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Home My WebLink About0111 LIETRIM CIRCLE - Health (2) 111 LEITRIM CIRCLE CENTERVILLE A = 169 040 s r , �z No. �s��•�� Fee`r`I/ rxo — THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ve, PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipphratton for Mtopozal *p!tem Con.5truction Vermtt Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System Wdividual Components Location Address or Lot No. { '' `, /j C(r� Owner's Name,Address and Tel.No. Assessor's Map/ParcelAal 1cel � ��j Ins is Name,Address,and Fad.No. Designer's Name,Address and Tel.No. S t7v 1 S �1 c G►�t.V��1 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 _31 gallons per day. Calculated daily flow jA 3?sq� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. NJ Description of Soil, Nature of Repairs or A terations(Answer when applicable) ` ` 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 o place the system in operation until a Certifi- cate of Compliance has been iss o . Signer. Date �b a , Application Approved by - Date 1z 7 Application Disapproved for the following reasons '�/ Permit No. (�' L� �� Date Issued "� CSGS 0 �:TOWN OF BARNSTABLE. -,f SEWAGE LOCATION 7,14 %_Nol & LOT- ASSESSOR'SAM-A VILLAGE P NO; INSTALLER'S NAME. .&P. HONE of SEPTIC TANK CAPACITY IeQ (size) LEACHING FACILITY: (type) --Vu�J�LA NO. OF BEDROOMS BUILDER OR OWNER ik PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Supply'Welland Leaching Facility, (If any wells exist on Private Water site or within Feet 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet.of leaching facility) Furnished by tt S fig 77-27 71\ #J�A No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS s T ZIppltcatiou for Migaaf *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System [!*dividual Components Location Address or Lot No. Ili tr j `rGdv Owner's Name,Address and Tel.No. GCt�t�,�✓v�1�•-� Assessor's Map/Parcel a� Inrstal-ler-'-s�Name,Address,and T No. Designer's Name,Address and Tel.No. 1Cab� 4}' C. Y ?t t �tVl.Yt O t 1' tw, Type of Building: r ; Dwelling No.of Bedrooms Lot Size "� q° ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 30 gallons per day. Calculated daily flow � � gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 19 rct S?i fA!b l Ct /!\ n,A Type of S.A.S. Description of Soil I te of Repairs or Alterations(Answer when applicable) t iN S 4 Ad� -Qv e tv,,Nature 1 fit., G`{`t V✓.'r(� (Gt`iG 11 JI Q Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system ,I 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 issue *Ahis_]Ioar4of Signed' Date �'`� � • Application Approved by Date Application Disapproved for the following reasons rf , Permit No. .2134P�.s ,f Date Issued — —————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CER that he On-site S e tDisposal System Constructed( )Repaired( )Upgraded Abandoned( )by r--�� 1� i at ` ( c>t r r�nn C�;�L CP�`C"t (Ltlm�� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit V 00 dated :2 Installer Designer v / The issuance of this pe sha 1 not be construed as a guarantee that the s s m will function as des gned� f / t .F Date Inspector 777/ f I./.�'r"/IJT �� — p No. � ./�^�_ �k` -------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS ]0tgPo5a1 *pgtem 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. Provided:Construction must be completed within three years of the date of this. it. Date: Approved by , =4G �' .? , 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AIND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) NIN L a ✓� \y , hereby certify that the application for disposal works p construction permit signed by me dated concerning the property located at C—�rcr� �� `� 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. • 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 c/ 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.jAdjust 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) t B) G.W. Elevation ��"� +the MAX. High G.W. Adjustment DIFFERENCE BETWEEN A and B SIGNED : DATE: r�- - :, `� [Please Sketch posed plan of s m on back]. '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 is ��. :� �� +� J-.._ �� •1 , r ✓ j //fir- p d�� V eLo -OL skaf Ic-- �`Y_�C�ly��j_GCm�� - �kh�c_ e�ti-��C�-��e_o_f__cLm� ��a�nc.:e �,A �K Uq �,� -- !il I'I I� I I I I __III_ III III - - -1 - - -- III --- -- III III --- - I I II --- --- III III -- - �� - II ___ III - ---� I TOWN OF BARNSTABLE \` LOCATION I �1 0 V i�1al/�,C� !� SEWAGE # H '�- VILLAGE CCV�-1,Z:�-yuo ASSESSOR'S & LOT INSTALLER'S NAN E&PHONE NO. 0 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 'I4�� a�Cd6� (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: 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 1 O � b s r