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Home My WebLink About0140 CLIFTON LANE - Health 140 CLIFTON LANE, CENTERVILLE A=247-014.001 //// UPC 12534 ° No.2153LCR4a HASTINGS.YN TOWN OF BARNSTABLE LOCATION 14 0 C I i F+ft v, I,ri SEWAGE # y VILLAGE (eNf9 WIl'%ASSESSOR'S MAP & LOVAI-b`q'00 INSTALLER'S NAME&PHONE NO.W v 1 60-e- f% SEPTIC TANK CAPACITY 1500 i I A5+,C. LEACHING FACILITY: (type) MAX i tni 2 e/S (size) NO,OF BEDROOMS .� BUILDER OR OWNER �i�'�rre� sr� PERMITDATE: .1o/;1� /1:3 COMPLIANCE DATE: I/1,41 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 '" . . • ''� r �� t6 v � �� _� -a��,��.s 3��,t�� 'h y No. ` l Fee$50 .00 THE COMMONWEALTH OF MASS VCHUSETTS Entered in computer: • Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(ppYication for Migpogal *pgtem Congtruction permit Application for a Permit to Construct( )Repair(x)Upgrade( )Abandon( ) El Complete System O Individual Components Location Address or Lot No. 1 4 O Clifton Ln Owner's Name,Address and Tel.No. (91 4) 4 7 8-3 5 5 6 W Hyannisport Joanne Trautmann Asses sor'sMap/Parce a 78 Maple Ave, Hastings-on-Hudson NY 6 Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. Wm E Robinson Sr Sept Sry PO Box 1089 Centerville MA 02632 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ng 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 Repair consisting of; 1500g tank, D-box, and three H-20 infiltraotrs. 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 thi j&Boaoof Healt Signed ` Date "-IT r Application Approved b . j� Date °� - l Application Disapproved for the following reasons IV Permit No. Date Issued `'`� V` N..• / Fee$5 0.00 °�r Entered in computer: THE COMMONWEAL'I I MASS HUSETTS Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Migoe;at bpztem Construction Permit Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) O Complete System 0 Individual Components Location Address or Lot No. 140 Clifton Ln Owner's Name,Address and Tel.No. (91 4)4 7 8-3 5 5 6 W Hyannisport Joanne Trautmann Assessor'sMap/Parce 78 Maple Ave, Hastings-on-Hudson NY 6 Installer's Name,Address,and No. 775-8776 Designer's Name,Address and Tel.No. Wm- E Rob nson:_S.r__Sept Sry PO BOX 1089:;:=Centerville MA 02632 Type of Building: ' r Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( n9) 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 a plicable) Title 5 Septic Repair consisting of; 1500g ta0l, D,bpx, and three H-20 infiltraotrs. 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 provisiong of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance Eds�been issued by Wh' loa,4 of Healt . Signed ' / ` Date ",7-3 Application Approved b Date Application Disapproved for the following reasons �P 1 ` i Permit No. '°` l Date Issued 74 v --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS s Trautmann BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(XX)Upgraded( ) Abandoned( )by' at 140 Cl i f ton Ln, W Hyannisport has been constructed in accordance�t� with the provisions of Title 5 and the for Disposal System Construction Permit N w dated01 " Installer Wm E Robinson Sr Sept Sry Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date `� Of -7 Inspector ' ----------------------------------- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE., MASSACHUSETTS Trautmann Mopoga[ *pgtem Con0tructton Permit Permission is hereby granted to Construct( )Repair(X35 Upgrade( )Abandon System located at 140 Clifton Ln W Hyannisport Installer: Wm E Robinson Sr Septic Servicdee 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 rmit. Date: 14P `� �' " Approved l r ' r 10/9/97 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) 1 ✓ " , hereby certify that the application for disposal works construction permit signed by me dated L�concerning the 1? g property located at l f 0 �' ' �� '� '� meets all of the following c 'teria: • T ere are o wetlands located within 100 feet of the proposed leaching facility rl�r� • re -no private wells within 150 feet of the proposed septic system ere is no increase in flow and/or change in use proposed • bT�erere no variances requested or needed. • If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will=be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. n Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) B)Observed Groundwater Table Elevation(according to Health Division well map) SIGNED: `�/ 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:health folder:cert a z•