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Home My WebLink About0159 AMES WAY - Health Is 159 AMESWAY, CENTERVILLE A=169-089 I� o — --- --------- ll7/f/iP.[ilG® � UPC 12534 No.2153_ HASTINGS, MN i� i o 4 a No. - f Fee $50 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Application for Digoml *p6tem Con6truction Permit Application for a Permit to Construct( )Repair(x )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components L c i n dress orLQ t No. O ner's N e ddrss,and Tel.No. � � AAmes Way, Centerville`, MA ion fa�mer Assessor's Map/Parcel/ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E . Robinson Septic Service PO Box 1089, Centerville , MA Type of Building: Dwelling No.of Bedrooms 3 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 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Sand. Nature of Repairs or Alterations(Answer when applicable) New Title-5 septic- tank, D-b o x and. 2 leach chambers . 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 issu5d by this B.qzd gWealth. �j Signed ti c Date ��/"9 ' Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued No. / Fee THE COMMONWEALTH OF MASSACHUSETTS' Entered in computer: _ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Z(pprication for �Di000af *pgtem Congtruction Vatmtt Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Lac iQnAdmesrLWay, Centerville , MA ° onN alMeY'andTel.No. Assessyor'sAMap/Pazcel� �y N Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E . Robinson Septic Service PO Box 1089, Centerville , MA Type of Building: Dwelling No.of Bedrooms 3 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 gallons. Plan Date Number of sheets Revision Date Title g= Size of Septic Tank Type of S.A.S. ' Description of Soil Sand Nature of Repairs or Alterations(Answer when applicable) New Title-5 septic- tank, D-box and. 2 leach chambers . r Date last inspected: Agreement: The undersigned agrees to ensure the construction and m_ainteriance 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 issue by this B o ealth. �� Signed �� Date �" Application Approved by _ Date Application Disapproved far the following reasons Permit No. Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS Palmer BARNSTABLE, MASSACHUSETTS Certificate of Comphance _ THIS IS TO RTIl , th t t e.On-site S a e Dis o 1 S stem Constructed( )Repaired (X )Upgraded( ) Abandoned( j by Wm. E . RODinson e5t1c� erYvice at 159 Ames Way, Centerville , MA has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. �.V dated J4 � Installer Wm. E . Robinson Sr. Designer The issuance of!is permit shall not be copsrued as a guarantee that the s it unction as designe Date "t 's•e � �� Inspect -�^ �,::X"_27 ——————————————————————————————————————— �-' "� $5 0 No. A Fee T 5 THE COMMONWEALTH OF MASSACHUSETTS Palmer PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS lwigposar *pgtem Congtructton Vermtt Permission is hereby granted to Construct( )Repair( X)Uppgrade( )Abandon( ) System located at 159 Ames Way, Centerville, MA t 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. r' 1Wovided: Construction must be completed within three years of the date of this it. D e: ' Approved by ti 116199 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 concerning the property located at S A ifias 4jb, meets all of the following criteria: i. ,_T,ue failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. Asoil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. here are no wetlands within 100 feet of the proposed septic system here are no private wells within 150 feet of the proposed septic system [here is no increase in flow and/or change in use proposed L-11_ Ilere are no variances requested or needed. The bottom of the proposed leaching facility will not be located less than five feet above the /11/m&-cimurn adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] /- 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) G.W. Elevation +the MAX. High G.W. Adjustment . _ DIFFERENCE BETWEEN A and B SIGNED : Zz DATE: (!f LI 7 J [Sketch proposed plan of system on back]. q:health Folder.cent ! �. U � -J---,. �� . � L �\ �` \ �� l� 1 � �� - 'F ......... \y TOWN OF BARNSTABLE LOCATION I] A Yn 25 W ra y SEWAGE # VILLAGE ]n tdn+ 7 ASSESSOR'S MAP& LOT,—/ y 4 4' INSTALLER'S NAME&PHONE NO. W o g R 0101 n 30r-i SEPTIC TANK CAPACITY i SOO LEACHING FACILITY: (type) �P- U` 1A r n be r--5 (size) 5OC7 NO.OF BEDROOMS BUILDER OR OWNER 3!A I M Q.C- PERMITDATE: (- 14 e-9`Z 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 feel of leachin faci ity), Feet Furnished by dY e.5 3gck of O