The URL can be used to link to this page

Home My WebLink About0075 CLIFTON LANE - Health 75 CLIFTON LANE, CENTERVILLE A=247-156 No. 4210 1/3 ORA ESSELTE 10% 0 0 ® 0 ^2)DA s ' No. n Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pphratton for Dtgogal bpgtem Congtrurtton Vertu Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. "7 5 Owner's Name,Address ands No. Assessor's Map/Parceloe2c�/ /�w.w.,t 7 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms P'g�' 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 Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 iss by this B d He Signed Date Application Approved by Date Application Disapproved forte fol owing reasons Permit No. Date Issued °? —t;z f .y Q/ 'f., /r-� No. ..... f C III� Fee _' � THE COMMONWEALTH OF MASSACHUSETTS , PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppri ratio n'for Migogar *pgtem Cottgtructiou 'Permit Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. ?5 C „ 7vft " Owner's Name,Address and,,,Iq No. i Assessor's Map/Parcel �ytc ya�2 S/'7/�,H,�,.f ?�S'GSZS� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. SG(/ UC4G",el A,,� Type of Building: - Dwelling No.of Bedrooms 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 Description of Soil t �`a Nature of Repairs or Alterations(Answer when applicable) 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 and o Heal ' Signed Date ,Zr-1- Application Approved by Date Application Disapproved for a fo ing reasons Permit No. 9V� Issued ? -<Z= g(v --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance JFHIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced(---j/on 7-/ �r by Installer at _ has been constructed in accordance with the provisions of Titl-tand the for.Disposal System Constructiori rmit No. -72.07 dated Date "'°Zit=/cz_ *!�4 Inspector THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYS- TEM WILL FUNCTION SATISFACTORY. ---------------------------------------- No. �l4 �71�Q7 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migogar *pgtem Cougtruction Permit Permission is hereby granted to construct( )repair( an On-site Sewage System located at No.# ,"'- C� �,.t � IF Street and as described in the above Application for Disposal System Construction Permit. No. Date The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. a All construction must be completed within three years of the date below. Date:. 7 / — ..-Approved by ' Board of Health j i CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I, hereby certify that the application for disposal works construction permit signed by me dated "1— 1 -2— , concerning the � � `property located at '7 s � ��u.o 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 fat of the proposed'septic system • The observed groundwater table is 14 fat 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. OF SIGNED : DATE: . 7 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]. jr 1 1•i 3 �.c��i,c ti 6 cl TOWN OF BARNSTABLE LOCATION:— 3 C C L f f r® �tl�;9 SEWAGE # W VII,LAGE_ i/ �.� ASSESSOR'S MAP & LOT ' I�"�J�' INSTALLER'S NAME&-PHONE NO. �cl�aS C Oa SEPTIC TANK CAPACITY S®n LEACHING FACII.TTY: (type) ( g m. f j e>V (size) !a x 'Y® NO.OF BEDROOMS BUILDER OR OWNS PERMTTDATE: 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 wetland's exist within 300 feet of leaching facility) Feet } O Furnished by " _� 4? \.�� 1i r V� } l s Q �� . r g � � � � - - . _ . _ J6 0' A& 0 c) Yzic .. ...... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ....................... . .............O F.........................------.......---------------------..........---•--.............•- Appliration for Mivosa1 Works Toustrur#inn lirrutit Application is hereby made for a Permit to Construct ( ) or Repair �an Individual Sewage Disposal System at S' c_\, 4L ..................................Locatio dress or Lot No. ` .� a�o�---�..._ ------�rg�l�.S ...... ......... S.... .4- \\ Owner A ress . ------ _ ....VM. . -- --- Installer Addres Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ .Showers ( ) — Cafeteria ( ) � Other fixtures .----•-------------------------•---•-------------••--------•-••-••-------•----------•----•-•••---•-•--------------------•-••••-•-----•---•-------•--- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capacity____.__.....gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No-----------_------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) - Percolation Test Results Performed by.......................................................................... Date....................................... Test Pit No. 1................minutes per inch Depth of Test Pit---------_.......... Depth to ground water---___--___-___----_---. (T4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water,....................... x - •---------- O Description of Soil.................{ � �.�- - --------•----•--- - ••-------------------------------•--------------------...._....