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Home My WebLink About0067 GLENEAGLE DRIVE - Health (2) 67 GLEN EAGLE RD., CENTERVILLE A= i SiQd o z z lui UPC 12543 No..._.53_LOR HASTINGS. MN No. / 0 Z1 r. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ^� Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Migoml *pgtem Congtruction permit Application for a Permit to Construct( )Repair(✓ )Upgrade( )Abandon( ) El Complete System O Individual Components Location Address or Lot No. (07 awl 600— Q, 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. 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 kDOU L a,k Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) A tA,\LAB- !�Sc\�kvc,, r s 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 Environm I Code and not to place the system in operation until a Certifi- cate of Compliance has been issueq this Board of Heal / Signed Date b (d, I r Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued No. 0 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: o PUBLIC HEALTH DIVISION - TOWN F PARNSTABLE., MASSACHUSETTS Yes EL 'fir�.. �` Z1ppricat t"1 o - loigpdg rt *psstem Construction Permit Application for a Permit to Construct( )Repair(,.Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. r 7�/ �i n �Q, " JO�wner's Name,Address and Tel.No. Assessor's Map/Parcel v Installer's Name,Address,and Tel.No. Designer•`"s'Name,Vdress and .el.No. Type of u' ding: v Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder(NO) 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[0()J)Q X�-5,k Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Ll—r—AQ—g r0a x 4,, i- �A r f Date ast inspect"gd A �t: f T�e undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in�ce6�ance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- �! cate ACo fiance has been issue this Board of Heal Signed Date 9 Application Approved by � Date Application;Disapproved for the following reasons Permit No. 9! 7-Z0 Z Date Issued el- Z_-�� , THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(VI"Upgraded ( ) Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for Di posal System Construction Permit No. Za?_ dated�l../—2—9 Installer.c _ �� Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date 1 '1 q Inspector ti 3 No. -... _ ��?Q� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migpogar *p!5tem Congtruction',permit Permission is hereby granted to Construct( )Repair( v6grade( )Abandon( ) System located at _ 1 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 permit. C Date: 7 — Approved by n /l TOWN OF BARNS ABLE L G _ LOCATION c SEWAGE # V VILLAGE CA /��-try`�� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. Sr c,�A, I 7 S S y SEPTIC TANK CAPACITY [bC7U CSG`L `X(f f QO�c LEACHING FACILITY: (type) ,�\ f�1aX1 lS (size) tJ U P NO.OF BEDROOMS,-? BUILDER OR OWNER 221, J-L.PERMITDATE: -1 It, COMPLIANCE DATE: (1h I5�- Separation Distance Between the: r 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 SC,c 2° A+o {a ODD oZ (o 3 s14 ® o s��-D d 3 <.:\ 13 G arc .•" vim � � IO/9197 NOTICE: This Forrn 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 c-y✓� tereby certify that the application for disposal works construction permit signed by me dated concerning the property located at 7 �� Ct J-\r-.it(&ets 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 nDI be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) (-2 -. B)Observed Groundwater Table Elevation(according to Health Division well map) SIGNED: 7z DATE: d �� 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 Lr - EE � J � J