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Home My WebLink About0005 AUTUMN DRIVE - Health 5 AUTUMN DRIVE CENTERVILLE A = 167 005 Owirford, NO. 1521/3 ORA w ,�..,..`�,,. fit .� ._... ...... ...,. _. ._v., ..; ..z.:'�•�""w.-,.•+--- •.n. (1 1. No. ��' /G Fee s. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Zipphratton for Mtgool *p!tem Comarurtton Vermtt Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. ��, v0Vle/p•4e Owner's Name,Address ^- \ Assessor's Map/Parcel 16 Z Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ;L 3 Type of Building: Dwelling No.of Bedrooms 13 Lot Size b �6 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 Type of S.A.S. y- /a J4 Description of Soil 5 i Nature of Repairs or Alterations(Answer when a licable) 7 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 provision of Tt 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss ed by th s. oar H th. _ Signed Date Application Approve Date Z?2;ejL-, Application Disapproved for the following reasons Permit No. Date Issued _ TOWN OF BARNSTABLE LOCATION :. . 1 `7 SEWAGE # 1 VILLAGE�d'� ASSESSOR'S MAP & LOT w INSTALLER'S NAME&PHONE NO. �S PTIC TANK CAPACITY LEACHING FACILITY: (type).:-T-- (size) NO. OF BEDROOMS 3 BUILDER OR OWNER k V PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility j "• Private Water Supply Well and LeachingFacility Feet ty (If any wells exist on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility '�w Feet. within 3W feet of leaching facifi (if,any wetlands exist Furnished.by.. J .r. __Feet �'• .... - --oh i L2 i 19 4d '1 No. .G. �.�ri.i Fee - THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pprication for Migonl 6p-5tem (fongtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Cam' —,,Al/tj / Owner's Name,Address and Tel.No. Assessor's Map/Parcel /6 Z-aGS Installer's Name,Address,and Tel.No. Designer's:Name,Address and Tel.No. _J_p 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 O O Type of S.A.S. w- Description of Soil Nature of Repairs or Alterations(Answer when ar licable)- OVI 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 o Tit IN5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by th. oard Hey.th. Signed _ / '' Date Application Approved b Date Application Disapproved Disapproved for the following reasons Permit No. Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (tompliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired (x)Upgraded( ) Abandoned( )by —7 M at 1 has been constructed in accordance with the provisi ns of Title 5 and the for Disposal System Construction Permit dated Z<-C� Installer L.1 "ef-2, 1224-7z.4/ Designer i T. The issuance of th's permit sh 11 not be construed as a guarantee that the system will function as,46sigri(e1d:�j�' ' ; ) r' Date C a Inspector ___- No. ;V o" r-; /o Fee �✓ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lisspoar *pgtern Con.5truction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon System located at -�.u,.� �ti. ✓e•�C.` 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 jbi eit. - `!Date: Approved + 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FORA DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, f hereby certify that the application for disposal works constlion permit signed b me dated p g y /L= :zZ- _-2 cc9a , concerning the property located at 5- A _,� meets all of the following criteria: *0, This 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 septic system • There are no private wells within 150 feet of the proposed septic system here is no increase in flow and/or change in use proposed /`There are no variances requested or needed. �h 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) �U B) G.W. Elevation +the MAX. High G.W. Adjustment. i DIFFERENCE BETWEEN A and B U SIGNED: DATE; -W-7—2 AC [Please Sketch propos 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 r L.J : C X/ JV O 4 TOWN OF BARNSTABLE •C• I LOCATION C-4 a:L-4d A) V/e' SEWAGE # VR.L:AGE C-s,41 ASSESSOR'S MAP& LOTJK--� INSTALLER'S NAME&PHONE NO. r M en ?xi _ � SEPTIC TANK CAPACITY 6 LEACHING FACILITY: (type) (size) k NO.OF BEDROOMS BUILDER OR OWNER fL o u l- 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) 366 ' Feet Furnished by 16 30 t2 ` ��