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Home My WebLink About0085 FARM HILL ROAD - Health 85 Farm.Hiff Road Centerville A= 247 - 077 I; �/�// aEcvctfo rio 2,a c�T UPC 12543 a No. 5....3LOR °on.co °�� HASTINGS, MN - No.� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS f 01pprication for Dig;pozar *pgtem Cow6truction Permit Application for a Permit to Construct( )Repair( )Upgrade( Abandon( ) Complete System ❑Individual Components Location Address or Lot No. 8 r FAAA& 141 Llk_j Owner's Name,Address and Tel.No. Assessor's Map/Parcel 1 0"1 dA vIJK tl'S Installer' Name,Address,and Tel No. Designer's Name,Address and Tel.No. vi1 Ua�Cons�ruG�Ion DX b2 -�oreS CSC¢ M� �2677 Type of Building: Dwelling No.of Bedrooms 3 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 k S7� !t- Type of S.A.S. .r.. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 0. D ice— �CJICc{�,�7tf—TCPS3 B LS• tit a a� .� "L 4111 d.i= vJn a 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 of a Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by s and of He Signt�7)w_ Date o Application Approved by Date Application Disapproved for the following reasons ,k Permit No. Date Issued r TOWN 0"OF BARNSTABLE 7 LOCATION SS F4 SEWAGE # 0 vu LAG ASSESSOR'S MAP & LOT 'ZY-7—o7-7 A INSTALLER'S NAME&PHONE NO. 4% SEPTIC TANK CAPACITY ISOG e141 t LEACHING FACILITY: (type) LL (size) NO.OF BEDROOMS BUILDER OR OWNER: -YoAb - PtRMITDA COMPLIANCE Separation Distance Between the: Maximum Adjusted Groundwater Tabl6 and Bottom:of Leaching Facility Facili Feet Private Water Supply We 11 and Leaching Facility (If any wells exist On site or within 200 feet'of leaching facility) Feet Edge*6f Wetland and Leaching Facility(If any wetlands exist within 300feet of leaching facility) Feet Furnished b y 77 4 0 0 .C. ppm Sc.I cc%r—i 4-16 S w,0A'% 'V -0.4 4 , - Fee THE COMMONWEALTH OF MASSACHUSETTS .*,Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Migpogaf *proem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( Abandon( ) Complete System ❑Individual Components Location Address or Lot No. t3�' �7AAAA ' (L` Owner's Name,Address and Tel.No. Assessor's Map/Parcel Z� � 01 `7 71Y Installer'k�e,Address,and Tel.No. ,U Designer's?Name,Address and Tel.No. R 5F.6. X b2 77 Type of Building: S a$ g33' 4,Erq ci Dwelling No.of Bedrooms�_ Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow f gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank l k,kJij, Type of S.A.S. k cijj G, l A.-1 Description of Soil l Nature of Repairs or Altera_�ns(Answer when applicable) a ._7fi' r)= A- < A c Date last inspected: L Agreement: The undersigned agrees to ensure the construction and maintenance of the aforeAscribed on-site sewage disposal system in accordance with the provisions o/bis f t e Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued and of Health,- Sign / 1 Date 7 D Application Approved by /��/� C^ Date Application Disapproved for the following reasons ti Permit No. Date Issued -----------------------µu------------�-- -- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( +j) Abandoned( )by —� 159V,4 r r v a. at rd&v w !/ ✓l v h constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ' ated= 4-/7-o Installer Designer The issuance of t is peymit shall not be construed as a guarantee that the syste.. i...funct' .a signed Date Inspector No. !'1�11� � � rf✓' ------------------------Fee __ %��✓^�" (/ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS lwigogaf *pgte Construction Permit o Permission is hereby gr ted to Construct( )Repair( )Up rade bandon( ) N 14 MnIG 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 :��D Provided: Constructio must a co pleted within three years of the datePr Date: , Approved by , � 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERItiIIT (WITHOUT DESIGNED PLANS) 9 6e"J t c,e_&JA , hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at j -F—LA.. meets all of the following criteria: • This 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) y B) G.W. Elevation +the MAX. High G.W. Adjustmen . _ DIFFERENCE B TWEEN A and B SIGNED : DATE: dl J [Please Sketch proposed plan of system on back]. �OTICG Based upon the above information, a repair permit will-be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cent LOT 22 LOT.24. !y 1 0p 4 p SHED =HSE'= l O p LOT 21 O LOT 25 r j tf �� k Ri a •} Mt i k- - ! y � .. t A j LOT 20 `NOTE PRE EXISTING�N0NC0NM"lNC L R ZONE " !' , ', : MORTGAGE , INSPECTION " Pl& u e°o�y FLoOD ZONE "C' • a REGISTRY OWNER- 1�EV d,BEZWL ------______ } 4 DEED REF: _ ,_- -- BUYER JANMALBQQGEB�_____-- _ PLAN :,dl13� LE:1' REF: _SCAu= 3Q---FT-- ¢ " t HEREBY;CERTIFY TO ' ' YANKEE SURVEY ---THAT THE BUILDING 'SHOWN ON -THIS PLAN IS LOCATED ON THE GROUND AS PAW, CONSULTANTS SHOIIN AND THAT ITS POSITION DOES CONFORM A. TO THE ZONING M ,MERrrNEW 40B (SUITE 1 IN LA SETBACK REQUIREMENTS OF THE INDUSTRY ROAD 4 TOWN OF B�BXSTABLF AND THAT Ha 8 IT DOES— KBT__ LIE WITHIN THE SPEC I,AL FLOO ,HAZARD 5 9E6n1Ea NS MILL% MA. 02648 Z AREA.AS SHOWN' ON THE H.U.Q" YAP'DATI'+D- � 1.$2�` ,fAcat up�o ' _TEL. 428—0055 i t — 250001—00 B—D FAX 420-5553 a ;'% '." • THIS PLAN'NOT MADE FROM AN INSTRUMENT SURVEY 4JJLS 'N T BE USED FOR FENCES BUILDING PERMITS ETC. 30419 =,OMF TOWN OF BARNSTABLE LOCATION /� SEWAGE # .ZOOJ VILLAGE ��-3� t�Iezlf/ieC ASSESSOR'S MAP & LOT Zf7-077 INSTALLER'S NAME&PHONE NO. ICE. �e��%a cG L,l� Cary 833-4gi9 SEPTIC TANK CAPACITY ISoo r4/ D/4c1, „f LEACHING FACILITY: (type) ( S-C*C, /r e ficAc .�k (size) 13 X XIaOL o NO.OF BEDROOMS-3 ',BUILDER'OR OWNER_.BOND ;YurjQVG(RVk PERMTTDATE: COMPLIANCE DATE: 1 . ,.:. 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