Loading...
HomeMy WebLinkAbout0087 FULLER ROAD - Health 87 FULLER ROAD, CENTERVILLE A=188-126 UPC 12534 ' No.2153LOR HASTINGS,MN No. < <O ( Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppfication for Migoml 6potem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ®.Individual Components Location Address or Lot No. e� Owner's Name,Address and Tel.No. Assessor's Map/Parcel vo' tj Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 04vt v-G0Q 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, f Design Flow 1`�U gallons per day. Calculated daily flow 'A�R, gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 2«57K J �000 01ti Type of S.A.S. cc,, T Description of Soil 0\.Z � 'Tf) ja S P� Nature of Repairs or Alterations(Answer when applicable) �nC-N IcXo`\ o OOe 'Ft v'e- \"kc&, W U t `1-Vv2, Ob✓ c5 (.11 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 nvironmental Co e and not to place the system in operation until a Certifi- cate of Compliance ha issued by t t of Hea Signed Date 9-30?& Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued No. to Eq= 'F? Fee t THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ Yes PUBLIC HEALTH DIVISION -TOWN OFb BARNSTABLE., MASSACHUSETTS 01ppYication for Miopozal *pztem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System 91ndividual Components ILocation Address or Lot No. e Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. a N o F_ S� N Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures F Design Flow �k ACC llons per day. Calculated daily flow 11 g g'� p y. y ` R gallons. Plan Date Number of sheets Revision Date - Title Size of Septic Tank kCC0 0►ti-/ Type of S.A.S. Cc,yb Ct TC a T Description of Soil 1 't n irk w.� - S W N z e Nature of Re airs or Alterations(Answer when applicable) N ST\C`\ O r T UoK Ft tr� I STOve, o� 51 61S. -t / ' Date last inspected: ,R Agreement: r 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 Fnvironmental Code and not to place the system in operation until a Certifi- cate of Compliance has en issued by thr of Hea Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued 1 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,�thnat the On-site Sewage Disp sal System Constructed( )Repaired( )Upgraded(K) Abandoned( )by ►'\1 , -C- at tlas een constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Y dated '4 ' Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector No. CJ � � ----------------------------Fee So. f_ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migogal *pgtem Conutruction Permit Permission is hereby granted to Construct( )Repair( )Upgrade(`Abandon( ) 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. Provided: Construction must be completed within three years of the date of thi permit. Q Date: �� D Approved by �—' TOWN OF BARNSTABLE LOCATION �7 lC p/ � SEWAGE # 7ff" 6 3 VILLAGE �%S 1i"—ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. e :fe,p 7� c SEPTIC TANK CAPACITY C S y o l LEACHING FACILITY: (type) /-ra.- 'o r'S (size) S NO.OF BEDROOMS y BUILDER OR OWNER PERMITDATE: -30-CIK COMPLIANCE DATE: f� / 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 ����� a Via, � 3 �z-' � 3 ay ' af �y` t 10/9/97 1_ �- 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) hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at 7 1 e �d C >> meets all of the following criteria: f (/• There are no wetlands located within,I00 feet of the proposed leaching facility (/• There are no private wells-,within 150 feet of the proposed septic system / -/ +. C There is no increase in flow and/or change in use proposed e'- There are no variances requested or needed. v�lf the proposed leaching facility will be located within 250 feet of any wetlands, the bottom of the proposed leaching facility will=be located less than fourteen(14) feet above the maximum adjusted groundwater table elevation. 1 Please complete the following: A To of Ground Elevation(according to the Engineering Division G.I.S.map) P ( g g g —_. � B)Observed Groundwater Table Elevation(according to Health Division well map) SIGNED: DATE: 91-310` LICENSED SEP IC 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 I r ,,. -r � v TOWN OF BARNSTABLE LOCATION v Z-<//, /? SEWAGE # / f" 6 ,3 G 7 VILLAG ASSESSOR'S MAP & LOT I • 11 b INSTALLER'S NAME&PHONE NO. !^?,�✓ ���.�> f�� , f; SEPTIC TANK CAPACITY %J 0 c. LEACHING FACILITY: (type) (size) NO.OF BEDROOMS_ BUILDER OR OWNER PERMITDATE: ! --212:2. 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 r. n { I t • ' A i Y ' 3 � r ,� Q c TOWN (OF BARNSTABLE A LOCATION O` ` V�1 C.r \ J SEWAGE# 0 1 3L VILLAGE ASSESSOR'S MAP&.PARCEL 24 INSTALLER'S NAME&PHONE NO. S C.o N (`,, S� 2 l SEPTIC TANK CAPACITY- L, � C c.. WiN \A % t aA (_ `X t S-+ LEACHING FACILITY:(type)- (size) NO.OF BEDROOMS 1A 10 +(,A VC OWNER PERMIT DATE: a. f(l a a COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility rr 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 rd A : p 3 - 30 o � o Z I;nn No. � — Fee _7 S U 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: f Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,'MASSACHUSETTS Application for Misposar *pstem Construrtiou Permit Application for a Permit to Construct( ) Repair(r/) Upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. Vu\kg,,r 2 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ASV zk. C Csv� �c) C— IStall N�am�e,Addrr esss,nJTel.No,.. I Designer's Name,Address,and Tel.No. 1 w O u 1� `'-�1 I)rpe of Building: ro 1�r a 5 4 O 6 6 Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building ' No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Iterations(Answer when applicable) \4(,e_ M C- end Q 0 V 1 Skrl \J�1 o r) 6h 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 Certificate of Compliance has been issued by this B alth. SigneAl Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued __---_------------------.----_. Vu ' No.��� 'I�� �f✓ � � _ Fee. THE COMMONWEALTH OF MASSACHUSETTS L Entered in computer: Yeses' PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE MASSACHUSETTS ` 0 co 01pplicatlon for Bisposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(:/) Upgrade( ) Abandon( ) ❑Complete System ® nT dividual Components Location Address or Lot No. _r ©Q 7 �r�`� 2 j Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel ct^ �Cr1\ �uy 'C ' t..��k'T f.k Ins talleg N�ame, ddr�eess,d Tel.No. ` 'Designer's Name,Address,and Tel.No. Type of Building: a 5 L{ 0 b Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 1 Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size bf Septic Tank Type of S.A.S. Description of Soil Lys Nature of Repairs or Alterations(Answer when applicable) ,h\t, C R_ M G. ,-� I-.\ ��n r+✓\ F Cat 61\O 1.1 < 'Date,last inspected: Agreement: " The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in fi accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board-o•f Health. r/ / Signed Date Application Approved by +, Date! Application Disapproved by Date for the following reasons t , j Permit No. •..�{ r Date Issued C__�;IJ&J --- - - -- --- -'- --- ---- - - J THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance !THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by S c-O\A M t`r-C NA/(_. at n _? Vu\\,e r n-J C 1 t l-e has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit NQ-A--A r• . Installer S c v M �rc"VC,_ Designer #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will function onn as�designed. (7 Date rJ 2 3 Inspector -- - --. . _ ---- ---- - ------------ � '""�...� - - "^-�,-----•----------------------------•--------------------------------------- Fee • �} ._. . No. /._ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS 33ispoBat *pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ` _Upgrade t(` )_ Abandon( ) System located at �`1�`Cl. Q c! and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 permit. ..�� / --� Date 14 f t)/C�- Approved by _ .,_