The URL can be used to link to this page

Home My WebLink About0032 DUNCAN LANE - Health 32 DUCAN LANE, CENTERVILLE A= 147.023 SIlI J� UPC 12534 No.2_ 153LOR HASTINGS, MN t No. Fee � THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 21pphration for Dupont *pgtem Construction permit Application for a Permit to Construct( )Repair( '✓Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Locati Address or Lot No. � , t {�} Owner's Name, �dpdhe's `d`Te�N0. KA 2? ,�Ct a Assessorel I t.l�er' arrddre� sus�d T_el.Igo. Designer's Name,Address Ad Tel.No. 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 Na T re of epaiirrs or Alterations(Answer when applicable) 'S rA Pv x I ` kjF-U L. 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 ed b i oard of f fea . Signed Date_6- Jq,8 Application Approved by Date /�z/gam Application Disapproved for the following reasons Permit No. `" Date Issued f 2 9 No. Fee �— THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Zisspoal *pgtem (ton5truction Permit Application for a Permit to Construct( )Repair( ✓ Upgrade( )Abandon( ) ❑Complete System ❑IndividuallpComponents Locati Address or Lot . (V. Ow�e e, dd e s agduTe)<iNo. sue'"'9 t�.,(o Assessor I taller's N ddress,and Tel.No. Designer's Name,Address and Tel.No. 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 /(w ) Type of S.A.S. Description of Soil Nature of pair or Alterations(Answer when applicable) �j rA U} A L 1 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 ed b i oard of ea J/ h Signed Date J Application Approved by f• Date Applicaiioti Disapproved for the following reasons , y Permit No. /� Date Issued f 2 r THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that theA -oe &a& Dip al SystConstructed( )Repaired ( V Upgraded( ) Abandoned at 6 n_*�?nstructed in accordance with the provisions of Ti the for Disposal System Construction Permit No. f dated 49ele E Installer A Designer The issuance of this p"l snit shad°not bet- ri`trued as a guarant a-that the system fu ctio'n as designed. Date e"'y�. ` � Inpecfor �/ --———————————————— , No. l /J Z 7 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS wligool *pgtem (Construction Permit' Permission is hereby granted to—Construct( )Repair pgrade( Abandon( ) System located at O tf, 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-pe it.r Date: Approved by �� .t,• . / � P r 10/9197 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) i L I hereby certify that the application for disposal works construction permit signed by me dated 6 concerning the property located at meets all of the following criteria: _ There are no wetlands located 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 within 250 feet of any wetlands,the bottom of the proposed leaching facility will Dw be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: (l A Top of Ground Elevation(according to the Engineering Division G.I.S.map) v B)Observed Groundwater Table Elevation(according to Health Division well map) (� SIGNE • DATE: Q 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 1� o TOWN OF BAR14STABLE (� 6b� � LOCATION 1V SEWAGE # "1 E) VII.L,AGE �� ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. 1 SEPTIC TANK CAPACITY bx LEACHING FAC1LrrY: (type) size) -� van ICI �� NO.OF BEDROOMS I isUII.DER O O PERMUDATE: 5 /'Z COMPLIANCE DATE: 71 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 GI(4L o - �k 1 TOWN OF BARNSTABLE LOCATION SEWAGE # ILAGEASSESSOR'S MAPLER'S NAME&PHONE NO. 1 �Z SEPTIC TANK CAPACITY LEACHING FACILITY: (type) r size) y1A rp►X'! NO.OF BEDROOMS BUILDER O GO ;< PERMTTDATE: ,Z COMPLIANCE DATE: -_T� 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