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Home My WebLink About0146 HILLSIDE DRIVE - Health 146 HILLSIDE DRIVE, CENTERVILLE A=193-055 , t j No. 42101/3 ORA Fa ESSELTE 10% O O O TOWN OF BARNSTABLE / LOCATION Z�� /-// /ll ,/f SEWAGE # VILLAGE (�rI7��1��i/� ASSESSOR'S MAP & LOT121 INSTALLER'S NAME&PHONE NO. 04!711® — 77�� SEPTIC TANK CAPACITY /SOO GGL LEACHING FACILITY: (type). $ 60 (size) !O'AT ` NO.OF BEDROOMS S BUILDER OR� �'-^�s 46 PERMTTDATE: 7 i' " f®/ COMPLIANCE DATE: '" le' l Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility �f 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 leachi��facility) Feet Furnished by A3"V7� 2 3 � No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Tipprication for Mtgool *pgtem Construction 3permit Application is hereby made for a Permit to Construct( )or Repair(/an On-site Sewage Disposal System at: Location Address or Lot No. �L�16 [�� $/ jo � Owner's Name,Address and TeL No Assessor'sMap/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 45� Garbage Grinder( � Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 1/ 0 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(An wer when applicable) / r m Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued y and f Health. Signed — Date />`/W Application Approved by Date r, — Application Disapproved for M follo ng reasons Permit No. e,' / L Date Issued No. w �' Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0ppYication for Migaar *pgtem Congtruction permit Application is hereby made for a Permit to Construct( )or Repair(/an On-site Sewage Disposal System at: t Location Address or Lot No. fL�16 �/r�$% ' �� Owner's N.,dame,,pAddre/ss and Tel Noo,.p Assessor's Map/Parcel J '✓v//� / � /�/I G'�G//fQ!4� ,,'. ! s��°c di: Cirv.ilk Installer's Name,Address,and Tel.No. Designer's Name'`Address and Tel.No. /- Type of Building: Dwelling No.of Bedrooms Garbage Grinder(1(10 Other Type of Building /�PSf t° '�'P No.of Persons Showers( ) Cafeteria( ) Other Fixtures e" Design Flow O ,,Zgallons per day. Calculated daily flow gallons. �F Plan Date 'Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer when applicable) - hF-ll3Z Gf o`C//`O A S 7`". S l%// ZIA, i;,a e?101 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system w. 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 issued by this Board of Health. Signed Date Application Approved by Date — Application Disapproved for t9 follo ng reasons Permit No. t> 7 Date Issued y THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS J Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( or repaired/replaced(�on by Installer A2 r 7/i2/ri^4L/ �DrJ S at G/ i has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Date Inspector THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE S , - TEM WILL FUNCTION SATISFACTORY. No. ��. .�� -- ------ 3—D5 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS ' 30iopogar *pztem Construction permit Permission is hereby graZn o 15 0/' to construct( )repair( On-site Sewage System located at No.# / ��% aJ �P ii✓, sweet and as described in the above Application for Disposal System Construction Permit. W,, No. Date The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within three years of the date below. Date: c(, �� Approved by Board of Health let co�� COP log i • t f J 7 x ! t ! : ..^e . `i?fk;';-•r`rif!'"'.,��x�... +'" s�;''Y. r>`=:�-� }. g .:.�- 7�" E'f:� -k3 �z�. ..� :;`�•r � E,u*". �32';"tzs..�� 5,�, :y:��.tk:#� �a..:'c''s,d„ ^"� 'r�' ��K -� a;..4-.cj�}r 4Pi�- � tt;'d?a �, +�,..t.�� "�'»��'`�r*:;: .r{.,,k �et��.�. ..,,.' 'd' -.,^ .S<>..,'`�:;r w..rh N f ,.._�. `� .�.�.� .:tp, �Y;�.✓+».{ �.a.:Y'. 7 � ,:lip% �,,�4 hx P. �''u r .i.{�4�z r.,y,.af.�� 4.:#.f .7r. ,.},.,:'�+''.�'-,.: .-,.;.:`, z�",...N .e �*✓,x,.;,'�''F n .::.:w fa .,_.,_r LRtl "� .��t.�..,�� ,�,,`� �;;'� � .:....,gr,, ,ti•: :z` .+?,::T�.. �:..+. c+.:rid`+ �.+ �a ,w�.� v '�' � � zr. �'' )s?„y,, �.� ,xt•.-�. ."S a ytr ,h, 1 i s u .�+ a.,:,a � Ti..a° r �-,,� �5...,i { �A t..ter:. c CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL 1YORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANSI L�7,- 4Vpr'b,�o1 4 hereby certify that the application for disposal works construction permit signed by me dated , concerning the property located at /�� /f/s�� as^, 4it1+/7/111e meets all of the following criteria: /There wi hin 0o feet f the r sed se tic em s arc no wetlands t 3 o proposed p system Y Thcre arc no private wells within 15o Pect of the proposed septic system +e The observed groundwater table is 14 feet or greater below the bottom of the leaching facility There is no increase in flow and/or change in use proposed JThere are no variances requested or needed. SIGNED : DATE: 0 �"eel;7 LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed Installer posesses it certified plot plan, this plan should be submitted]. -"e{� sy Kt:✓ :t ram- _ - r y, r f.. _ i 7 .�� 3� .¢. ; tw- r �. r �� i y' �:� K^ r � r Y• ,� -� �fey i.d.,� ak�`� ��3`�.-,. -A:�,t i,u 'e'-t �.a 4 �z-< 1 a ` � �.0 .a.� .,�rF :k.' .r, _ �-.�" x.°'�, x_m --cti-` r• ,,av ar 'iY.r ,." Y 'r' -:-.'�`i,a Y �.-�c" -.�;��`�, ... .n�+x«,�s.,��•"�ti�1"-fr�E xu: i_ ,. ,,...,.,,. i,r�.'�. ..w:'�,� .,...;a. .a. ,..? _ s..,_ . :., t_ M� .�' T'.' ."'�1�� ,. .,,+� "�_ �`s �'t^�"`�'__ .. .