The URL can be used to link to this page

Home My WebLink About0103 ANGUS WAY - Health 103. ANGUS WAY CENTERVILLE A = 251 040 111! 0.ECYC(pp llm c�� UPC 12534 ��' No. 2� 533LOR �Aosr.coNS� HASTINGS, MN O � I C` a v No. l '� '"r ! Fee " THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS s 0(ppItratton for Migpogal *pgtem Congtructton Vermtt Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No./03 qqW UA� Owner's Name,Address and 1.No. Assessor's� 1 ar blye, /O 3 /y�/1/ (�l �✓ � �/ltit�� /,�/�, — Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel. o. c=GGs(S ,3 itos 4e9Vk�7 Type of Building 2 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 Z aSZ" Type of S.A.S. > ` Description of Soil Nature of Repairs or Alteratj)ns(Answer when applica sl/�7 2.4 X X L 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 e Environmental Code an Sixot to place the system in operation until a Certifi- cate of Compliance has been issued by s B"board of Health. Signed 1 2---- Date 2 ��'� Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued No " / Fee Ir_ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0[pprication for �Dioaal *raem Couttruction 30ermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot N .03 nq VS 0.4 r1 Owner's Name,Address and el.No, Assessor'sIp/—az0yb �" > '/•'fit/ (/ tv/�(' �e.vGLt�e/lam a Z✓ ` ' Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Buildin Dwelling No.of Bedrooms '3 Lot Size sq. ft. Garbage Grinderl�4/9 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 _ I Size of Septic Tank Type of S.A.S. r Description of Soil Nature of Repairs or Alterations(Answer when applic ble) �� u-� T �` S {� ✓� x XI 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 Titlf the Environmental Code and not to place the system in operation until a CertifI e o - cate of Compliance has been issued d of Health:,, Signed / �-'— Date, y Application Approved b Date .�- Application Disapproved for the following reasons Permit No. Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY.that-thee 0 -site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned by at r- / "" �` has been constructed in accordance with the proy sien o Titl d the for Disposal System Construction Per 2'�dated ' Installer —Designer The issuance oft this e t shall not be construed as a guarantee that the s ste tll f io Ids desi ned7 /� D Date rye g Inspector y—� � ——————————————————————————————————————— No. �' �y THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS t Migpooaf *pgtem construction permit Permission is hereby granted to Construct( )Re air( )Upgra yK )Aban n( ) System located 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. q Provided:Construction must be completed within three years of the date of tL�mht. ~ Date: ` i / J 4_D Approved 6/;� 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. f CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL; WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS). ._ hereby certify that the application fordisposal works construction permit signed by me dated Ga , concerning the property located at 0 of �.-, eets all of the following criteria: �/• This failed system,is`connected to a residential dwelling only. There ar'e.no commercial or business _ ti .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. \V 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 +r�o increase in flow and/or change in use proposed There are no variances requested or needed. e 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) G.W.Elevation /® +the MAX.High G.W.Adjustment. %,A DIFFERENCZBEEN A and B SIGNED : �►: l��"* DATE: ,'f�•�+ [Please Sketch proposed plan of system on back). NOTICE Based upon the above information,a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert _i ........r I k. ti TOWN OF BARNSTABLE LOCA`i ION 1O3 AWK00-S Ld,E SEWAGE # VILLAGE 14,0IVT.hVlAz ASSESSOR'S MAP& LOTZS/ QYO INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /4:4= LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDEROR OWNER&t/17rs [reYA/1' ford/�J" PERMTTDATE: 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 facility) Feet . Furnished by ' � z�i � � � ��',� � � I TOWN OF BARNSTABLE k 2000-741 LOCATION 103 ANGUS WAY SEWAGE # CENTERVILLE- VILLAGE ASSESSOR'S MAP &LOT 7 �57 /0 INSTALLER'S NAME&PHONE NO. E L L I S BROTHERS C O N S T . SEPTIC TANK CAPACITY �' S �� A s/!� LEACHING FACILITY: (type) Y All C,/i 10141441i -(size) I X 33x a- '- NO.OF BEDROOMS BUILDER OR f O'"V-1 y� PERMTTDATE: 14 0 0 COMPLIANCE DATE: Z.Z_/� 6,d 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 g f leaching facility) Feet _ Furnished by O IT- — 4Sf Z 3TS s3 s r TOWN.OF BARN STABLE 2 p 0 0-`7 41 . . LOCATION 103 ANCUS`WAY - SEWAGE # VII,LAGE C E N T E R V I L L E ASSESSOR'S MAP & LOT INSTALLER' S NO. ELLIS BROTHERS CON ST . 77 SEPTIC TANK CAPACITY , S LEACHING.FACILITY: (type) ./`f�'�/ IA'W41G iulz%--(size) ILL�3 x NO.OF BEDROOMS BUILDER w . . , . y ° PERMITDATE: 4/0-0 COMPLIANCE DATE: Z// G l Separation Distance Between the: Feet Maximum Adjusted Groundwater Table and Bottom of Leaching Facility I Private;Water..Supply Well and Leaching Facility (If any wells exist Feet ' on.site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility-(If any wetlands exist 77- within 300:feet g f beaching facility) Feet Furnished by - 5 �r V �r 1 3