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Home My WebLink About0079 DONEGAL CIRCLE - Health 79 DONAGEL CIRCEE,CENTERVII.LET I A=169.028 - i UPC 17534 No.2153COR "bsr�es kASTINGS. MN No. Fee i5r-o-e-V THE COMMONWEALTH OF M SSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 3pprication for �Disspaal *proem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel -- U 0-b�Y�ry 20 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �wo-" S eput 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 c gallons per day. Calculated daily flow ��"�5 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank �J_C'4ni`1-��_ t(�� Type of S.A.S. 4t L Description of Soil / �S Nature of Repairs or Alterations(Answer when applicable) tQ-(\ POU IL at, i c L- �c V O.v 56p+r -f V tti 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 Enviro mental Code and not to place the system in operation until a Certifi- cate of Compliance has n Issued by this o ea Signed I Date Application Approved b Date Application Disapproved for the following reasons Permit No. '� Date Issued Fee ' THE COMMONWEALTH OF M SSACHUSETTS Entered in computer: i VYe r PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(ppYication for 3Digpogar 6petem Construction permit Application for aPermit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System Individual Components Location Address or Lot No. (C� O►va E' C 2- Owner's Name,Address and Tel.No. Assessor's Map&azcel '�C, _ O Q (e(J r. (J Installer's Name,Address,and Tel.No. '-Designer's Name,Address and Tel.No. �tl 0--C4 p�e_-(;-e(E?C t _ Type of Building: Dwelling No. of Bedrooms _ Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures --77 -7 Design Flow �73n - gallons per day. Calculated daily flow 3c gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank _55<( rT 0-� C ,1,/ Type of S.A.S. t C Description of Soil Nature of Repairs or Alterations(Answer when applicable) -=VLS•t A,(\ �DU/2 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 Enviro mental Code and not to place the system in operation until a Certifi- cate of Compliance hasissue`d by this"$ ea7f Signed Date a `�� Application Approved b Date 6 i% Application Disapproved for the following reasons Permit No. Date Issued —————————————————f----———————————————Zj THE COMMONWEALTH OF MASSACHUSETTS BARNS-TABLE, MASSACHUSETTS _CertTtate of Compliance THIS IS TO CERTIFY, that the On-sit sewage Disposal System Constructed J-�JRepaired Upgraded( Abandoned( )by t -C i at t>` e L rc 2vt7C�ivr has been st cted in accord ce with the provisions of Title 5 and the for Disposal System Construction Permit No. 1 datddl Installer Designer /1 The issuance of this ermit shall not be construed as a guarantee that the system-l"wi•Il unction as des peed: !� Date �� 0 ) Inspector YPI r� � I � 'V � l(' v v v v r — No. �!� ------------------- ------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH-'DIVISION - BARNSTABLE, MASSACHUSETTS Zv5po al &pgtem Construction Permit Permission i�'hereb ranted'to Construct Re air Upgrade ,y g ( p ( )Upg ( )Abandon System located at. O a C,� L C ' cv µ and as described in the above Application for Disp%al,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 thi it. ' Date: � �" � �- Approved by { 1 y 4/ + J 1/6/99 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 DESIGNED PLANS) hereby certify� that the application for disposal worksI construction permit signed by me dated -i —��j concerning the property located at �-I :Qo meets all of the following criteria: The 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) B) G.W. Elevations+the MAX. High G.W. Adjustment.`'? _ DIFFERENCE BETWEEN A and B L/o SIGNED : DATE: [Sketch propose plan of system on back]. q:health folder:cert w � I " ri lam+ � p�.�� I � _ ��,� 2 �. �'�� •TOWN OF BARNSTABLE LOCATION 22 IY ' '' ,,// SEWAGE # ' VILLAGE (-' �/r'L[ ASSESSOR'S MAP & LOT 7 INSTALLER'S NAME&PHONE NO. W1 U r.1 S',Ln* G SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 11/7Z1 T/d%tahl(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 -:?T Z V Ib a