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Home My WebLink About0175 STONEY POINT ROAD - Health 175 Stoney Point, Barnstable A= 336-026 4-0 CO VMAS _ ll � , -- No. � •— � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppliCation for Misposal *pstem Construction permit Application for a Permit to Construct( ) Repair 6Q Upgrade( ) -Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.1,� S C�c . ?b VNOwner's Name, ddress,and Tel.NQ.C:5681 3&j_L j®Q0 Assessor's Map/Parcel Ora= \\ mClt��Na nstaller's N�C rte,Addres ,and Te�No. �G Designers Name,Address,and Tel.No. " I►XCc-.� �t� • ,Dso G.� FU V\ 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(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revis' n Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable)�(� ca��, o_,C\ C)q l�J Date last inspected: r 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 Certificate of Compliance has been issued by this Board of alth. Signed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No.�_� ��Y 1 Date Issued 7 I No. Fee 1 A THE COMMONWEALTH OF MASSACHUSETTS Entered in computer PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes C 2ltlflcatlon for Disposal 6pstetn Construction Permit ._ Application for a Permit to Construct( ) Repair( ) Upgrade(,)-Abandon(. ) El Complete System ❑Individual Components Location Address or Lot No. �i( f' •' Z�C, <tir �.:i.��3 t Owner's Name,Address,and Tel.No.fJb�� Assessor's Map/ParcelJ 'i "Gv(' `+L." Installer's Name,Address,and Tel No. ��c-' +;L Designer s Name,Address,and Tel:No. Type of Building: Dwelling No.of Bedrooms ,J ;Lot Size sq.ft. Garbage Grinder( ) Other Type of Building [ / No.of Persons Showers( ) Cafeteria'(' ) Other Fixtures i Design Flow(min.required) Kill A- gpd Design flow provided / �. ' gpd 1 Plan Date ( Number of sheets Re vision Date Title Size of Septic Tank Type of S.A.S. Description of Soil f Nature of Repairs\`or Alterations(Answer when applicable) \-AC rC:• �C N 0�- V\10 k T 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 Certificate of Compliance has been issued by this Board of Health. Signed Date kc '.1 ,,\ Application Approved by '�,��f,�.. f t t� { s 1A,)�44 �9 : T Date ((11 ( ( ( Application Disapproved by,,, m Date 1 `j V for the following reasons Permit No. 0 ` —<' to Date Issued 1-0 1 -_ THE COMMONWEALTH OF MASSACHUSETTS - - BARNSTABLE,MASSACHUSETTS r Certificate of Co rnpriance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( () Upgraded( ) Abandoned( )by 1_,i 1-A t-1'{'1S . . at n xA 04-10 Q--;G V'V -� QD— � (ia-been constructed in accordance t • . y w� N with the provisions of Title 5 and the for Disposal System Construction Permit No.>,fl a.)..+�jr'7dated Installer L.Jsjls'C--, r Designer 1 Y #bedrooms Al Approved design flow Al 114 gpd The issuance of this permit shall notbe construed as a guarantee that the system wi(t Ifflnction as designed. Date , I Inspector \.` �/ ��I A /r m w _..:.,. >:_=o-. _,a=_.:._ M = u.. -•-- ----------•-----•- No. � ,.\ ..• (4 Fee -. r " THE COMMONWEALTH OF MASSACHUSETTS r PUBLIC,HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS MispoSaf 6pstem (Construction j3Prmit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at r!' T �1 t �"'i'� ("`l� {"1: -'� and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 (�1 ) �t? i 1! Approved by I `i,N��( V ,Q: ( V No. �O Fee• 1� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zipprication for Digpo.5al *pgtem Construction Permit Application for a Permit to Construct(- )Repair( )Upgrade(_/Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 1'a S 5—TON y ut r\ Lv Owner's Name,Address and Tel.No. Assessor's Map/Parcel 7✓in ��j� ,4 V— Installr�Tel.No. Designer's Name,Address and Tel.No. 