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Home My WebLink About0094 HARBOR HILLS ROAD - Health E94 HARBOR HILLS RD., CENTERVILLE A= 247 085 ' I UPC 12534 No.2 HASTINGS. MN v., No. 9 Fee THE COMMONWEALTH OF MASSACHUSETT Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Rpprication for Xh6 polaz *p5tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade(/Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.CM �61 W, Owner's Name,Address and Tel.No. Assessor's Map/Parcel 01f4�� 2 Installer's Name, ddress,and Tel.No. s -77e Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 33C� gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 4 a\Aj Type of S.A.S. Description of Soil Nature of Repairs or Alterations(An wer when applicable) t- V' l 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 been isamadj2y this BoA of Heal Signe Date Application Approved by Date -L5?— � Application Disapproved for the 61lowing reasons Permit No. `` ' Date Issued TOWN OF BARNSTABLE �v " LOCATION 'qtA SEWAGE # -Iq VILLAGE ASSESSOR'S MAP & LOT a q Z- G 3_J INSTALLER'S NAME&PHONE NO. I(n i p--L4pCC-- SEPTIC TAN_K CAPACITY LEACHING FACILITY: (type) r J GI L--rce-CrOCS (size) �NO.OF BEDROOMS Is `n t BUILDER OR OWNER C PERMIT DATE: d 3—0 6 P 'Y 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 l no 'NO. / / Fee "+F THE COMMONWEALTH OF MASSACHUSETTV Entered in computer: Yes jPUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS �! Application for Mioogal *pgtem (tongtruction Permit Application for a Permit to Construct( )Repair( )Upgrade(/Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 1 1' C�` S �� Owner's Name,Address and Tel.No.n / Assessor's Map/Parcel `�— YO—offS • , ' Installer's Name,Address,and Tel.No. ?l� 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 �✓�-11� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank _____Type of S.A.S. 1cc,oco t L. Description of SoilC✓�ci 1!a w Nature.of Re airs or Alterations(Answer when applicable)—�lti �' 1 L � Q Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system irf.'accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- o cate of Compliance has been issued bv this Batill of Heal . Signed Date '- Application,Approved by Dateld4LIO 50M— Application Disapproved for the ollowing reasons,,-' Permit No. Date Issued Iv.,THE COMMONWEALTH OF MASSACHUSETTS ',,,_BARNSTABLE, MASSACHUSETTS QCertificate of (Cam" fiance THIS IS TO CERTI Y,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded Abandoned( )by �r r at ( has been constructed in accordance with the provisions of Title 5 and the for is al System onstruction Permit No. f/47 dated Installer Designer The issuance of this permit shall n t be construed as a guarantee that the sys em will function as designed. Date 3 ^ 10 $ Inspector / --------------------------- -- No. Fee J.6 Q"!J r THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migogal &paem Congtruction 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. F Provided: Construction must be completed within three years of the date of this it. Date: Approved y� " 1019197 Form Is To Be Used For the Repair.Of Failed NOTICE.• This F Septic Systems Only. CERTIFI CATION OF SKETCH AND APPLICATION FOR A DISPOS AL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) i I ! Ye hereby certify that the application for disposal works 1' concerning the l construction permit signed by me dated � �J �� meets all of the rt located at � *pe y following criteria: r • ere are no wetlands located within 100 feet of the proposed leaching facility V private wells within 1 So feet of the septic system • There are no pri proposed l There is no Increase in floc and/or change in use proposed �7,, are no variances requested or needed. s,the bottom. he in 2 propose d leaching facility will be located within fourteeen(14)feet t or any ealbove the maximum Of proposed leaching facility will no be lasted less than groundwater table elevation. Please complete the following: Q' A)Top of Ground Elevation(according to the Engineering Division O.I.S.map) U B)observed Groundwater Table Elevation(according to Health Division well map) • i DATE: SIGNED LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF 8A1NSTABLE NUMBER (Attach a•ketch pint of tM ptepewd•YOM.Also Irth•Ile•nad Imtaller pon•se•a o•rUA•d plot plan. this plan should be submitted). i i ' r hank tmdw.ow , 2 � TOWN OF BARNSTABLEC/ LOCATIONGu/�Otir �-!�� 1C.b/� SEWAGE# - qL VII.IAGEbsC � ASSESSOR'S MAP Bc LOT a Y 7• (J 8cS INSTALLER'S NAME&PHONE N0. "-QA a sCft C-- SEPTIC TANK CAPACITY ►Amu LEACHING FACILITY: (type)SNG� —'F<<"TO(LS (siu) D ell ' NO.OF BEDROOMS BUILDER OR OWNER PERIVII`TDATE: 0 3'y �' %� COMPLIANCE DATE: 3— Separation Distance Between the: w Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Privaie:Wjter Supply Well and Leaching Facility (If any wells exist otsteor within.200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by i i . j t 1 00