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Home My WebLink About0075 ANGUS WAY - Health 75 ANGUS WAY CENTERVILLE A = 251 043 ��il �aQCYCCFpc� UPC 12534 No. 2�153r_L_O�R HASTINGS, MN L� • /,,1 �l , No. Fe$Eb THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pplication for �Digp0'gal *pgtem Cungtrurtton Permit Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) El Complete System O Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No.9hUses9�S1UKckane, enterville Carol Buge' Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service P O Box 1089, Centerville Type of Building: ,r 5 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 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) Title-5 septic consistiny -n€ ' a tank, n—h� and—3 leaeh ehaFnbers with stone all around. 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 this BQard ofV�- Signe 4 Date Application Approved by 0 Date Application Disapproved for the following reasonC71 Permit No. .0- Date Issued va TOWN�OfF,rBARNSTABLE�) LOCATION 55 CuJ 6aE l ftwF "� 6�- (�R)SEWAGE # ICCO •-5;, b VILLAGE CC-W 4- -,J i (e- ASSESSOR'S MAP & LOT. -' INSTALLER'S NAME&PHONE NO. (24VWJSorJ :5 C 1 7S-PUC, SEPTIC TANK CAPACITY 1 SvC LEACHING FACILITY: (size) g x tV X 3 0 NO. GF`EEFiROOMS' � ` N� � iL) 'rCA N BUILDER OR OWNER A NI✓ r A PERMITDATE: 40co 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 s, j Furnished by i i i I � o 0 f 4%, 50 No. a Fe THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -\TOWN OF`BARNSTABLE, MASSACHUSETTS jZipplication for W5poeal *patent Con5truction Permit Application for a Permit to Construct( )Repair( x)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 55 Cent%:r �ane, enterville Carol Buge' �* r. Assessor s Map arce r j r Installer's Name,Address,and Tel.No. r Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service P 0 Box 1089, Centerville ,. 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. CalculateAdaily` ow 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) Tj tt lam—5 geptiC cc3ns jgt_4,4 g Of a• tank, D—box aND30sleach chambers with atone all arniinrl, 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 ' ued by t 's B d of Hea h. _ Signeftl r O Date Application Approved by 4 > U Date Application Disapproved for the following reaso ol Permit No. Date Issued 421 --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS Buge' BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned�( by Wm. E. Robinson Septic Service at 55 C�en er ane, entery 1e en constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. (AN-W. dated Installer WdI. E. Robinson Sr. Designer -A The issuance of this permits all n t b construed as a guarantee that thh s st ln, wyillll uncti n aVdesig/nne�dl - � Date li 0 .�I4p efor /I"/IX 1 L /l t% l�✓ eG. IV y THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Buge' Migpooal *pgtem Construction Permit Permission is hereby anted to Construct( )Repair( )Upgrade( )Abandon( ) System located at 59 Center Lane, Centerville and as described in the above Application for Disposal System Construction Pe6it.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. � I_ Provided:Construction ust be/completed within three years of the date of WiWqermit. ' . Date: (J(/ Approved by r ✓ �. 116/" 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) Y, W i l l iain E. R ob ins on,Stweby certify that the application for disposal works construction permit signed by me dated /�` , concerning the property located at 55 Center Lane, Centerville meets all of the following criteria: • The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. 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 sepuc 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. 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: 1 A) Top of Ground Surface Elevation(using G1S information) B) G.W.Elevation +the MAX. High G.W. Adjustment . _ 0- -DIFFERENCE BETWEEN A and B SIGNED : v/'/ DATE: y / [Sketch proposed plan of system on backl. y:health folder:cat _1 'r OI". +�.� � � + i `�. �..-� �— Y' ,. �, J J f� a v �,� �` �a �- � L,o .�G ?A TOWN OF BARNSTABLE � oy LOCATION 199W4M /c N IS ��A SEWAGE # ot1000 VILLAGE COW 49.4i(I- ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. W0-%uJScyJ S iC '7 75-LIX SEPTIC TANK CAPACITY 1 500 LEACHING FACILITY: (ty ) _ 'D!2�/CA-4A (size) e"l )L CV X 3 NO.OF BEDROOMS1"' BUILDER OR OWNER Y3v2C- NO n 39 A PERMIT DATE: -si 3 t A000 COMPLIANCE DATE: 1_I a a-C,06 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 v L s i ae o �, ��`Fe �p�a�� 251043 rnd9Owtter 251043 DI==k�°' V AY aun q'tt 001612 0000000 arc � � rr�hw#a BUGE,CAROL s a a9 ass'._ 101 3 r r M J/ q BE 1 00001104 E% 500 S SIERRA BONITA AVE `" r c .d 00 im, LOS ANGELES CA 90036 � w 4"c 00 0000 000 � r Fk 4 D spa 060193 f eferen 11177 28 �"�� ` � �� „ BUGE,CAROL .. ee =M Y1 0693 prgd ref 8648/238 000036300 1 000052000 tt! 0000000400 3=: ANGUS WAY o� 0031 #g 0105 P as# CO VW e 0000 r tg 0000 ; k r Y g 4+k �J yyyy .� .✓ say. 1y 3,- ,�." w',� ^>9 '".�,So"� ."� •da;a�3>�-a .s