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Home My WebLink About0092 ASHLEY DRIVE - Health 92 ASHLEY DRIVE, CENTERVILLE A=172-085 UPC 12543 4 No.53LOR HASTINGS MN 9 N. / Fee S� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for 30igpooal *pztem Conotruction Vertu Application for a Permit to Construct( )Repair(v)Upgrade( )Abandon( ) El Complete System O Individual Components Location Address or Lot No. / -1 Q L � � Owner's Name, Address and Tel.No. Assessor's Map/Parcel J J l DoArS 4 _3_�7CL Installer's Name,Address,and Tel.No. SAO# 0qC/01T& Designer's Name,Address and Tel.No. 0-ma-0 Cal Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Buildings 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 /Ow Type of S.A.S. G Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 EVir pnmentpKCode and not to place the system in operation until a Certifi- cate of Compliance has been issued b is BoardAWealth. i Signed Date Application Approved by Date e°--2(o °/9 Application Disapproved for the fo owin easons Permit No. - 3 o2s Date Issued TOWN OF BARNSTABLE 7 CU t r SEWAGE # LOCATION \/IhiLAGE (/_dT1Ar AN//� ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1060 (size)� X LEACHII`1G FACILITY: (type) — NO OF BEDROOMS B:UII;DER OR OWNER <PERMIT DATE:_S:��—COMPLIANCE DATE: Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility `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 Feet Ji ithin 300 feet of leaching facility) .' :Furnished by VTO o99 No. - Fee r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH-DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIppYication for Mi.5paal *pgtem Construction Vermit Application for a Permit to Construct( )Repair(Vf 6pgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. J" ^) 11-91LC-I �F*6- Owner's Name,Address and Tel.No. Assessor's Map/Parcel � t,9^&5-r 4-ao__3j_7j Installer's Name,Address,and Tel.No. 8RIP R yan�—� Designer's Name,Address and Tel.No. aoTpla-X'CAR. fnzL1_5� 7. c �G- 8 Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other i` Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 2 gallons per day. Calculated daily flow gallons. a Plan Date Number of sheets + - Revision Date Title t Size of Septic Tank /600 Type of S.A.S. 6404 VA KO /Q Description of Soil r Nature of Repairs or Alterations(Answer when applicable) 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 Env Signed nmenta ode and not to place the system in operation until a Certifi- Cate of Compliance has been issued by :s Board of alth. Jr i Date — Application Approved by Date Application Disapproved for the fo owing easons Permit No._ $ off,7 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired( VUpgraded ( ) Abandoned( )by_a iX/ A at - has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. - dated Installer ?1A 1&�— Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date �!g 1 1 i Inspector No. ———————————————————————————— J51, Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migpogar 6peum Construction 3permit Permission is hereby granted to Construct( )Repair( 1J(Upgrade( )Abandon( ) System located at !?a--A (1 0,91 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 ^� 10/9/91 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 ENGINEERED PLANS) hereby certify that the application for disposal works construction permit signed by me dated i��-'�� ,concerning the property located at meets meets all of the following criteria: There are no wetlands located within 100 feet of the proposed leaching facility • 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. If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will ngl be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) . B)Observed Groundwater Table Elevation(according to Health Division well map) SIGNED: DATE: LICENSED SEPTIC SYST INSTALLER IN THE TOWN O.F 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]. q:health folder:cert / Q / TOWN OF BARNSTABLE ° e ' LOCATION Role a&o SEWAGE # VILLAGE C, ILGL ASSESSOR'S MAP & LOT 6 85 /, INSTALLER'S NAME&PHONE NO. /�� `Y.o" Sr SEPTIC TANK CAPACITY /060 LEACHING FACEL=: (type) Ld� (size) NO.OF BEDROOMS BUILDER OR OWNER p PERMITDATE: �� 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 Furnished by i r { . 3' �t � � GR�-��` ' � � P � � CJ�r _� ,k, T'C;Wk OF BARNSTABLE I�� BAR-W 1823 ?; V * (.J Ordinance or Regulation WARNING NOTICE Name of Offender/Manager o CC(/ A9T3 �) 00e, Address of Offender ' 1 t �W11-6m7/MB Reg.# Village/State/Zip Business Name /pm� on 115 j Business Address o �s Signature of Ehforc ng Officer Village/State/Zip Location of Offense m #Ses IV a B E%nforcing Dept/Division Offense v 1l' �m_ffce RE G } A �0/v ' f Facts , ANY &GS A NO P0Y1tq,5 ! 1/� of:� 7 -o ".M 0 P yP 6 Y ' l�, 144h CAI 7 114alq7 This will serve only as a warning. At this time no legal action has been taken. Itr ism the goal of Town agencies to achieve voluntary compliance of Town Ordinances, ,Rules and Regulations. Education efforts and warning, notices are attempts to gain voluntary compliance. Subsequent. violations will result in appropriate legal action by the Town. 1% , ..TOWN OF BARNSTABLE O BAR-W1823 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager ¢ t�,t�°t� ' /'� Address of Offender A�jP Y r , cefflam Ldre-MV/MB Reg.# village/State/Zip i' yl ! ,. Business Name t t/pmr; ony 19 , Business Address 7,,t,{_ � � .Lgriature of iiforc'-ng Officer Village/State/Zip , Location of Offense _, En of rcing -Dept/Division Offense 1 YC6 �.t'7ff l l l i 9 Facts 1 f� .y 41V, This will "serve only as a warning. At this time no l.egal 'actiori ha's been taken. `Its' is;, the goal of Town agencies to achieve voluntary compliance of Town Ordinances,-;Rules- and. Regulations. Education efforts-and warning notices.-are :' ..attempts to gain voluntary compliance. Subsequent'tviol'ations will resul'�`in ' appropriate -legal action, by the Town. J + r +4' � M TOWN OF BARNSTABLE ? r C'BAR_W 1823 k � Ordinance or Regulation c' WARNING NOTICE ..f Name of Of f ender/Manager , Address of Offender , r, ,ri/r(/�MV/MB Reg.# Village/State/Zip n o M, / ') _ '" .,, , Business Name 1. azk'7pon_ 19r, Business Address Signature of 'Enforcing Officer Village/State/Zip + ' Location of Offenset Enforcing Dept/Division Offense I'AlCr- 1 _ Facts M,A IVY 1 t 7) Pxr <'1 1ilu..�� (j f rP ��f � This will serve only as a warning: At this time no legal action has been taken. " It, is the goal of Town' agencies to achieve voluntary compliance of Town Ordinances, Rules and. Regulations. Education efforts and warning notices are attempts to Ngain voluntary compliance. Subsequent violations will resulf"in appropriate legal action by the Town. �. f J LtOA ATION SEWAGE PERMIT NO. V AGE v I N S T A IIER'S NAME i ADDRESS 6UILDE0 OR OWNER Alk DATE PERMIT ISSUED DATE C0MPl1ANCE ISSUED 1 23� i 201