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Home My WebLink About0110 HORSESHOE LANE - Health 110 HORSESHOE LANE, CENTERVILLE A =207 140 ° wcobr," /W UPC 12534 No.2� 1'3, LOR HAiTINos UN I 13 No. 14 ` f .,,� Fee , THE COMMONWXALTROF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2ppficatton for Dtzpooal *pztem Congtructfon 3permtt Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) Nomplete System ❑Individual Components Location Address or Lot No. d1tE?49 0 e, 1 PLC_, Owner's Name,Address and Tel.No. Assessor's Map/Parcel D47—(,40 A0,_�1`,e*— Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 6410--c-fl(/Y— 5 C_ 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 3 3 d gallons per day. Calculated daily flow �`�� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank I J 0-D:�W d Type of S.A.S. R t Cc, 0 C.< i1- f C� Description of Soil o/Vt.<<Q .Sf4t,�,W Nature of Repairs or Alterations(Answer when applicable) fJ n S / 12 1� t� cl c'd y/,57' cJ�.s,d�f (y yr c c 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 b Signed Date Application Approved by Date l0-7l- Application Disapproved for the following reasons Permit No. Date Issued �� Z (177 ---- ————————— -h 61qNo. �i Fee ` 1 THE COMMOhiVII k;OF MASSACHUSETTS �. Entered in computer: es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS (pprication for Migpo!Ml *pgtem Cott!6tructiou Permit Applicd'tibnkfor a Permit to Construct( )Repair( )Upgrade( )Abandon( ) Xcomplete System O Individual Components Location Address or Lot No. 0 G Owner's Name,Address and Tel.No. Assessor's Map/Parcel a 6_—(q 0 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms L,o't Size sq.ft. Garbage Grinder( ) Other Type of Building tr No'of Persons' Showers( ) Cafeteria( ) Other Fixtures /"%. '' i. i� k' .f Y Design Flow 3�� gallons per day. Calculated daily-flow- 3��cl gallons. Plan Date Number of sheets -' Revision Date Title _ Size of Septic Tank 1 0-0 Type of S.A.S. C r Description of Soil f r � fJ Nature of Repairs or Alterations(Answer when applicable) / OU S� ! �- /� vU( ems_L� LT u Z nK2 f �t/V 1'� 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 be Signed Date 6, b �I Application Approved by Date V-Z Application Disapproved for the following reasons y Permit No. Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certiffeate of Compliance THIS IS TO CERTIFY,that the On site Sewage Disposal System Constructed( )Repaired( )Upgraded(t.,� Abandoned( )by fir" \ at 1(j C c.1•G= e v rs v has been constructed 't accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 9� �� dated Z Installer Designer i !{ The issuance of this pe t all not jI a-co strued as a guarantee that the syst fii will function as designed Date / Ins ector r p J �� ''�. Inspector- ------------------------------ ----- No. / ` 7 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mi5potaf *pgtem Construction Permit Permission is hereby granted to Construct( )Repair(C-l-}YJpgrade( )Abandon( ) System located at �/6 /�k, r (t S`r•- - t l� 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 thi a t. c�9 F I/ Date: ��/'��/1 Approved by TOWN OF BARNSTABLE „ LOCATION %/D SEWAGE # VII,LAGE__ "I ASSESSOR'S ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. InI47�.or��SEPTIC TANK CAPACITY /So LEACHING FACILITY: 7o2 5, (size) .25 NO. OF BEDROOMS ' BUELDER OR OWNER . PERMITDATE: COMPLIANCE DATE: � � I 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 TIE/ /• V 1 Y •• �• ZI 0 1/6/99 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) hereby certify that the application for disposal works construction permit signed by me dated /D—f b`5 5 concerning the property located at /!d X C ESQ /AJ, C�tic�r� I C 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 r/• There is no increase in flow and/or change in use proposed There are no variances requested or needed. u The bottom of the proposed leaching facility will not be located less than five feet above the ma.-dmum 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: A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation s y +the MAC. High G.W. Adjustment. to- _ t a DIFFERENCE BETWEEN A and B SIGNED : /� DATE: [Sketch proposed pl of system on c c]. q:health folder.cent � _ ��✓p,r� ., . . 4„ G O '� .�-- L TOWN OF BARNSTABLE C LOCATION —_ SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. / ij2C4Qe_ SEPTIC TANK CAPACITY /S"a o LEACHING FACILITY: ( pe) �,e/ /`y�1Ljo2S (size) l'/ NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: 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, r Q i . o 0 Lai- A I2y— B11L A ;L� . 3f6 ��