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Home My WebLink About0251 CEDRIC ROAD - Health 251 CEDRIC RD.,CENTERVILLE t A=148.092 LIPC 12543 No, 53LOR +� HASTINGS, h9N No.;•M Z Fee 5 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: • Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for Migaal *p5tem Cottgtruction 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. Centerville , MA John Rego Assessor's Map/Parcel 251 Cedric R d.. ,Centerville, MA Installer's Name Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service P.O. Box 1089, Centerville , MA Type of Building: Dwelling No.of Bedrooms 2/3 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 S and. Nature of Repairs or Alterations(Answer when applicable) Title 5 se tic system D—bOx and. 2 stone packed. leach chambers . $d c�� 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 B dof Health. ltj „/ Signed s�V Date Application Approved by Date Z Z� Application Disapproved for the following reasons Permit No. Date Issued *No. y^a^-• " Fee$5 0 1 t THE COMMONWEALTH OF MASSACHUSETT!§ Entered in computer: —�/ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 0(ppYication for Mi-4potal 6potem Construction Vermit Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Cedric Owner's Name,Address and Tel.No. Centerville , MA ' John Rego Assessor's Map/Parcel 251 Cedric R d.. ,Centerville, MA Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service P.o. Box 1089, Centerville, MA Type of Building: Dwelling No.of Bedrooms 2/3 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 s)rstem_..•D1-boy�. and. 2 stonepacked. leach chambers. Sdr� �a1/ �Cu b� ln2S 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 Bdjpf Health. 1 Signed Gt/ Dde .•�� _ Application Approved by `Date J Z Z 1 Application Disapproved for the following reasons Permit No. Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS Rego BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the,On-site Sewa e pisposal System Constructed( )Repaired ( X )Upgraded( ) Ab ned b Wm. E. Robinson Sep Service 'j� Ciyc a . , Centerville at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. IN dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date 12 a ),:IL- 9 Inspector Q No. f �' Fee $5 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Rego lwigotal *p.5tem Construction Vermit Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( ) Systemlocatedat 251 Cedric Rd.. , Centerville, MA 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: % ? 7- Approved by 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) I, William E. Robinson, Sr. ,hereby certify that the application for disposal works construction permit signed by me dated �oZ/` concerning the property located at 251 Cedric Road, Centerville, MA meets all of the following criteria: * There are no wetlands 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 with 250 feet of any 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 Elevation(according to the Engineering Division G.I.S. map) B)Observed Groundwater Table Evaluation(according to Health Division well map) i SIGNED: /' DATE LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 60 (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). J 77 TOWN OF BARNSTABLE LOCATION S ( C �„ 2ti C C�r)r�7 SEWAGE # VII.LAGE_ ASSESSOR'S MAP & LOT INSTALLER'S ER'S NAME&PHONE NO. W M (?t J 'oA/ S n�,C 7 7 S_q-7 7 L, SEPTIC TANK CAPACITY l. 0 0,U LEACHING FACILITY: (type)_Jr--a e (size) NO.OF BEDROOMS i BUILDER OR OWNER PERMITDATE:—i Z, /_ /4 COMPLIANCE DATE: l �- 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 o ' yL 7� 0 TOWN OF BARNSTABLE + LOCATION ('C—d f i(. , r) ) SEWAGE # Z VILLAGE C(;iv i g-ev i1 fi ASSESSOR'S MAP& LOT `yT-0%Z INSTALLER'S NAME&PHONE NO. UJM F( rwSyA/ SG/ 'i C `7`)S-10-7`)t, ., SEPTIC TANK CAPACITY l: oo LEACHING FACILrrY: (type) it--nCL CAr+A (size) 2�-i NJ NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: i ?-J a;)I9 F COMPLIANCE DATE:1 ZT 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 /��.� � � l�-��sc� ., i dos I, :�� 7� . ��- �`�o ` 6' . . O ,, ,