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HomeMy WebLinkAbout0323 HUCKINS NECK ROAD - Health 323 HUCKINS NECK RD. CENTERVILLE A = 233 060 UPC 10259 No. H_1630R NASTINOY.UN r' 0 Fee // THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓tV/ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Oizpooal *pgtem Com5truction 30ermit Application for a Permit to Construct( )Repair( �U/pgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3 a3 Rucu;-lsne Owner's Name,Address and Tel.No. t �IIZ�he�l� SGl.�pr*'� Assessor's Map/Parcel O 0 Installer's Name,Address,andkl&(B CANCO Designer's Name;Address and Tel.No. 350 Main Street W. Yarmouth, MA 02673 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 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. 2 S cS Description of Soil /M L w .6 'j"kY IF r'Z<ZX i 3 k 2 Nature of Repairs or Alterations(Answer when applicable) )f�l. — ��D S 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 issued by this Board of Healt . Signed Date Z, -� Application Approved by Date / Application Disapproved for the following reason Permit No. Date Issued No. -�-�` Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS 01ppfication for Migpoal *pgtem (Cow5truction Permit Application for a Permit to Construct( )Repair( 4upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. d 3 VC =SO ec.. Owne '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 offUilding: 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 gallons. Plan Date t Number of sheets Revision Date Title Size of Septic Tank ) 5 Cj: Type of S.A.S. 2>�C�:IC— L.G•l� t S Description of Soil A _ Nature f Repairs or Alterations(Answer when applicable) -� /f 00, Date last inspected: Agreement: i 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 by this Board of Healt . Signed Date Application Approved by D Date 1 Application Disapproved for the following reasons6L J 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 ( N' Up raded( ) Abandoned( )bpi C' �-,U C U at :. a / UC t 15 1 P C:(/. -e_ be constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No �Y ated Installer Designer The issuance of thislpermit hall not be construed as a guarantee that the system function as designed. Date I O I 1C) Inspector • Y c No. _—= Fee THE THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mizpooal *p6tem Cori.5truction Permit Permission is hereby granted to Construct( Repair( �gra e( ) barn ( ) System located at �o� AcC V r�,I s ? C (� 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: Co nstr tion in t be completed within three years of the date o t s e it. Date: L Approved by T *• 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) I, rA-VVVI. A , hereby certify that the application for disposal works construction permit signed by me dated �o� , concerning the property located at a3 Ruc, p�Q, meets all of the following criteria: / This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. I • 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 1 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 fff 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) -7 0 B) G.W. Elevation aS 3 +the MAX. High G.W. Adjustment.3•a = �j , 5� DIFFERENCE BETWEEN A and B . SIGNED : l DATE: 1 U [Please Sketch proposed plan of system on bacl<]. NOTICE Based upon the above information,a repair permit will be issued for bedrooms maximum._ No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert dt � .'3'ry I INYr. 'S' of r..k.r•lt -.,�' i!d r1Sd...2i.'7.d :. r µ� �..' i .1.x o- � 4.-t'E7 tj �34[ - :BAR AR�i a "TOWN O STAB r LOCATION.:Z�.� .NW\'r7",S y1gc-k 964P SEWAGE VILLAGE ���T��� � ASSESSOR'S MAP & LOT. INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY I$'60 f LEACHING FACILITY:(type)(2 2 d I BIZ WELLS (size) 2 13 A 2, --- - -- - J�, NO OF BEDROOMS � PRIVATE WELL OR PUBLIC WATER �f(. WA, • • 1 K BUILDER OR OWNER ��i© � r DATE PERMIT ISSUED: (,> Z23 /L DATE COMPLIANCE ISSUED: . VARIANCE:;GRANTED; t F 1, V TOWN OF BARNSTABLE L ATION�� �j N�K � � Ck �G" � SEWAGE t VILLAGE ( rtjTC rcy:' -LQ�' ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. A & B C M 775-6264 SEPTIC TANK CAPACITY LEACHING FACILITY:(typeo) 22!�i, tt Z, ✓CCLS (size) NO.OF BEDROOMS ,-3 PRIVATE WELL OR PUBLIC WATER C ' BUILDER OR OWNER,. <-1711f ,746 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No; • � I «��- _ __� I �� GA2�cx `� .� � _j — " ��, ,\`- `�. ,