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Home My WebLink About0044 LINDEN AVENUE - Health 44 LINDEN AVE. , CENTERVILLE A=208-015 / t No. ..B y !� t 4 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 01pprication for &!6poga1 *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( /Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. blo ew p Owner's Name,Address and Tel./N�o. Assessor's Map/Parcel i'Z 4)11J'5 I-ee vwee,�-_e Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. bfla- 1, 1111 l' ,n6l"'_ 7V--�3�9 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder KW Other Type of Building 491?'Gv No. of Persons Showers( ) Cafeteria( ) Other Fixtures fJ Design Flow 160 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 ��` G�1� /G�` 2- Nature of Repairs or Alterations(Answer when applicable)_ r)7-le -2Z- 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 b his d He Signed A Date l Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued TOWN OF BARNSTABLE �G U LOCATION::.;!y z l�weo ape SEWAGE # _Z� VILLAGE 'G e� ��✓�"Ile ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ISUO 64.L , LEACHING FACILITY: (type) /*A 4r' (size) X y l'3-X� NO.OF BEDROOMS Y '� BUILDER:O O b oe PERMITDATE: L I COMPLIANCE DATE: �^ G —�r -7 Separation:Distance Between the: _ Maximum Adjusted Groundwater Table and Bottom of Leaching Facility S 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 leaching facility) Feet Furnished by fi _�`►''S v 96 •4W N<`.. No. S d "+t a.x` t "��ee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS 4 2pplichtion for Migoal 6potem Con.5truction permit Application for a Permit to Construct( )Repair( )Upgrade( V)/Abandon.( ) 0 Complete System .El Individual Components Location Address or Lot No. /'iJ J� Lp� p Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ,61rA40,�'/ G®x82"` 7V- W9 i Type of Building: Dwelling No.of Bedrooms 7 Lot Size sq.ft. Garbage Grinder 449 Other Type of Building of Persons Showers( ) Cafeteria( ) Other Fixtures i Design Flow �� -~ -gallons per day. Calculated daily flow 7�a gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil i' • Nature of Repairs or Alterations(Answer when applicable) 7 1-r!e 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 b his d . He h --- Signed Date Application Approved,by Date Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CER FY, that the On-site Sewage Disposal System Constructed( ) Repaired ( ) Upgraded(!� Abandoned )by d 4/' ®Co at //It? ee /1be 6&w has bedh constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 0 dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date �;° - �, . 7 Inspector ——————————— ———————-—————— ———---_ — No. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Miopozaf *p5tem Con.5truction Vermit Permission is hereby granted t Cons ruct( )Repair( )Upgrade( VAbandon( ) System located at /� � "_ b�Pe,,,e 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:Constructi ust b cometed within three years of the date of thi pe*t. Date: / Approved by (. 1 � V NOTICE: This Form is to be used for the Repair of Failed Septic Systems Only CERTIFICATION OF SKETCH AND APPLICATION FOR DISPOSAL WORKS CONSTRUCTION 1'ElZMI'I' (WITHOUT DESIGNED PLAN //�C/,e/,Acreby certify that the application for disposal works construction permit signed by me dated � ?7 , concerning the property located at �� G�� q��_ C `� ' � meets all of the following criteria: There are no wetlands within 300 feet of the proposed septic system 6/Z.7 � re are no private wells within 150 feet of the proposed septic system �e observed groundwater table is 14 feet or greater below the bottom of the leaching facility g T ere is no increase in flow and/or change in use proposed There are no variances requested or needed. SIGNED : DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. j:ccrt �4 4 v TOWN OF BARNSTABLE LOCATION 6 li�� L�y1 / % SEWAGE # —Z� VILLAGE Ge`I �f✓ `� //ASSESSOR'S MAP& LOT 9-6--,S� INSTALLER'S NAME&PHONE NO. �/G4�� SEPTIC TANK CAPACITY I�SUO 6�r,L LEACHING FACILITY: (type) A)/*p4r (size) NO.OF BEDROOMS Y BUILDER Oli�01 � PERM TDATE: W/- 7 COMPLIANCE DATE: Jr" —2 -7 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) 4 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) 1 Feet I Furnished by q /2.S,11 ��,,..� l I 1 i J