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 _3 3 Z) gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil VIA 15� 17 'C' Nature of Repairs or Alterations(Answer when applicable) " i�� fV- tic t� r �� C S`TU la ry S� 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 Cod and not to lace the system in operation until a Certifi- cate of Compliance has b,wAri ue y is Signed Date /b`?'M? Application Approved by Sl Date Application Disapproved for the following reasons Permit No. Date Issued No. �, b Fee, go THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE., MASSACHUSETTS .Ppfication for Mizpogar *pztem Corittruction Permit Application for a Permit to Construct( )Repair( )Upgrade( /Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. '`�.S ��N e� i olJ LUVh Owner's Name,Address and Tel.No. Assessor's Map/Parcel �'.0 Pl'B f39 I v�d c.,S . Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. l` C_uti.w's I i 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 3 gallons. I Plan Date Number of sheets Revision Date Title l� Size of Septic Tank p Type of S.A.S. Description of Soil on 12�_ n S 10-v".o r Nature of Repairs or Alterations(Ans Ir when applicable) `� ter' Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system j in accordance with the provisions of Title 5 of the Environmental Code and not to, lace the system in operation until a Certifi- cate of Compliance has bb ssue y flits Healt Signed Date Application Approved by Dateor Application Disapproved for,the following reasons ;gPermit.No. ". Jl A.''w Date Issued THE COMMONWEALTH OF MASSACHUSETTS ' BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIVY, that the Pn-sit ewage Disposal System Constructed( )Repaired.( )Upgraded Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and thip.for Di posal System Construction Permit No.92.* dated/,6^ Installer Designer -� The issuance of I's.permits hall(notbe construed as a guarantee that the syste ill function as designed. Date f L �' Inspector 1 r �•'^ /� ----------------- No. 'If -----Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,; MASSACHUSETTS Mie;pomt *pgtem Conotruction.permtit 4 Permission is hereby granted to Construct( )Repair( w<pgrade(n )Abandon'( ) i ,.System located at�_�T�`�` )Ir2 / � 1 u ,,qz iC, 00 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 Pea it. . Date: 7 �.� Approved b} CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I b hereby certify that the application for disposal works construction permit signed by me dated —�,�_• concerning the property located at /7 Sd N� C` '' ,/`—meets all of the following criteria: Or There are no wetlands within 300 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed f. • There are no variances requested or needed. SIGNED: DATE: LICENSED SEPTIC SYSTEM INSTAL R IN THE TOWN OF BARNSTABLE idbWER (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). _ . G ,.: �� . V b t \!-TOWN OF BARNSTABLE LOCATION 1 7S_ SEWAGE # VILLAGE /)ASSESSOR'S MAP & LOT 3-76 7 6 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY f LEACHING FACILITY: �7� �"��f.��fa�! (size) �/ (type) Le NO.OF BEDROOMS_. BUILDER OR OWNER � �—�• ' �- PERM TDATE: I8 —. COMPLIANCE DATE: /a G� 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 ve:�f -�3� Z_�, `�vit T — l q'"I� -- a�v,�,��Z,. ' Cif�-�2 cv-5 G✓ ,5_%�.�2_T-- /� T_�j' ULL j>G� �1�,�42Lts�S /�• �rJ`��_L a r' 4� 4j --- — - - - ---- ---- -- �— — --- -- J Pic, Sys e _ A %S®X Idl ¢ ^ r D` ive i -- 1 bk \�-TOWN OF BARNSTABLE LOCATION S SEWAGE # / �l VILLAGE �.- �p ASSESSOR'S MAP& LOT 336 b 1 INSTALLER'S NAME&PHONE NO. �f/L 7,229_ 66g y SEPTIC TANK CAPACITY /�� LEACHING FACILITY: (type) y�nf'��fUP� (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: J h COMPLIANCE DATE: 16 Separation Distance Between the: Feet Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facilitywetlands exist ' Edge of Wetland and Leaching Facility(If any Feet within 300 feet of leaching facility) Furnished by i 3 t j I -. R3 � f �