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Home My WebLink About0004 CAP'N LIJAH'S ROAD - Health q.CAWN LIJAH'S RD. CENTERVILLE A = 192 188 UPC 10259 �a No.H- HASTINGS. UN No. �J Fee SQ ^ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: zo � PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zippfication for �Digpogal *pgtem Congtructton Vertu Application for a Permit to Construct( )Repair( �de( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 4t� 614 p4 n /,j a kg S P Owner's Name,Add ss and Tel.No. CI — ( T� Cen4tt.V,ILe— rckC.- %rr-Y Assess'ar's Map/Parcel Installer's Name,Address AnlPONCANCO Designer's Name,Address and Tel.No. 350 Main Street W. Yarmouth, MA 02673 Type of Building: Dwelling No.of Bedrooms- 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 /uoo Gxrsa i—g Type of S.A.S. Description of Soil /✓t f j j. xan e Nature of Repairs or Alter tions(Answer when applicable) n a fA / t� 3 a X 4-v SUO 4a4 le2c C4A vt Fs w/ Y S -c ,.Z�' X 13 , S X 1 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 Environmep4al Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of e�lt Signed � Date 7 qY/ Application Approved by Date Application Disapproved f e following reaso Permit No. PaOnq Date Issued 1/6/99 a ' 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 hereby certify that the application for disposal works construction permit signed by me dated 6, �� o i concerning the r property located at /Q-P 4 i n L 1 .4 S 2 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 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 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) J B) G.W. Elevation a +the MAX. High G.W. Adjustment. 3.02 = z) F. 1c DIFFERENCE BETWEEN A and B • 0 SIGNED : 'I / DATE: IQ a [Please Sketch proposed plan oY 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 . . a L� A No. �— J .' � Fee �j V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Yes Appricatton for Dtgool *p.5tem Congtructton Vermtt Application for a Permit to Construct( )Repair( v4Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. C �J U h cll. /? Owner's Name,Add ss / and Tel.No. 1�'1 / - 1 � Ceo4erl;ILe � 7 J Cctt" Assessor's Map/Parcel d- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 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 /u o o (f x s g Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) !n f A a x �, SOO le4c� cl1 o..��e�S ��J� 4t S �an X 13 . ) X 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 al Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of a It Signed Date 7 Application Approved by Date Application Disapproved f e following reaso Permit No. Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certtf tcate of Compitance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( -f pgraded( ) Abandone ( )by 0 at �. C P / h n constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this a sh 11 not be construed as a guarantee that the syst 11 f 'o desig d. Date Inspector ------ ----------------------- No. Fee .� U THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Dt.5po5al *pgtem (flon5tructton Vermtt Permission is hereby granted to Construct( )Repair(grade( )Abandon System located at `Z �A;O�a Y A Fire �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: Construc on must a 7leted within three years of the date of t ' pe Date: r/) Approved by TOWN OF BARNSTABLE �- LOCATION SEWAGE # VILLAGE�'� ASSESSOR'S MAP 6z LOT IV Z INSTALLER'S NAME PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY LEACHING FACILITY:(type)�� AM��s (size) 2f X 13JXZ t✓ ,fydML- NO. OF BEDROOMS PRIVATE ELL OR PUBLIC WATER BUILDER OR OWNER L IN/ DATE PERMIT ISSUED: --7 DATE COMPLIANCE ISSUED: / _ 61 VARIANCE GRANTED: Yes No `OF '�.�- alp�• a ?J 4'1 SS. I T a#y O-OPT �i-P �l 6 I LO• AT ION ,� C SEWAGE P RMIT NO. �VI L AG E w ( ��E - INSL" ERIS NA E & AC RESS (Q.) B U I'l D E R OR OWN ER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED r o�• �e 04 Q�G ►J �`` Z ' z9 J TOWN OF BARNSTABLE F LOCATION ff //1/�C� � S � / SEWAGE # ��T VILLAGE��/V%LI�Z�l«�r ASSESSOR'S MAP & LOT INSTALLER'S NAME S& PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY C- y LEACHING FACILITYAtype)(-,i)S66 C4,4,gbe/J (size) 2 X 13/YZ NO. OF BEDROOMS PRIVATE ELL OR PUBLIC WATER OR OWNER Z /_ ER ,/ BUILD � C DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: r VARIANCE GRANTED.: Yes Na I o v .SS J