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Home My WebLink About0130 FULLER ROAD - Health 130 FULLER RD., CENTERVILLE A = 189 125 1 i �I,&RECYC(Eoro ® m UPC 12534 No. 2-1�53LO,R � � HASSTINGS. HN ..i.:4.iiWi•_..ui::wx..::. .-.,..K;...Yf_ '_.�:�.ae�..uau`td..._,�•: ....••s_• ,.iiar.LrYiYtlWad�lYeY�,ww.,.•:a�� •�•..•.:•.••—..•,.••• _.... ..... - _ - -c,,.�a. - .wnNuthliuewruv��u.d.�1tM�_.-.......ew.w.,.0 No. —� * FeeQ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYfcation for Migaar *pgtem Congtructfon Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) :Complete System ❑Individual Components Location Address or Lot No. 130 Owner's Name,Address and Tel.No. Assessor's Map/Parcel ` CG _ �S & &XV Installer's Name,Address,and_Tell.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 0 gallons per day. Calculated daily flow 3 m gallons. Plan Date Number of sheets Revision Date Title 4f� Size of Septic Tank �� Type of S.A.S. o L scription of Soil �yl c�Q Sy3 Nature of Repairs or Alterations(Answer when applicable) a7ck s l\ �Ll -,xv? 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 th visions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance een issue Bo alth. _ Signe '� Date �� Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued . l d �7 i No. �J Zi .._ Y Fee THE COMMONWEALTH MASSACHUSETTS J;_ Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplicatiou for Migpozar *rgtem Con6truction Permit Application for a Permit to Construct( )Repair( )Upgrade-( )Abandon( ) Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. C Assessor's Map/Parcel t 79 _ ' Installer's Name,Address,lmd 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 �`C) gallons. ' Plan Date Number of sheets Revision Date Title #ft)escription Size,of Septic Tank I 10 5 Type of S.A.S. C c l -of Soil Sty Ut Y-,-;, 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 withihe_proyisions of Title 5 of the Env' onmental Code and not to place the system in operation until a Certifi- cate of Compliance tins been issue Bo Health. _ Signed` ---- Date 'GL� Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued ----------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (tompliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Con t� cted�( )Repaired( )Upgraded(V-) Abandoned( )by C e's(P E 51=rN k at �3 U 1 t-C' A_N has been constructed t*n accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated .S Installer f Designer Th , � e issuance of this permit shall/not be construed as a guarantee that the systtem gill.function as designedy: Date /�� h �� Inspector �t�f `/�! �/; ��l ► �i% '"��i f.� f No.iC/�"" �' 33� --------------------------Fee �i THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mizpooal *pg;tem Congtructton Permit Permission is hereby granted to Construct( )Rep a* ( )Upgrade( L..Marrdon( ) System located at �3 o I—�/� �-- ✓fQ f_, 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: Constructionmust be completed within three years of the date of this-pre 't. f i Date: �f '� � Approved by--: C` TOWN OF BARNSTABLE Cam. LOCATION _ 3e �4 iill,-- r /?,4 SEWAGE # 000� VILLAGE _ CP,fll eo^�Z- ZZ4 ASSESSOR'S MAP & LOT -' INSTALLER'S NAME&PHONE NO. /?'I/h,— .,yeo�- SEPTIC TANK CAPACITY LEACHING FACILITY: (tyQe) 14/ T2A Tat? (size) NO.OF BEDROOMS `!7� ti # .✓ BUILDER OR OWNER PERMTTDATE: 0k——:::COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility + c ect 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 " o a A23o 2 .8' 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) I, }e , hereby certify that the application for disposal works construction permit signed by me dated to concerning the property located at 1 ® c>\� �� ® C:!��t r meets all of the following criteria: d This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. 6/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 I./There is no increase in flow and/or change in use proposed t/ 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 r'� gr [Adjust g g F imptor method when applicable] JIf 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: f/ / A) Top of Ground Surface'' Elevation(using GIS information) —1 , 1 B) G.W.Elevation /J 'O+the MAX. High G.W.Adjustment ,7 = / 7, DIFFERENCE BETWEEN A and B SIGNED : DATE: [Please Sketch propos a of system on back . NOTICE 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:cert � 1 _ . . � G I � t i , ;- 4 ...... 4 � ` TOWN OF BARNSTABLE ! LOCATION 136 ,�i��/�r 2 SEWAGE # i VILLAGE_ CC,11 P r,-i 1/, ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 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