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HomeMy WebLinkAbout0140 ELLIOTT ROAD - Health 140 ELLIOT RD., CENTERVILLE A=248.057.009 Slllll s UPC 12543 : No.5... 53LOR HASTINGS. MN 11SSESSO�SINAPN� r �f No. '� Now Fee ` THE COMM R UBLIC HEALTH DIVISION -TbWN OF BARNSTABLE., MASSACHUSETTS a s � R� sue- Appitcattott for Mtgpogal *pgtem �Congtrurtton Vernttt l Application is hereby made for a Permit to Construct(�CJ or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. Jkl Owner's Name,Address and Tel.No. - /'� Installer's Name,Address,and Tel.No. Designer I s Name,Address and Tel.No. ��� �`�" { �`�r �'NYC �►..�c. Type of Building: 2 Dwelling No.of Bedrooms �.J Garbage Grinder Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures t Design Flow L gallons per day. Calculated daily flow T A gallons. Plan Date (0:442 umber o heets c� Revision Date Title LW t- f L.i Description of Soill ef>--,9, ` Le>wol e 500Br I L r 1 (���-1 �aI _Y71" � �I Nature of Repairs or Alterations(Answer when applicable) 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 Environgiental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board 6_f'lleaA. Signed Date G— g Application Approved by Application Disapproved for the following reasons Permit No. < Date Issued 4?—� 065"' f a +~, , ��•}ti �� � � � � � ' Fe N o. es; G+C.�'vCJ - / 7�l/ r�� e7 4 � THE COMMONWEALTH OF MASSACHUgETTS L UBLIC HEALTH DIVISION -` 6WN OF BARNSTABLE,MASSACHUSETTS - r- rication for Migooal *pftem Con.5tructiou Permit Application is hereby made for a Permit to Construct�K)or Repair( )an On-site Sewage Disposal System at: F Location Address or Lot No. Rs Owner's Name,Address and Tel.No. -, t'— " Installers Narne,Address,and Tel.No. _ esigner'ss Name,Address and Tel.No. or of Type of Building: f Dwelling No.of Bedrooms Garbage Grinder(00 ' Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow U L-J-r) gallons per day. Calculated daily flow t'I �i�� gallons. Plan Date 1, —I I : - -< ,Number f sheets _ Revision Date Title lrc� t.t 1 L,,a r t•A I. -i.>;r f i'i-�I.a ( `� , 1'A,� l ' Description of Soil 4n t r�lrt va�� �F �(��>`/ _(-7_1 -wl 1-j)I, 7r nature of Repairs or Alterations(Answer when applicable) Dale last inspected: Agreement: The undersigned agrees to ensure the construction and�fiaintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environ ental Code and not to place the system in operation until a•Certifi- , cate of Compliance has been issued by this Board of e f Signed Date V_�~ S Application Approved by "Application Disapproved for-the following reasons -� - Permit No..` �' � Date Issued c3 — `9 b THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate of Compliance I THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/re lace ( n � by for '"� as _ has been construc i cc..or nc with the provisions of Title 5 and the for DisposAirgystein Construction Permit No. - dated Use of this system is conditioned on compliance with the provisions set forth below...-. r F j No. ''s' ��.� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Digpogar *pgtem Cougtructtou Permit Permission is hereby granted to to construct(/_�_I repair( )an On-site Sewage System located at / © L G- / 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. All construction must be completed within two years of the date below. 