---------•--------•--•------...-------..... •••-•...•-- -------••-----•--------------------------------------------------------------------------------------------------------------------•-•- U ---------•-----------------------------------------------------------•----•------•---....-----------....--------------......----•-------------------------------------------•-•--------•--------------- UW --------------------------------------- ii Nature of Repairs or Al erations— swer when applicable __ �S'�.�-___�S ca 1?�l0 -----s t. ._ - ...... . 0 w Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iT i l_Z4 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has On issued ky the board of health. Signed.- Q- --- , a .....................--------))n -----•---- _ Date Application Approved By.............. .... ... j---------•-----•-•--------•------•- Date Application Disapprovedf or the following reasons-----------------------------------=--------------------•----------•-------------------------••-•-----•........_ ......-•--•----------------•-----....-----....__...---------•-------------•----------------------------- Date PermitNo....87.-...V-92---------------------------- Issued....................................................... Date CA T O �..o I i ! F B��....�.....�.. ' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................... ..................OF........................................ ........... Apptira#iun for Kliupuua1 Workri Tonitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ^an Individual Sewage Disposal System at: .............. `............ �. ...._.. ---- ......................................... T�L'�ocatic ddress ........�. ° _. _ or Lot No. dot I f i ....... i . - .:.._..._ ..:... ........................................... i , Owner r 1I Address �^� ,.� .. InstaIIer _ ...... . ... ..... � Addres UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures -------------------------------•-----•----------....--•---•-......•••••----•--•--•-•--...-----•--•---------•---------••---••-----••--•-•-------------. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ODescription of Soil (a� ......... ...•----•••----•--------------------------------•-----•----•----•••----- -•-•-•--•--•-•-••-......---•-•.---.-----••- x - ----------------------- a, Nature of Repairs or Alterations— saver when apphcabl ______________ __________`_____....,_.:.___:___--_-_.-______-- _-_._.. ----------------- 06C 0�' ....................... Agreement: The undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance with the provisions of L_111 _ ; of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has en issued.by the board of health. Signed. ..0 ti. .._.......OQn�✓1. }--- u' t --•- ................................ Application Approved By.............. ._ _.. fA_.�_c- .... ...................Date-------------- Date Application Disapproved for the following reasons:---••--------••-•--••---•-•---••-------...•-----...•----•••.............•-•--------.......................... --•-••-•-•-•---•-••--••---------••--------•-•--.....-•••--•--...--•--------------•--------•-•---•-----••-I...........................-................................................................... _ Date PermitNo...5.7.-:_.. ............................ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ ...........OF. .................................... (9rdifiratr of Tomplionrr IS TO CERTIFY, That the nd:vidual Sewage Disposal System constructed ( ) or Repaired by -= .-- .......................I......................---'.'-�.'..... �"�------:........Y...................................................... � � Install- �j S ~! G, e '.. .� has been installed in accordance with the provisions of T i T 1E j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated_.-............................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE................. ?..-�3,P.. .. .............................. Inspector.....�- --- ..... - -------------•--• .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH firOF No.?2M.....11. FEE �iu�ou�1 Turku C�onu�rnr#uan rrutit Permission is hereby granted........ = -1�........ ::_, ' ------•-------------•--....---------.....------.....---.......------. to Construct ( ) or Repair >e) an Individual Sewage Disposal System r No Street ( as shown on the application for Disposal Works Construction Permit No('?2 ? -_- Dated.......................................... ........................... � . `_.. . .. ------------------ —board o[ Health�� DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS < F, U TOWN OF BARNSTABLE LOCATION S^ c-� j�,� 4� SEWAGE # �� VILLAGE ASSESSOR'S MAP & LO INSTALLER'S NAME & PHONE NO.Cr rI� 1"C C1LS. SEPTIC TANK CAPACITY SRO -D LEACHING FACILITY:(type) _ ` (size) , 0 C7-0 NO. OF BEDROOMS PRIVATE WE L OR PPUBLIC WATER BUILDER OR OWNER U "L-A -t ` ` ) �,i?� DATE PERMIT ISSUED: 7 t 7 DATE .COMPLIANCE ISSUED: - ?, 9 7 VARIANCE GRANTED: Yes No i/"f CX40 f,e"o,