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HomeMy WebLinkAbout1300 CRAIGVILLE BEACH ROAD - Health 1300 CRAIGVILLE BEACH RD. CENTERVILLE A = 207 073 i rrir co Al uu UPC 12534 No. 2-153LOR NA^STIMGS. UN Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipprfcation for 3igpool *patent Construction Permit Application for a Permit to Construct(vf Repair( )Upgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. /304 �j/`!q/y�//��/_=UE / Owner's Name,Address and Tel.No. Assessor's Map/Parcel G��rrt✓�/ice /?�/9�/C ��s D _ Installer's Name,Address,and Tel.No. Designer's Name,4ddress and Tel.No. �os�pLi l,�e 614elle_S Type of Building: Dwelling No.of Bedrooms ry Lot Size sq. ft. 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 Size of Septic Tank Type of S.A.S. Description of Soil Nature of IteDairs or Alterations(Answer when applica e) _11a1v 4fllwe Do ,4/, 52901 - d .S>bhio 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 pf He th. Signed Date el —.2�- ®Q Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued No - O A Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Yes 0(pplication for Migpoml Op.5tem Construction Permit Application for a Permit to Construct(vrRepair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /j'Q 0 ��r�� t/j/�_- � lj Owner's Name,Address and Tel.No. Assessor'sMap/Parcel ry �d7 07:�� Installer'sName,Addtess,,and.Tel.No. L/7'J-O�y� Designer's Name, ddress and Tel.No. J0.5 pl l)4 C/.s N � 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 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 Nature of epairs or Alterations(Answer when applica e) , i 1 oa-6,w vx- Date last inspected: Agree_went: 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,. oard f I 1 th :_ Signed.,- Date`S' Application Approved byt- Wigf /L Date Application Disapproved for the following reasons Permit No. Date Issued -------------------------------(------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS I_S TO CERTIFY,/that;the On,.site,Sewage Disposal System Constructed(G,,.)-Repaired( )Upgraded( ) Abandoned(l-' )b at fo - has been constructed in accordance with the provisions of Ti e 5 and the for Disposal System Construction PermitNo. (' ,-dated Installer .Ja-st,,eo4 `7� f�ahF��S Designer I > n The issuance of this permit shaWW071;e) e ced as a guarantee that the syste °will function a�s/designe� '\ Date Inspector T 44 , A No. 075 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS miopo.5al *pgtem Conotruction Permit Permission is hereby granted to Construct('Repair( )Upgrade( )Abandon( ) System located at 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 m st/be competed within three years of the date of this pe .'t. Date: / If Approved by 7-3 NOTICE: 'This Form Is To Be Used For the Repair Of Failed .Septic Systems Only. CERTMCATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS COr�`STRUCTTON PERMIT (WITHOUT DESIGNED PLANS) I, t,4,3,::; ,v ����"'��' hereby certify that the application for disposal works construction perrnit signed by me dated y— 2G— vU concerning the property located at e;-Wd A�91 meets all of the following criteria: S4jThe 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 C•' There,is no increase.in flow and/or change in use proposed There are no irahances requested or needed -The bottom of the proposed leaching facility will Mt