The URL can be used to link to this page

Home My WebLink About0025 CHADWICK AVENUE - Health 25 Chadwick Avenue Centerville A = 246 - 068 S M EAD® No.2-153LOR UPC 12534 ameadcom • Made In USA _ f No. ZJ'S Z Fee 19 v I THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zippfication for Mtopw6af *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. C Owner's Name,Address and(Te/l.No. Assessor's Map/Parcel -Tr A p JL '`''^-' Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 0A C j PV f- C 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 ��i� gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ) OW 5..7% Type of S.A.S. 30 0 Description of Soil Nature of Re airs or Alterations(Answer wheV applicable) •� 5 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 onmental Code and not to place the system in operation until a Certifi- cate of Compliance has a lth. Signed Date CG �?� Application Approved by _ Date 9' " Application Disapproved for the following reasons Permit No. _5 3 Z — Date Issued — 7 Fee S0 No. �'g / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ it _ Yes PUBLIC HEALTH DIVISION —TOWN OF BARNSTABLE., MASSACHUSETTS— 0[ppYication for Mioozal *pgtem Cow5truction permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.Q�shoc Owner's Name,Address and Tel.No. Assessor's Map/Parcel 2_ W -0(p Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. r 0 -C aA f,,-a S-eP-r\C_i \� 5 Sect 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 1 gallons per day. Calculated daily flow ' gallons. Plan Date Number of sheets Revision Date Title r Size of Septic Tank , ` t ' Type of S.A.S. Description of Soil Nature o�fReppairs or Alterations(Answer wh n applicable) ®D S� 6�- 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 he-Envvironme tal Code and not to place the system in operation until a Certifi- cate of Compliance h een tssued b'y flitI alth. -- —�" Signed Date q7-M) Application Approved by Date 9'' Application Disapproved for the following reasons y� Permit No. Z14Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS , ARNSTABLE, MASSACHUSETTS Certificate of Compliand' r THIS IS TO CE lFYrthat the Ow site Sewage D spos�l System Constructed( )Repaire )Upgraded( ) Abandoned .�Lby �- I - 1 �.t at �. , ` has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit NOT-~ _S dated �' 7- Installer ! Designer 1� ! N ) The issuance of th s p�rmit shall not be construed as a gi arantee that the }stem,will function as�Jesigried. Date ;1 � -✓ InspectorU PIWA� �f f - ----- ------------------------ No. .' Fee t THE COMMONWEALTH OF MASSACHUSETTS Z G -bG PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS } jBigo5al *pgtem -ngtruction permit Permission is hereby gr to Cpas)ct J Re air Upgr ( )Abandon( ) s System located at 'M'C �� r andfas 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 cotidEtibns. 4rovided:Constructi mus be completed within three years of the date of thi e it. Date: Approved by G Lak + 1/6/99 NOTICE: This Form Is To ge Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL L WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) r- - I hereby certify that the application for disposal works construction permit signed by me dated q7—cf V , concerning the property located at o� c-L& L i24(Z_k 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) l ,-7 B) G.W. Elevation )iy +the MAX. High G.W. Adjustment.A f DIFFERENCE BETWEEN A and B d , SIGNED : DATE: ?r� [Please Sketch pro sed plan of 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 . �dtiT 1 da a f TOWN OF BARNSTABLE i LOCATION o,�� SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. Q7 SEPTIC TANK CAPACITY _-_jsc�0 LEACHING FACILITY: ( pe) /�r/�/,7,C�%OiC' S' (size) NO. OF BEDROOMS o BUILDER OR OWNS C PERMIT DATE: COMPLIANCE DATE: 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 F/ V .