4' Date: ti I " 7 Approved by VD v { i TOWN OF BARNSTABLE � LOCATION �y0 Gl�o �1Gr' SEWAGE# �6 3g� 1 Y8 Os, VILLAGE ASSESSOR'S MAP&LOT _ INSTALLER'S NAME&PHONE NO. 14 n A� alow- SEPTIC TANK CAPACITY /5 0 0 LEACHING FACIL=: (type) -e 16 / (size) X 5 y X 1 NO.OF BEDROOMS UII.DER R OWNER �c✓�7 e /3v,/o%�y PERMUDATE: COMPLIANCE DATE: 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 ® � 51 �z 3 Y5" �S®OS sT 73 3I p-/3ox /a X 5V X I Town of Barnstable 'THE Regulatory Services Richard V. Scali, Interim Director * &UMSrnat.E. MAC' Public Health Division i0ree one. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Sewage Permit#20/7 - 1.?e Assessor's Map\Parcel 249, 3 Designer: G,4 4 C d,A ENG/NE �/4Installer: Sca'`� /g0&AGT Address: /2 0 3 o k /.s"/ 7 Address: SST" DEnVOv/j , /21,9 `'AG 4 � 0 On S / 77 5-c- rr /ot^/ `_ was issued a permit to install a (d te) (installer) septic system at /,f 3 eLL i o 7"r-- RD r based on a design drawn by (address) CE,.i TfR-v iG GE, n.i ig /Z C&W— /0"-t S-. AC dated SS Z di / (designer) ad I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms of the I\A approval letters (if applicable) or � (Installer's Sign re) " �L (Desi is Signature) (Affix Desi `e �`,,8,tamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc �c5I6N �ATA SHEET 1 of Z Sn�le F-avns 1%4 4- Sedrdoowi No Garba$c Gru dcr 4 s 3 Qdily FIoW = x 11a '�� --i'��� S file Ta„1c + . x Zoo fo : 6�0-- ' 1 12' 4, q" Pc�f PJG CSca 40.E Cop Ems sel.d f�vc +e i _ � g 115C ISOOGAt..LoN 'rAyfl� 3' ,moo a7�s*, Sox Jtl L1r�tHWG SYSTEM d�E3IGN A so /�ppl�cafton Area Re vwx-O 14 GPD: 0.74 CiPO/SF = 5 g 6 SF AppILa}uft Arc: D--sian _�- 4'P,j PdC 2"Pe.s4wnc Be 1lotin Ama 12'x 50, = C.60.5Fit 3j4°.IV' WZsheeP -fa�a T04al AKx 31 y let f STEPHEN S�Fc'ER w i:• b ALLYN 'T,6.F. va a4oa9 1 ;; WILSObO t� 41.0 u r IIGsf F�ofe I f P 4476 ; 7 f 301s 6 31.3 1 34,5 i.- G 30 0 l nave F L9.5 F-• ` �� Sub5ail —_� _ 29,6 I Z1 LeACH W/ELG 2E.6 T ISoe 2'9,3 IM�tiP��.. s ric t8.s Gwa,. TwWc I Gch-%ft TVt&4 The Pr.PescA Dwellisj :54owh SITE t 5fEPT:G PLAt4 Heenan coon-f+l js Lit" Tha S&Aci~ A`%cA Set- LOCATION = L-OT 2� ` I(to4- 1?�� .Cev,ttrvilfC beck Ret.,lmonutf's Of 711e Tovn a SCALE. 1'= 4o' DATE % MAP /,/9S$ n Bams+Wc Ad Sa%�ct'Lees+.ad W%+k!v% A PLAN REFERSNC.E' Spec.al F{.e.R Haaa4 Zo,fe , ASSESSCRS MAP: ZA6. PARCEL: 57-� APPIZCANT: Kuruw C.'tn�Pt�t LL J,+sswma1 Ainr/ SwNri r- �Ac DAY-TER , INC._ LAND S "ey*05 • Glue-. EQGwWcP-S 0:Ttrw>tLLe, MAssAc.MU1&ETT5 �Q9'ae♦s fe oen bei1dw%4jS skootot Ket be UseJ ?eb Ne : G'6 672. 'tsft6Itsh rpreecr4!j Imncs. i sNi.e*r- Z o f z wad` Go0cr 3s 3� 3, I Je 06 w i / o. c •^_ , OVA As 2r OO 30 J ^� 1 LaT 2 47 coo sR if 20 wc 23a.o — w �A STEPHEN gg A t; ALLYN ��AL6 -4o BAXTER 4A 2a�sB tr .rr ` s 1!e st�2e5 DAATIM NY6 =Wc. 96 07Z • � � � �IICET � of 2 DES DATA FAM u-G oti! 'BAIL u _ 64:D SU' var�`� �ww ' �4•x Ilo ��o6Po S�TG TANS A�o ?oo x Ut 15�0 GAS• VEfi&N L�1tGL}lIJls .`�Y`1 l :� " N 4 hYG. 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WIUIAM NYE V �2 L 33 O �5 su to r � 4% �� / TOWN OF BARNSTABLE LOCATION �y0 o SEWAGE # Vl ASSESSOR'S MAP &LOT ZV8 p- VILLAGE _ — INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 5 `�p LEACHING FACILITY: (type) t.r/U/ (size) /a X 7 0 NO.OF BEDROOMS_ / UII,DER R OWNER fix✓IT e 19, /0 is COMPLIANCE DATE: �& PERMIT DATE: Separation Distance Between the: Feet Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by G�f h� H 2 3 S5 ; 3 �05 sT y 73 3/ ia'x y