be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor / method when applicable] L•' If the S.A.S. «011 be located with 250 feet of any vegetated leaching faciE y will DZ be located less than fourteen(1)feet mdbove the maximu a proposed groundwater t<<ble elevation, Please complete the following: a- A) Top of Ground Surface EIevation(using GIS information) I B) G.W. l;levadon�5 D +the MAX. High G,W. Adjustment. �'ER]ZlCE BETWEEN A and B ^� SIGNED DA (Sketch prop o'plan of TE: q:health road¢CMsystem on backj. W dc now it dw i y , t `"w�`,� °3�.'�va'Y TOWN OF BARNSTABLE ; °C® LOCATION 400 Z�P WlaVAA FK/i SEWAGE`# 60 -s 2G/ VILLAGE �_ ��1"���/��F ASSESSOR'S MAP &"LOT207 075 INSTALLER'S NAME&PHONE NO. '-17'7'0Y9? SEPTIC TANK CAPACITY 019y LEACHING FACILITY: (type) 3,32V 1/oW (size) .3.3 r3 NO. OF BEDROOMS , BUILDER OR OWNER Ofw--4- fllS PERMTTDATE: 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 ��. . - d .�' - - n � .� _ '�,w �,. � + '17d¢i -'� . �_ ' � 1 h � J � r . � � e � . �1 4- C,���y���,�- 3F�� �� f c, w N m " �P^1T o F Lon IsaftA MIN TO- �Et`w �C x.._r a7 cam. ,� a 2a .' ..� � ��� ..� x�..R+ �^-fie...��.�-,-� '.fy.�,•� �4i -�'"` a,e � �.�-•�.� ,� .�� .x�t �..��,'.�,�:�...�. C � '� ✓�'n'' fn�-'- 7i - � r ay -`-�; � .=:. � 3'..�4�'..�3�t q.s Tom`.- r - _-'�-.,�P�117".,- — :'.-" �-x-hs,-- 1-�x�'. "-'-�' '".Sz9 `r.""'S,�. '' '^-.r"�-,^ - ,::. � ,° "+- 'c-.>Y d r '^-asY.r-F�e' •x+`�" _`�I."� -c-^yrtx�' �„w-,,,x...L ' ��"5,�,,'�-�-- was . .. a'.»fi}f°Sd'�'", ..nj y. 'r i3'y�A">n 3sc,.� � ,� N k 'x. r ;- � rn�„�--.�"`,�-N-'� ! x`e-. s..•••.^"` r .,s:. `i��g3-.r 11l.: ti;�t e „a e i e a A 56 r ;,L,: �,, 3:z ...s, „� ram^ 'S:_ ,�- - .f�, x`^ Tgm,",��.^use-�.a..z �... z- r a......- . - ._ r a! t"fi" i- h _ r- - d - .-. -. . TOWN P"'A STABLE Y5 Z3 LOCATION 0 t/lI� ,C SEWAGE 00 2Gl r , ,r=. . VILLAGE rF�T of/"F ASSESSOR'S MAP.&LOT207 073 h, ,.. w INSTALIER'S.NAME&.PHONE NO. 'y7'� ©3y9 �ase'.m� ,�J 94vA4S ..7 - .. - - -., .. ... �� . '.:SEPTIC TANK CAPAETTY T `' } LEACHING FACMrrY• (type) 1,3770 � —_, ,_,I-- _y (Size). .3 3 r� Z3 -f NO.OF_BEDROOMS ,� ��-,.�,t1,��_'-':.--�;�',;..�'"'�--�L..--1-L.,,�iI,, E t ` �.J - - _-_ _ _—_—.__—___._-_.__-.—__.-_.-_ __.__—.-__ BUII.DER OR OWNER . � p. . . f 00: COMPLIANCE:-.DATE Y-28 i , f PERMTTDATE - Separagon Distance Between the -f I-i4 r - j .., �_'s [ "' blaxunum:Adlusted Groundwater Table to the Bottom of Leaching Facility -:, r Y . ..- ee n Private:Water Su I Well and-Leaching Facility (I my wells eusf }Y t r PP Y Feet J� Y �r ;; on site:or wttlun 200:feet of leaching faciLty a' "' I 7'`'�; '�;',r!T Edgy of Wetland and L,eacttmg Facility(If any wetlands east ` -� `�u , r, �,, "'- Feet pka€� ; r� T { within 300 f`e$t of leaelung face 2 a— -P, ^w r t�,,I ;,t m Fiirrushed by t C M 71 a ,r w -t LLa n 7 +s -T" t• 'a'3 f 1 ,a I E r ' i. si ti' Y sa ,- L 4.: f ; h' t s 1 Y ,,5 -a y t t 7� r� „ n v.S 9 , S Y 1 ft I I F i , aF ?Fx t is 'n !� , f .: i f F 2 Mtn ,,...t it '$ IS 1 H ;if F �,} 4 r mad r, .:- i. - .. „ _ 0 ' 'i t ...L [ .5 l Ff�. ; of id t t ; 0. 1 I t t�.yfi.1 G1 R ; - ,; r i ,y3 i'Ji iR_.t a ?. `1r J 11 Y. r x. .d /J/1���j/J -/��/�/Jw� .y 1 //)//y /L/) / i k .7 (J. ^i / �{ / • �I/ �Y/ 1A� ,;_ , x i [fir S ry, 1 jk ,..., r I Gi ,iC [.; (S i t �r4ft i yfS+t.�,Y_F Ye +.l elf .{1,:.'�.5„,�j 4"" s u ' �.. 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