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Home My WebLink About0044 HARBOR HILLS ROAD - Health HARBOR HILLS RD., CENTERVILLE A= 247 071 UPC 12534 No.2_R HASTINGS,MN No. /�! ��J�E2 Fee J" r .� f THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: • ' PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS v �p fi ation for Mioo!W *patent Cow6tructiou Permit Application fora P rn' to Construct( )Repair( )Upgrade V Abandon( ) Complete System ❑Individual Components Location Address or Lot Noy 011( r ` 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 1�� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 6Z t� Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) t S CIb Se � '� u 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 t Environmental de and not to place the system in operation until a Certifi- cate of Compliance has b ue 1 Signed Date a Application Approved by - Date Z Application Disapproved for the following reasons Permit No. Date Issued z \ 7/!!! TOWN OF BARNSTABLE LOCATION r y' Is SEWAGE # l -AS,(, VILLAGET.r.,a i t ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.L�-►d �a�P Self► C j �iJ/I� SEPTIC TANK CAPACITY So D ✓ LEACHING FACILITY: (type) -iA Fit I♦IrCL4-0 T S' (size) NO. OF BEDROOMS_ BUILDER OR OWNER_ P>>�,r •P0 PERMIT DATE: COMPLIANCE DATE: 9 k 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 I I^l Y. No. / C� FeeTHE COMMONWEALTH'OF MASSACHUSETTS Entered in computer: Yes `PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Application for Migooa[ 6potem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade(%)()Abandon( ) J<Complete System ❑Individual Components Location Address or Lot No. L` lko-< �b r �,�� Owner's Name,Address and Tel.No. Assessor's Map/Parcel 14 Installer's Name,Address,and Tel No. ti Designer's Name,Address and Tel.No. r: Mt -c.�+�25� ti Type of Building' ' s� Dwelling No.of Bedrooms 1_" Lot Size sq.ft. Garbage Gunder( ) Other Type of Buildings F" No.of Persons Showers( ) Cafeteria( ) Other Fixtures 1 ti P . :+7 'tom,l` Design Flow allps per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank � , �; �Type of S.A.S. i�i C SC i i � QJ Description of Soil S K1 Nature of Re airs or Alterations(Answer when applicable) _=NSTR0 1 S C(z) Se.�J C`C"tf�✓ — 2 \ r r v� (. r� v / cJ G tA- 1 t 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 o!l-ttpEnvironmentalkde and not to place the system in operation until a Certifi- cate of Compliance has bpefr, sue az Signed Date Application Approved by _ Date Application Disapproved for the following reasons � r Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded�011) Abandoned( )by + V at � A f2, . has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction ermit No. -37T-6 dated ? Installer Designer The issuance of this pe t shall n be construed as a guarantee that the system yvill function as designed. Date r`j�' �(j Inspector V --------------------------------------- No. / p Fee S THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS 30i.5 poza[ *pztem Con.5truction Permit Permission is hereby granted to Construct( )Repair( )Upgrade�)!)Abandon( ) System located at v-vcllr Vn 2 i1 1( C �- rr j20 r;?. 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 x1m1t. Q Date: Approved by � - 1019191 f ♦ � This Is To Be Used For the Repair.Of Failed NOTICE:. This Septic Systems Only. CERTIFICAT ION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) at the application for disposal works hereby certify that pA it signed by me dated "2S�- � concerning the oorotruction perm tined � meets all of the property located at . following criteria, �T%en are no wetlands located within I reef of the proposed leaching f`cllity Thera we no private wells within 150 fret of the proposed septic system �\ • 'These b no Maease in&W andlor,change In age proposed H' I no arlmw Mpeoted or needed. ' will be located within 250 Feet of any wetlands,the bottom of the Irthe proposed leachin`fbetlitp p�posed leach Mg 1kility will at be located less hen fourteen(14)feet above the maximum adjusted groundwater table elevatioft i please eonlplete the followle1: ng Division O.I.S.map) A)Top of Oreund Elevation(aceordin g to the Engineeri it)observed Oronndwater Table Elevation(according to Health Division well map) DATE: 31oNED' MSTALLER Ttm TOWN OF BARNSTABLE NUMBER LICENSED SEPTIC i pt•n of tin prep•wd•yNwM. A%*If rM Ileeeeed M@Mllw p•�eea•eerrlA•d plot pie", IA110%a de rv* d+b plan dwM be aubmilled). ; ., d t C� U ------ t