HomeMy WebLinkAbout0033 CENTERVILLE AVENUE - Health 33 CENTERVILLE AVE. ,A=246-010 CENTERVILLE
{"
1
i
i
I
No. 42101/3 ORA
ESSELTE
10%
(a
O O 0 0
3AP ,r Fee
"THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
2pplication for Zigool *patent Conotructiort permit
Application is hereby made for a Permit to Construct( )or Repair(fo)an On-site Sewage Disposal System at:
Location Address or Lot No. y 3 6-e#1ew1/ e ,1W Owner's Name,A dress and el.No.
�� �p,^e ���'
Assessor's Map/Parcel G ei 3,3 Ce-&=1/1,e Q
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Garbage Grinder( �
Other Type of Building �C 1GG��4A!?-N of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow Ile gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Description of Soil
Na re o Repairs or Alteration Answer when applicable)
/ -ram ets Al # .O
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 oar H th.
Signed Date
Application Approved by Date �'' 96
Application Disapproved for the following reasons
Permit No. Date Issued
..r 4�
No. 0I6 - 3 � b
-r Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -TOWN_OF BARNSTABLE-,L•MASSACHUkSETTS
' 0[ppficattou for Otgponl *pgtem Con!6truction Fermat
Application is hereby made for a Permit to Construct( )or Repair(t/)an On-site Sewage Disposal System at:
Location Address or Lot No. 33 C&#► e '(/l/ e AOW Owner's Name,Address and el.No.
.¢de �JOr ay Sr'
Assessor's Map/Parcel %/
c ee Iry 3 3 ce& e?
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Garbage Grinder(Vl�le
Other Type of Building I�IP_.51fIGPNo.of Persons Showers( ) Cafeteria( )
Other Fixtures
i
Design Flow Ile gallons per day. Calculated daily flow 3 3O gallons.
Plan Date Number of sheets Revision Date
Title
{
Description of Soil
t Nature of Repairs or Alterations.,Answer when applicable)
33 4-X 2 d
� 4 �
Date last inspected:
i
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 iss ard-af He th. _ j� /
Signed s Date J f
Application Approved by Date -P
Application Disapproved for the following reasons
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
a
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Dispos System ins ailed( `•)or repaired/replaced( on
by Installer
�/',S�D1 �4y�
at L3: C h �-e°r v i/�. C7y{P_ �u�'•9 TEE'✓vi��G has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction a flit No. (,-- 3 k-1 to
Date rp—-' , -A Inspecto ,
—�.--
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYS-
TEM WILL FUNCTION SATISFACTORY.
----------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
i PUBLIC HEALTH DIVISION . BARNSTABLE., MASSACHUSETTS
jBtqogar *pgtem Cougtructton Permit
Permission is hereby granted to l��l 7'�'LD, � G Oy✓`'
to construct( )repair( V)0an On-site Sewage System located at No.# eh Y"i, /1 4 v
Street
and as described in the above Application for Disposal System Construction Permit. 94
No. Date
The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions.
All construction must be completed within three years of the date below.
Date: �' `3 G, Approved by
Board of Health r
i
i
Li 41
v I
�v
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION I'EIN11'1't�Vl'1'IIOU'I' DESIGNED PLANS)
t, ����y' ,(�/ (� j�, hereby certify that the application for disposal works
construction signed ned by me dated r� ` , concerning the
p B
property located at 3,3 Gee&lylyle �2� meets all of the
following criteria:
/There are no wetlands within 300 feet of the proposed septic system
/Thcrenre no private welts within 150 feet of the proposed septic system
/The observed groundwater table is 14 feet or greater below the bottom of the leaching rocility
here is no increase in now and/or change in use proposed
There are no variances requested or needed.
SIGNED: DATE:
LICENSED SEPTI SYSTEM INSTALLER IN 714E TOWN OF BARNSTABLE NUMBER
(Attach a sketch plan of the proposed system. Also If the licensed installer posesses it certified plot plan,
this plan should be submitted).
s
` naa ✓� ',� r 3
qp
aiN i -', s: �t rgCid.•• x; r .2^n ?V,; h,;:
.4 its f.:t9✓ng'6kq $'S`A'.,y �'" f 'F: �:'� �. .„;+iJt r.;, 1..��yaL� 3 '' `•��+rd. �� �.�z^`^ .3 ,rn".� )nx �+._�1 3 �.w�7ytLy .� ,��C .,$�. xh Te s°v
.�.. .. Yam' k-'�.. #:' � ia � � a= Y .��..�,ss �x�' b't r' �• s��"�. �� •-,r��.-:
�, '-•e f +$`- b��p �'�t�'`�"'""�i:''Yes c b �§. �� F �Y�`a':ke� � 2 t� �, ��' h- .yg- �•`.� i��P .�("dv�. ram-i.<> +'4 ,�;
'a. .....a.-.• ".-7. ','' k:.. 'Sd..-+?x,., ba,;' :', �..,_.�i .n.� ,..... r,.a,, .#,.�v cN,.... x .'K-ltin. ,�.,. .w^ 'u-w :: u .,..., `-.�" 'e..
4 v7J �/ TOWN OF BARNSTABLE p
LOCATION 3 3 Get��'7e'l/Le �� SEWAGE # ��`
352
VILLAGE Ge-4 ASSESSOR'S MAP& LOT Z.e- i6— 0�D
INSTALLER'S NAME&PHONE NO. ,�®�" r �
SEPTIC TANK CAPACITY /11aD L
LEACHING FACILITY: (type) (size) 3 �J�Ok 1
NO.OF BEDROOMS JJ�
BUILDER OR OWNER ZS! , A?
PERMTTDATE: 19"f$—���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 le g facility) IV/it Feet
Furnished by .%���sl`%
L�
w
e
4
19.1
03s as
—3