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Home My WebLink About0406 LAKE ELIZABETH DRIVE - Health (2) I 406 LAKE ELIZABETH RD. , CENTERVILLI _ MAP-227 PAR-023 104 L"•c- Z-t , TOWN OF BARNS TABLE - LOCATION ® C'� � � �`�-- ► SEWAGE # I'�® VILLAGE ASSESSOR'S MAP & LOT d- — INSTALLER'S NAME&PHONE NO. J?b b i w_��-$..,z. 7 S 7?` y SEPTIC TANK CAPACITY /-$� 6`a LEACHING FACILITY: (type) NO. OF BEDROOMS �1-- J BUILDER OR OWNER 6C.J•4 / 5 IY PERMITDATE: 0 —/S'Z `7 COMPLIANCE DATE: �l --� G 7 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Ching Facility Feet Private Water Supply Well and Leaching Facility (If y wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wit ands exist within 300 feet of leaching facility) Feet Furnished by ✓ � � �/�, i :�, //l �� l � �- ` ' i � `mod � � , � U No. T7—Sd -S Z 2 / 0 2� Fee $5 0 .0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS es Zipphration for Miopool 6raem Construction Permit Application for a Permit to Construct( )Repair( x)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 406 Lake Elizabeth R owner's Name,Address and Tel.No. 61 7—6 6 5—7 3 4 4 Centerville, MA Margret Walsh Assessor'sMap/Pazcel 34 Perkins St, Stoneham, MA 02 80 Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. Wm E Robinson Sr Septic Service PO Box 1089, Centerville, MA 02632 Type of Building: Dwelling No.of Bedrooms 2 Lot Size sq.ft. Garbage Grinder( no 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. Description of Soil sand Nature of Repairs or Alterations(Answer when applicable) We will install Title 5 septic system consisting of 1500g tank, D-box, and three stonepacked high capacity infiltrators. 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 Co and not to place the system in operation until a Certifi- cate of Compliance has been issue by this d ealth. Signed a Date Application Approved by Date Application Disapproved for the following reasons - Permit No. ^ - dS Date Issued fob L � C..Q.•.CY. � TOWN OF BARNS TABLE LOCATION C7 p lei f SEWAGE # VILLAGE L/�j ASSESSOR'S MAP& LOTa2 7—6 2 INSTALLER'S NAME&PHONE NO. �0 6 i a- a 7 7 s 8 SEPTIC TANK CAPACITY .S G O LEACHING FACILITY: (type)NO.OF BEDROOMS �-- BUILDER OR OWcN�ERL.2�t) G /S J PERMITDATE: / —/S`�1 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of ching Facility Feet Private Water Supply Well and Leaching Facility (If y wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any w ands exist within 300 feet of leaching facility) Feet Furnished by 4z- -� 1 CV r n p9 %� No. O 2-� Fee $5 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s " PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 1, 4[pplication for �Bigoga[ *p5tem Construction Permit Application for a Penh t to Construct( )Repair( x)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 406 Lake E 1 i eabeth downer's Name,Address and Tel.No. 61 7-6 6 5-7 3 4 4 - Centerville, MA Margret Walsh Assessor'sMap/Pazcel 34 Perkins St, Stoneham, MA 02180 Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. Wm E Robinson Sr Septic Service PO Box 1089, Centerville, MA 02632 Type of Building: Dwelling No.of Bedrooms 2 Lot Size sq. ft. Garbage Grinder( no 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. Description of Soil / sand `" Nature of Repairs or Alterations(Answer when applicable) ;We Will install Title 5 septic system consisting of 1500g tank, D-box, and three stonepacked '( High capacity infiktrators. f 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 Co and not to place the system in operation until a Certifi- cate of Compliance has been issu�by is ealth. ^r/� Signed Date 7J Application Approved by Date Application Disapproved for the following reasons Permit,No. �/ �J�� Date Issued Permit, / THE COMMONWEALTH 4F MA46CHI9ERS Wa`]sh BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Dispo4l'System Constructed( ) Repaired(lgyj Upgraded( ) Wfn E Robinson Sr Se t5i'ct Service Abandoned( ' )by ,.. P at Lake Elizabeth()R , Centerville has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. CT _ - o.� ated Installer Wm E Robinson Sr Septic Sery Designer The issuance of this permits all not beconstrued as a guarantee that the system will function as designed. Date Inspector ---------------------------- No. v� Fee $5 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS Walsh PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Walsh &.5pogar *pgtem Construction Permit Permission is hereby granted to Construct( )Repair( x)Upgrade( )Abandon( ) System located at 406 Lake Elizabeth Rd Centerville, MA ` Installer: Wm E Robinson Sr Septic Service 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:Construc 'on must be completed within three years of the date of thispermr /�� `� 5 �',� Date: Approved by 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,William E. Robinson, Sr.-,hereby certify that the application for disposal works construction permit signed by me dated 9 -7 , concerning the property located at 406 Lake Elizabeth Dr, Centerville MA meets all of the following criteria: * Mo e a no wetlands within 300 feet of the proposed septic system. * rei' no private wells within 150 feet of the proposed septic system. * ` obseved groundwater table is 14 feet or greater below the bottom of the leaching facility. Ze re�'s no increase in flow and/or change in use proposed. re r n are o variances requested or needed. SIGNED: `/� DATE J 5' LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 60 (Attach a sketch plan of the proposed system. Also if the licensed installer proposes a certification plot plan,this plan should be submitted). -:� �--� ...r -- � � 1 `i� �,�--� v �