less than Lve feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the?rimptor lif metho when applicable]. .the S.A.S. will be located with 250 feet of proposed any vegetated wetlands. the bottom of the P . osed 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(rising GIS information) - /` Z B) G.W.Elevation ! +the MAX.High G.W.Adjustment.3 =b = l DIFFERENCE BETWEEN A and B SIGNED - DATE: 7A0 [Sketch pmposed plan of systm on baek]- 4F ham fthr am a �G r