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Home My WebLink About0140 BUCKSKIN PATH - Health 140 BUCKSKIN PATH, CENTERVILLE A = UPC 12534 NU. 2�QfR �9isrCONs�`� HASTINGS. UN TOWN OF BARNSTABLE LOCATION jqQ 61;;cCS4C,►U `Dram - SEWAGE # VILLAGE ASSESSOR'S MAP & LOT`40�nq INSTALLER'S NAME&PHONE NO. ;, i tiSO S�f�;'tL _T) S--`6 -7 7 SEPTIC TANK CAPACITY (SO 10 LEACHING FACILITY: (type) (size) A A t ZL 3_S NO. OF BEDROOMS 2- BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE: 11 a 4 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 Ir 0 J J� V V No. Fee 5 0 THE COMMONWEALTH OF MASSACHUSETT9 Entered in computer: ✓ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2ppriratton for �Dtoogar *raem Conaruction 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. 140 Buckskin Path, Centerville Neilson Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E . Robinson Septic Service P 0 Box 1089, Centerville 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 Type of S.A.S. Description of Soil Sand Nature of Repairs or Alterations(Answer when applicable) Title-5 septic system, consisting of a tank, D-box and. 2 leach chambers 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 oar of Health. Signed Date I;X`2 Q7 Application Approved by ate Application Disapproved for the following reasons Permit No. Date Issued - f nt - . 50 No. _ Fee 01 THE COMMONWEALTH OF MASSACHUSETT Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYication for Mitpozal *pztem Couttruction Permit Application for a Permit to Construct( )Repair(X)Upgrade( )AbaMon•S f) ❑Complete System ❑Individual Components Location Address or Lot No. Owners Name,Address and Tel.No. 140 Buckskin Path, Centerville '_`lgeilson Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service P 0 Box 1089, Centerville 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 Type of S.A.S. Description of Soil Sand. " Nature of Repairs or Alterations(Answer when applicable) Title-5 septic system, consisting of a tank, D-box and 2 leach chambers 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 oar of Health. Signed Date /;L—2— 4'I 2 Application Approved by ` to Application Disapproved for the following reasons h Permit No. ` Date Issued ----------------------- ---------------- THE COMMONWEALTH OF MASSACHUSETTS Ne ilson BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( X)Upgraded( ) Abandoned( )by Wm. E . Robinson' Septic Service at 140 Bucks In Pa h, Centerville has b constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ated Installer Wm. E. Robinson S r. Designer The issuance of this p t shill of V21`?s - ed as a guarantee that the js�/4f=i>will unction as designed, Date Inspector r r f�. f — ____ —No. .rs Fee t50 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -`BARNSTABLE,, MASSACHUSETTS Neilson lwigozar *pgtem Construction Permit Permission is hereby granted to Construct( )Repair( X)Upgrade( )Abandon( ) System located at 140 Buckskin Path , (1Pi;tPrvi11a and as described in the above Application for Disposal System Construction Permit.The applicant recogn'zes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction st e c d within three years of the date of s Date: Approved by f � • , I r 116/99 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 PERMIT(WITHOUT DESIGNED PLANS) l W i l l ianl E Robinson ,S,rhereby certify that the application for disposal works construction permit signed by me dated 1,-A: 9 concerning the property located at 1 4. 1-" R t i n k c k i n 12@-th, g e nt e r-;4 94 a 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 septic 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 I eaching facility will not be located less than founeen(14) feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface§Ievation(using GIS information) B) G.W.Elevation +the MAX. High G.W. Adjustment . _ DIFFERENCE BETWEEN A and B SIGNED : /1-" DATE: [Sketch proposed plan of system on back). — q:health folder:cert +y, �' '.�l o�� 1 ��e r � � G� W t � _ . TOWN OF BARNSTABLE °C• I LOCATION SEWAGE # 3 VILLAG ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. ,&612SQhs �CER UC 72 S—T`7'7C SEPTIC TANK CAPACITY 1S00 LEACHING FACILITY: (type) ,�1/i,JC t�S (size) AA l a 7`,-� S NO. OF BEDROOMS Z _BUILDER OR OWNERS PERMTTDATE: 1a /C,, COMPLIANCE DATE: h I a 9 9 J t Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well 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 r _ __: _ �3Ar1� O� !-luvSE •� � �yi • �• r O 3� �r � �F� a � •� , I ��