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Home My WebLink About0038 CENTERVILLE AVENUE - Health 38 Centerville Ave Centerville A=246-012 S M E A D No.2.153LOR UPC 125U amoad.com Made In USA qfR IiD N 11i NIODULT t�E LF I NAM rf*SWK '°°aximm"s OOF TK SA PODGM No. / `� -`{ &/ Fee �Z TH'E COMMONWEALTH OF MASSACHUSETTS "'Bptered in computer: b ` Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE. MASSACHUSETTS Zipprication for 3Mzpozal *pztem Congtruction Permit Application for a Permit to Construct( )Repair((/S Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3 8 en f�rt/i � p(.e— Owner's Name,Address and Tel.No. Assessor's Map/Parcel tt1�1t N-y ark- Installer's Name,AddreAA 1k."NCO 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 3 fyJr gallons per day. Calculated daily flow .33o gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /DO o Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) TnS fp�� 3 �� O �n�i I f t X-fQ J`S ('S P,J� �Z �Sf�Yie �C/-dilm e f, /-,',rc, /Zselo 94-1 44221< 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 Board of Healt Signed V I Date /a - 1 1- el 6 Application Approved by 1 .C_ !/2=,- Date �.-2 l —e,C Application Disapproved for the following reasons Permit No. 6 ' le Date Issued _....... No. ��`� �/ wr � �'4 Fee VVV� THI COMMONWEALTH OF MASSACHUSETTS entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS Rpprication for 0igpogar *pgtem Congtruction Permit Application for a Permit to Construct( )Repair(Upgrade( )Abandon( ) El Complete System E Individual Components Location Address or Lot No. 3 8 en-left/i ffe XW Owner's Name,Address and Tel.No. 7 3'12 Assessor's Map/Parceli le�t 14y ar-f-� ZQI+a"Ls(<c'.s Installer's Name,Address,AcVVA N00 Designer's Name,Address and Tel.No. 411 W, MA Type of Building: x Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder(. ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures j Design Flow 3w 7 gallons per day. Calculated daily flow 33d gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /DG n Type of S.A.S. Description of Soil R 1 i Nature of Repairs or Alterations(Answer when applicable)T n.S f,q�f' 3 ` �� y 1, 4t f r) t 01"S e7 rs !,J/ 41 j7/a)l 12F"C: �,rit ,'� G /oao EA 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 Board of Healt.. Signed �LIAMA)_ Date /-) Application Approved by Date Application Disapproved for the following reasons Permit No. Y6 ' 667 Date Issued Ik --------------------------------------- a THE COMMONWEALTH OF MASSACHUSETTS ! BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( )Repaired ( ✓j Upgraded( ) Abandoned( )b O/g1je U at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 9 G'6 G 7 dated ,/-> Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date '7 Inspector _-----------------------------------Fee-----(' S No. 9 U THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migpogal 6pgtem Congtruction Permit Permission is hereby granted to Con sct( )Repair(✓j Upgrade( )Abandon( ) t System located at p) fP (/-e 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 thlUermit. Date: / �fl- �G Approved by l P 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 /9 . 9 6 , concerning the property located at meets all of the following criteria: There are no wetlands within 300 feet of the proposed septic system / There are no private wells within 150 feet of the proposed septic system The observed groundwater table is 14 feet or greater below the bottom of the leaching facility There is no increase in flow and/or change in use proposed /• There are no variances requested or needed. SIGNED : " °J C. DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. Q�� l b ox o Ale� Arco- it SEPTIC SYSTEM DESIGN-- .� RarDi �rS A?' .. G AL/DAYI BBDJOOM _ .. GAL/DAY S_ FPTIC TANK: GAL/DAB' x 2 DAYS GA USE GALLON SKPT IC TANK ,LEACHING ARZA.' USE 8 INFILTRATORS AX I MI ZBR CHAMBf 1RS WITH V Off' STONE ALL AROUND if x Z DEEP) SIDE .AREA: So + tl 2 -x 2 164 (.74) GAL/DAY B rTOM ARIA: XT x If .74) nr 244 GAL/DAY CAPACM CAL/DAY 1 TOWN OF BARNSTABLE LOCATION e�' � - /�1C(� SEWAGE # 'S MAP&LOT a VILLAGE l� 04 r ASSESSOR I �- INSTALLER'S NAME&PHONE NO./�24irCy 7 e7S 2 IFOy SEP-`I`01ANK CAPACITY LEACHING FACILITY: (type) , Ze"1�5 (size) ,5 X A NO.OF BEDROOMS PERIvITTDATE: 7-_ I� COMPLIANCE DATE: 1' 6 ' / 7 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Ater Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge 0.Wetland and Leaching Facility(If any wetlands exist within.-300 feet of leaching facility) Feet Furnished by y: 38 a� 0 c�3 30' TOWN OF BARNSTABLE LOCATION � e✓' e 1 A� Ave, SEWAGE # 66 : .VILLAGE �D� ASSESSOR'S MAP & LOT VN- 6I �- INSTALLER'S NAME&PH NE NO./f ��nCfi' SOU SEPTIC TANK CAPACITY Ii 12,0,Q 9//O,�7.S LEACHING FACILITY: (type) 3 10,W Pll Z 9 s (size)�, 5 -X l/ x,;2, NO.OF BEDROOMS BUILDER O OWNS :2�4 rZAU5111,AJc PERMTTDATE: If - 7 ,62_COMPLIANCE DATE: / ° 6 ' 7 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 K- 0 C�3 30 i' SY ----------------- � � o TOWN OF BARNSTABLE LOCATION &il� ASEWAGE# VILLAGE t ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY a LEACHING FACILITY:(type) .. (size) ervz� , NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER R OR OWNER �7'd,��'°�� DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No se �gAj56� i a ` 3a� 4'f