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Home My WebLink About0015 MARSTONS LANE - Health - r a 15 MARSTONS LN. , BARNSTABLE A = 350 - 016 F TOWN OF LOCATION )E A a C& o n11 Lh SEWAGE VILLAGE jc r n c+AILI f ASSi SSOR'S1MAP & LOT 3,5 INSTALLER'S NAME&PHONE NO. 1h0 r'►45 yt✓`I o r�v,z, .'�6� 3 6 6 S SEPTIC TANK CAPACITY 15 O O �J LEACHING FACILITY: (type) (30AL41s (size) 3 ' Li w� y's ohs NO.OF BEDROOMS 3 BUILDER OR OWNER -aaY)z t o PERMITDATE: I'd• iq I COMPLIANCE DATE: /3. - 1/) 9� 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 rnac Rsia n s �h Sa, c 0 No. / L Fee %5_Lq f THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(ppYication for Migaar 6p a Construction Permit Y Application for a Permit to Construct( )Repair*Jpgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /S *5s 7vpu' Owner's Name,Address and Tel.No. APT Assessor's Map/Parcel Ins ler's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 1 Lot Size s . ft. Garbage Grinder X40 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 (� 4 � �/ eQt/T_��-� M e�-%�/ j I✓/Ac Nature of Repairs or Alter i s(Answer when applicable) J �i 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 of the Environme and not to place the system in operation until a Certifi- cate of Compliance has been issu s Board of, �� Signed Date Application Approved by Date/ 1 - L!- Application Disapproved for the fol9wing r sons Permit No.�7 - n Date Issued t_"" - �s�Vl. --.. µt W � : -_.,w. *t.> .-.-,.;-, j ".'-.t;. - -.,- � , k' .♦ �f-•----^ .. . _F f -_.g., .. � .,_` No. 9 Fee THE COMMONWEALTH OF MASSACHUSETTS Enterd in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS k 0[pprication for Mi.5pont *p a sCou!5truction Permit Application for a Permit to Construct( )RepairUpgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 15—InAIMMILIS ZAI Owner's Name,Address and Tel.No. Assessor's Map/Parcel s - V/ 5 `"" Ins aller's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size s . ft. Garbage Grinder0 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 ro "�' /F 6(yy C/_y � M ep,�/l V* /,P . �GC.Gc (� 9 kNature of Repa -s or Alter tis(Answer when applicable) /C I fle II Date last inspected: II 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 of the Environme Cod and not to place the system in operation until a Certifi- Cate of Compliance has been issue s Board of .ett Signed t Date / f0 r Application Approved by d +1 .�,�....,% Date Application Disapproved for the fo w g"r sons ' Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS r Certificate of Comptiance o THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( )Repaired>, Upgraded( )4 Abandoned( )by �tv at 1 5- MsA M t t, ��PD.c has been constructed in accordance E with the provisions of Title 5 and the for Disposal System Construction Permit No.4eQ dated Installer ll Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date \ 1 J„ Inspector l i i _ ———`——/——————————-—————————————————————-- No. l �I t!) Fee f t THE COMMONWEALTH OF MASSACHUSETTS r PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mi!9pogar *pgtem Construction Permit Permission is hereby granted to Construct( )Repair )Upgrade.( )Abandon( ) System located at 'i- /XAzr' 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: Approved by s r 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) I, , hereby certify that the application for disposal works construction permit signed by me dated o� (5� , concerning the property located at L0C__AWVW1S kt/ meets all of the following criteria: t t r The no wetlands within 300 feet of the proposed septic system Ther e no private wells within 150 feet of the proposed septic system The o d groundwater table is 14 feet or greater below the bottom of the leaching facility There i increase in flow and/or change in use proposed There are no variances requested or needed. SIGNED : --DATE: / f 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]. i q:health folder:cert - - �� ,. �� : r ,,- 5��. __�__ _ i � ,�� . - �- _ _ --- � � � �' �. � ,_ � � 1 �; ��- �� i� : % _ J