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Home My WebLink About0058 DONEGAL CIRCLE - Health 58-Db 4j[IAL CIRCLI' CLNTERVILLE g A = 169 073 ,j UPC 12 34 No.2.153� R �n HASTINGS,MN 7- 407-3 No. Fee $50 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 0(ppYication for Oizponl *pgtem Construction Permit Application for a Permit to Construct( )Repair(x )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components L tion Address or Lot No. Owner's Name,Address and Tel.No. � Donegal Circle , Centerville , MP John Bearse Assessor's Map/Parcel 4.28-0 955 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. m. E. Robinson Septic Service PO Box 1089, Centerville , MA Type of Building: Dwelling No.of Bedrooms 2 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 S and. Nature of Repairs or Alterations(Answer when applicable) Title-5 Leach System consisting of 3 H 20 Cultexes and. a D- ox 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 Bo of Health. Signed Date a `q Application Approved by Date '2� Application Disapproved for the following reasons Permit No. Date Issued TOWN OF BARNSTABLE LOCATION/5 ✓/L'�1 �;G� C, t SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO._ Cc>syh Inc �r1�,i�i� ,` ,�!- 7 7 y- Y SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER 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 ^ty l Cft i I ;_ CI 7-3 No. Fee $50 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. Yes r !PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS,, Zippricatiou for MiZpo5al *pgtem (Eougtructiou Permit Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components L tion Address or Lot No Owner's Name,Address and Tel.No. Donegal Circle, Centerville, MP John Bearse Assessor's Map/Parcel 428-0 955 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. m. E. Robinson Septic Service PO 'Box 1089, Centerville, MA Type of Building: Dwelling No.of Bedrooms 2 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 Sand Nature of Repairs orAlterati ns(Answer when applicable) Title-5 Leach System consisting .� of 3 H n Cultexes and. a - ox 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 Bo of Health. Signed Date L �229-T Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued - -------------------------------------- --- THE COMMONWEALTH OF MASSACHUSETTS Bearse BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( X )Upgraded( ) Aban e bWm. E . Robinson Septic Service at onegal Circle, en ervl e, IVIA been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No:'� ''�v dated `' Installer Wm. E. Robinson S r. Designer k'9 The issuance of this pew(shall not be construed as a guarantee that the sy'tem will function asydesignezIl /) ,�J� ' Date c'f C� Inspector l,.i�'l/ , ,1 7� /1,�,.(,� y,, c 1 e.. " — ---r Z/ Fee $5 0 � -------------------------- — No. ,��, /6 c?— 0-7) THE COMMONWEALTH OF MASSACHUSETTS Bearse PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Zigpogat *pftem Zougtructian Permit Permission is hereby grgnt!loneognstTcb(jAr egair( e i p� di(1lbAba&n System located at 7 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. ,k Provided:Construction must be completed within three years of the date of this It Date: ��Z 3 — / Approved by i rµ NOTICE: This Form Is T® Be Uged e®r The Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) I, William E. Robinson, Sr. ,hereby certify that the application for disposal works construction permit signed by me dated `5 � , concerning the property located at 58 Donegal Crcle, Centerville, NM meets all of the following criteria: * There are no wetlands within 100 feet of the proposed leaching facility. * 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. * If the proposed leaching facility will be located with 250 feet of any 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 Elevation(according to the Engineering Division G.I.S. map) B)Observed Groundwater Table Evaluation(according to Health Division well map) SIGNED: DATE LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 60 (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). -' Y t. ,� . �I /�� w _ J � � --� ��_,�.r 2 �.��. f TOWN OF BARNSTABLE 1 LOCATION/5�j�D�One G/ C��~t� SEWAGE # _'7 l" I S VILLAGE ASSESSOR'S MAP & LOT/ INSTALLER'S NAME&PHONE NO. " � /C z6Jnse)/j SEPTIC TANK CAPACITY _106.) LEACHING FACILITY: (type)AfU IIIA' (size) AQ -C'd X cl NO.OF BEDROOMS— BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: `y% 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 r 01 �u,