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HomeMy WebLinkAbout4366 MAIN ST./RTE 6A(BARN.) - Health 4366 MAIN ST., RT.6A, CUMMAQ'UID A=351-04.1 'e • Y o- � e t p .•y 0 is • o. � S'r' �ia. Y a T. .. � ,. ,. V. m .. - s -F t f.. Q �.. ..N a : Y i f� 't F , v a' TOWN OF BARNSTABLE LOCAPJUN -- q 36�- Nam[ Or SEWAGE # VI'-LAGS &.edmgz,0-4 ASSESSOR'S MAP & LOT Z-,T O q/ INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) _ �J/�<� Sg-!9 �B� p1 (size) g X�D NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: 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 faciliy) Feet Furnished by b ��` V4 TOWN OF BARNSTABLE toct.TivN' ��bfT /� 7�`Gii �I�;I! SEWAGE4.. ' 17.LAGE G�CIv1n1Qf u/�O ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILrrY: (type (size) NO.OF BEDROOMS BMDER OR OWNER -S PERMTTDATE: Z—/ 7 —If 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 within 300 feet of leaching facility) Feet Furnished by e a G r W t i .. t No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Oigool *p5tem Construction Permit Application for a Permit to Construct( )Repair(►' )Upgrade( )Abandon( ) IJ Complete System ❑Individual Components Location Address or Lot No. /� 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. Boy�lo�i' C�rt�y: Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(Ale, Other Type of Building A— J,le_xce— 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 /,�O Type of S.A.S. —5-4�9 y 2_10e T'� Description of Soil Z/(yD 1-rl49 Nature of Repairs or Alterations(Answer when applicable). n z6e�z?--lewwlm 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 bj4his Board of ealth. Signed Date Application Approved b Date Application Disapproved for the following reasons I� Permit No. " 2 Date Issued "'1-7-- Y , -i—off = � NO / ` e Fee , �rG/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: aPUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS es 2pprtcation for Mfe;pogal *pztem (fow6truction Permit Application for a Permit to Construct( )Repair(►' )Upgrade( )Abandon( ) IJ Complete Syre ❑Individual Components Location Address or Lot No.L( l /� Owner's Name,Address and Tel.No. Assessor's Map/Parcel �%� ,AA N N, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. BO! fOCOJI �4i�5 Type of Building: Dwe lling No.of Bedrooms L/ n Lot Size sq.ft. Garbage Grinder(A e of Building Type d�e5/Gi��'/IG-�Other T No. of Persons Showers( Cafeteria( ) Other Fixtures Design Flow I/ gallons per day. Calculated daily flow yyO gallons. Plan Date Number of sheets Revision Date -Title Size of Septic Tank /5�00' Type of S.A.S. —G� Description of Soil 7— y© /d Nature of Repairs or Alterations(Answer when applicable) Z:/ Date last inspected: r Agreement: , The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposarsystem 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 this Bo d of ealth. Signed Date Application Approved bye Dates - -W--ta Application Disapproved for the following reasons Permit No. l --51 Date Issued 4-9 --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY.,that the On-site Sewage Disposal System Constructed( )Repaired(✓ )Upgraded( ) Abandoned( )by O/7e at ��3/� f C d v/ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No '- dated - �- � Installer Designer The issuance of this peter lmit hall not be construed as a guarantee that the system will function as de"g ned�f Date .�.! �q Inspector ��, --------------------------------------- No. r %` �G( Fee ' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Miopoml *pztem on!5tructfon Permit Permission is herebyr ted to Construct ),Repair "' Upgrade Abandon g ( ) P /( ) p. ( ) ( ) System located at A6 9312 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 tthis permit. � Date: Approved by- IMM NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. ., CER TIFICATI ON F O SKETCH AND APPLICATION FORA DISP OSAL OSAL WORKS CONSTRUCTION PERMIT TTHOUT DESIGNED PLANS) 1 i ALE . Alr):: 1&11 , hereby certify that the application for disposal works - construction permit signed by me dated Z/V/`?` �,Lconcerning the _ located at 3y1� �13�1 6� GC�/ti! Q�l/� me ets eets all f th - property `� � o e following criteria: �-/The 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 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 There are no variances requested or needed. [1 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 maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) Groundwater Table Elevation Z - S max adjusted g.w. Z _ DIFFERENCE 3 Z SIGNED : DATE: [Sketch PmPosed Plan of system on back]. �- Lnlf>t foidec oat MINr ^L c_4- e_,JULA-AAA-6 Q 9 0 Q 1 / TOWN OF BARNSTABLE LOCATION �344 � b� �Q"�/I ��: SEWAGE # VILLAGE G�CINhIQCt��!%,0 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. CDW-V -7 -7 ; SEPTIC TANK CAPACITY LEACHING FACILITY: (type (size) NO.OF BEDROOMS f BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: i 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 within 300 feet of leaching facility) Feet Furnished by El 91, r L fd , 0LZ �•rr; �I J, Uo