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Home My WebLink About0106 GREAT HILL DRIVE - Health 106 GREAT HILL DRIVE, CENTERVILLE A=174-038 14RECYCIFO� UPC 12534 No. 2� 1� 53LOR ��osncoNS°`� HASTINGS, MN No. r r / Fee THE COMMON.NEALTH OF MASSACHUSETTS Entered in computer: ✓/ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,s MASSACHUSETTS Application for Migonl 6p5tem Cow6truction permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System �4rldividual Components Location Address or Lot No.10(2 Owner's Name,Address and Tel.No. p k-� k 3 e vv'�, 4Y-1�S Assessor's Ma /Parcel L,_ i4 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 '330 gallons per day. Calculated daily flow 73`" gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 2 U elJ Type of S.A.S. kACk L` Description of Soil i Y"`_a S Nature of Repairs or Alterations(Answer whepp applicable) X70.5-VO \ ✓I.fsL �CT� S"CGt, _ U h �' 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 Certifi- cate of Compliance has Signed Date -� Application Approved by Date Application Disapproved for the following reasons Permit No. / "-� 77 Date Issued 7 '- F` No. "/ / 7 Fee THE COMMONW.E"ALTd}1 OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION —TOWN OF BARNSTABLE., MASSACHUSETTS Yes zp*. 0[ppYication for 0igpo.5al'*p!5tem (Construction Permit Application for a Permit to Construct( k').Repdir( )Upgrade( )Abandon( ) ❑Complete System Kndividual Components Location Address or Lot No.10( (>°u—t �` `� r Owner's Name,Address and Tel.No. �tti� �,u► 14-1 Assessor's Map/Parcel ,"� 1� A-j Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: V Dwelling No.of Bedrooms 27 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures-3-3 ue l � 1�, Design Flow 0 gallons per day. Calculated daily flow _" gallons. Plan Date er.., sheets.. Revision Date Title Size of Septic Tank � .5'1 G'�w{(yCY C�1�` �� 1 Type of S.A.S. v Description of Soil Nature of Repairs orAltera ions(Answe"" -terwenapplicable) I/L 5�141� 0- CIAct°l Its r 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 toiplace the system in operation until a Certifi- cate of Compliance has ep-issued+"hi h. Signed Date ' - -� Application Approved by - Date Application Disapproved for the following reasons Permit No. 7 Date Is sued !�- 1pr- --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewa a Disposal System Constructed( )Repaired ( )Upgraded Abandoned( )by 't 1 at f c-c c €. � �C J t has been constructed im accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated ` . - Installer Designer The issuance of this permit shall not be construed as a guarantee that the sys will function as d- gn Date l •" a�' e� Inspecto r --------------------------------------- No. / / `/ 77 �. /— Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE., MASSACHUSETTS Mi5pooaf *pztem (Construction Permit Permission is hereby granted to Construct( )Repair( )Upgr de Bandon( ) System located at ► L7C 2 t IP c-1- t t Y 1r J P f�,—_—I/A7 J t� 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 Date: �" / / Approved by 1/6199 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) L hereby certify that the application for disposal works construction permit signed by me dated E-�--�-`�� , concerning the property located at �-�eY �f meets all of the following criteria: • The 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: Q/,/ A) Top of Ground Surface Elevation(using GIS information) l ( U B) G.W.Elevation 3 -? +the MAX.High G.W. Adjustment. Z- 3 = 3l, 3 DIFFERENCE BETWEEN A and B C) SIGNED : DATE: [Sketch proposed plan of system on back]. q:health folder:cert d�� 3 0 I __ I r� TOWN OF BARNSTABLE LOCATION � _�� SEWAGE # VIILAGE ��.� ASSESSOR'S MAP & LOT�T" y �' INSTALLER'S NAME&PHONE NO. l�((� SEPTIC TANK CAPACITY %Q^� LEACHING FACILITY: (type) ,0�2'1 C (size) NO.OF BEDROOMS OR OWNER PERMITDATE: COMPLIANCE DATE: �2 Z Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 �z'isa7�l - ;'�a`�� x:- 64L i / C / C r. r