The URL can be used to link to this page

Home My WebLink About0043 BACON LANE - Health 43 BACON LANE CENTERVILLE A = 207 018 UPC 12534 No.2-153LM NASTING9,YN No. woo—( Feed/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: VYes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for Migpogar *p$tern Congtruction Permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. iv.? (2 4 Ar se>AdQressd Tel 'N t"o SAssessor's Map/Parcel k� / (►J &�) (�,.? (3,,C-,,,^, L� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinderl� 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 Natu of Repairs or Alterations(Answer when a licable) �D G -�- e.1C�b VLvyj C e Q'000 L. LIJ Caen V T6 .Pe— C-�-t--or T. .j- (.( 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 Environment - e-and not to place the system in operation until a Certifi- cate of Compliance has been iss - by this oard of Heal S Date /Ir �G Signed Application Approved by Date Application Disapproved for a following reasons 61 Permit No. Date Issued 1 O� No. ' Fee-9 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0[ppricatiou for Migo5ar *p5tem Cow6truction Permit Application for a Permit to Construct( )Repair(Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. wne 's N e, res d Tel.N . Assessor's Map/Parcel Installer's Name,,,Address,and Tel.No. Designer's Name,Address and Tel.No. V, Type of Building: Dwelling No.of Bedrooms l 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 Nature of Repairs or Alterations(Answer when a licaabble) �D LC- --' e K(��t^`'! �S�dU L 1�C� Cx�� @�. �� \c�VX Zn ��I'�'t.`�'C�rT W cl '1 � s v+ �u w_ 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 Environme and not to place the system in operation until a Certifi- cate of Compliance has been is d by this j3oaxd of Hea Signed i a Date Application Approved by 1 / Date Application Disapproved for the following reasons0' T Permit No. Date Issued If zw ------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the O -site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by \LU U t"`V('ys f e1 at 43 r'-, C \ has9dated constructed in accordance with the rovisions of Title 5 and the for Disposal System Construction Permit No InstallerCvk �-N Designer The issuance of this per t jsha e t be cot►tstrued as a guarantee that t ys w' 1 f- cti n as�� 'gne� Date VV'' 4 CC// Inspector i C U l —— ———— ---------------------------- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS lwigogal *pgtem Cou.5truction Permit Permission is hereby granted to Construct( )Repair(V)Upgrade( )Abandon( ) System located at f3 A G Un Lam— CA.,—i-u'V 1 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. Provide rstru f'bn us be completed within three years of the date of t I Date: �v Approved by 1/6/99 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 PERIMIT (WITHOUT DESIGNED PLAN w n hereby certify that the application for disposal works construction permit signed by me dated f f V (OQ , concerning the property located at � ` �� _0,— C-<Ao� � meets all of the following criteria: • 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 4" There are no private wells within 150 feet of the proposed septic system L 9/' There is no increase in flow and/or change in use proposed _ Y 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] y 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) y / B) G.W.Elevation _+the MAX. High G.W. Adjustment. DIFFERENCE BETWEEN A and B 3 a 3 <�JSIGNED : DATE: [Please Ske 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 �� •� � �� Q b Q J _\ �/�?Q� Y ` �4 v �. V n TOWN OF BARNSTABLE LOCATION �4 3 vim.co' n A SEWAGE # �600 VILLAGE rssc--Ax•,j��N k_ ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY �770 0, GGA LEACHING FACILITY: (type) L-�NQ—*\fit cz. & (size) GJ LA « js' �. NO.OF BEDROOMS � lr�C' ''S V",O tr � � BUILDER OR OWNER ZOO D exm(or n 1 'O PERMITDATE: .�, I o 0 COMPLIANCE DATE: Separation Distance Between the: { . Maximurn,Adjusted Groundwater Table and Bottoin of Leaching Facility 3 o Feet sPrivatei aier Supply Well and Leaching Facility (If any wells exist- p � on site or within 200 feet of leaching facility) I V y Ae Feet Edge'of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching f cility) �� Feet Furnished byt\ 0 �9� O � � nc:v TOWN OF BARNSTABLE LOCATION wn SEWAGE # VILLAGE C-Z ASSESSOR'S MAP & LOT f INSTALLER'S NAME&PHONE NO. Ln i SEPTIC TANK CAPACITY QOX LEACHING FACILITY: (type) W7-�Cm,.��ti. frS- (size) L.Z LA NO. OF BEDROOMS v>\o CT BUILDER OR OWNER �7 CAM 6r�i t a PERMITDATE: �4 C5 O COMPLIANCE DATE: / SS/O U Separation Distance Between the: . Maximum Adjusted Groundwater Table and Bottom of Leaching Facility n Feet Private:Water Supply Well and Leaching Facility (If any wells exist AA � on site or within 200 feet of leaching facility) IV C)nB Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching f cility) ij C) Feet Furnished by s O p ..E::E 3c2 � z ox yl