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Home My WebLink About0035 LONGFELLOW DRIVE - Health 35 LONGFELLOW DR. CENTERVII,LE A= 188 036 UPC 12534 No.2 HASTINGS,MN No. / *✓ Fee$5 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Mi-4poar *raem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon �� 1 Y( ) ❑Complete System ❑Individual Components Location Address or Lot No. OWJ 6g d Z Zaud 1 Tel.No. 35 Longfellow Drive, Centerville Assessor's - o MA taller' am dress,and Tel. Designer's Name,Address and Tel.No. m. o�inson eptic Service PO Box 1089, Centerville , 1V1A 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 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 whets 'a plicable) t — — — and leach trench. °I / 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 thq Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by tW B d of Hea c Signed r Dates o Application Approved by z Date Application Disapproved for the following reasons Permit No. Date Issued -, �}�,.+w.. .,�.rf...�,. ,.. r .. ... ..,..�. , ' .�eo.-.. .._-_"i*--=�'--^. �'.� '�:�''* c+.a,'F:-,y�aa„..y�. s�r�' "-+`•`�:,,,,�`'t�w,."...ti.' _ sy tr'"'y� :�" No. 1 Fee• $59 A THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0[pplication for Migogal 6pgtem Congtruction Permit Application for a Permit to Construct( )Repair OC )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. Ow3%dYmep¢cjjyV Tel.No. 35 Longfellow Drive, Centerville uyy r� Assessor's MG3 G MA d k " I�ml.r')gTe.-AO t�rel�'1S On P �b pt is Service Designer's Name,Address and Tel.No. ` PO Box 1 89, Centep�ril ,/"FiV+A Type of Building: y Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow `' gallons. Plan Date Number of sheets Revision Date Title 'Size of Septic Tank Type of S.A.S. Description of Soil Sand. s I 1 Nature of Repairs or Alterations(Answer when.applicable) jitle-5 leach system— D—box ' j and. leach trench \ Im- ,. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sews a disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by t ' B d of Hea >p Signed lao t Date �!o - Application Approved by Date Application Disapproved for the following reasons ' 4 / Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS Pr i z z i BARNSTABLE, MASSACHUSETTS (tertificate of QCompliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired(X )Upgraded( ) Abandoned( )by Wm. E . Robinson Septic Service' at 35 Longfellow Dr. ; Centerville, MA has been construe din cco nc with the provisions of Title$and the-for'Disposal System Construction Permit No. '' �' dated r�/', Installer Wm. E . " RO tunson Sr. Designer of n r o The-issuance of.this permA M"ohe construed as a guarantee that the sys I wYl function as designed. Date- "I Inspectora � P � ------------------------- — — No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Pr i z z i M igpogar *pgtem Congtruction Permit 1 Perm sion is hereby gran ed to Construct( )Repair( X)Upgrade( ))Abandon( ) Systt located at_ 3:,._Longfellow Dr. , C ent lll�ery le , IVIA and Is 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 it. Date: "' J Approved b wl� � s- 116199 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, Wm, F . Rob n-,nn sr .. , hereby certify that the application for disposal works construction permit signed by me dated l-/ �j concerning the _ property located at 35 Longfellow Dr . , Centerville , MA meets all of the following criteria: failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. 'he soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. G•�here are no wetlands within 100 feet of the proposed septic system \ • ere are no private wells within 150 feet of the proposed septic system �! change in use proposed J•/There is no increase in flow and/orp p j• There are no variances requested or needed. /The bottom of the proposed leaching facility will not be located less than five feet above the mxdmum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor _ method when applicable] • I e 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 mxdmtun adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation +the MAX. High G.W. Adjustment . _ DIFFERENCE BETWEEN A and B SIGNED -4: DATE: ` [Sketch proposed plan of system on back]. q:health folder.cent TOWN OF BARNSTABLE LOCATION ri L a 4.C, f-c= jl .�� J SEWAGE # qr --3 VILLAGE �=a—1 ASSESSOR'S MAP LOT-nE—H, INSTALLER'S NAME&PHONE NO. i G SEPTIC TANK CAPACITY LEACHING FACILITY: (type) L1.1 D c f i c s (size) 37 NO.OF BEDROOMS BUILDER OR OWNER -7 1 PERMITDATE: a/ COMPLIANCE DATE: —r1 `7 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching F cility Feet Private Water Supply Welland Leaching Facility (If an/it gist on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands Feet within 300 feet of leaching facility) Furnished by Feet n i �± 7r.