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Home My WebLink About0444 NOTTINGHAM DRIVE - Health 444 NOTTINGHAM DR., CENTERVILLE A=147-013 1 TOWN OF BARNSTABLE LOCATION SEWAGE # EL ZI9 i VILLAGE C,-,025,, r 12 ASSESSOR'S MAP &LOT/97-015 INSTALLER'S NAME&PHONE NO. �77-o3y4 dasei�; ��L3erra5 SEPTIC TANK CAPACITY /Boo LEACHING FACILITY: (type) 2,-500&A,/ 0RV Gv 11 (size) 25'X r NO.OF BEDROOMS 3 BUILDER OR OWNER B04,ye,* Q roa!e PERMTTDATE: 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 faci ' ) Feet Furnished by 3� NorT,h�� 00r No. Feeb THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0[ppricatton for Zigpogar *pgtem Cotwtrurtton Vermtt Application for a Permit to Construct(Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Y qzl 1V6TP'/jl A14"_j �/t /�� Owner's Name,Address and Tel.No. Assessor's Map/Parcel Y <3/ Installer's Name,Address,and Tel.No. "t 7 7-03Vf Designer's Name,Address and Tel.No. Jost Oe igAOAI�s vN� a e4, 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. Description of Soil A v Nature of Repairs or Alterations(Answer when applicable) 2 —Sn� wt3� (wPi i�lL Gye T�i ' ` .Sl-ol�I G 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 Health. Signed Date 4�/4 Application Approved by Date c. �� Application Disapproved for the following reasons Permit No. 9 Date Issued No. / J/ Fee U 2:5" THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Yes 0(ppYication for Di.5pool 6p.5tem Comoructiou Vermit Application for a Permit to Construct(Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ly 4/[1/ n/o r/.1qh,Wry Q�,t jl� Owner's Name,Address and Tel.No. Assessor's Map/Parcel y Installer's Name,Address,and Tel.No. y 71 I Designer's Name,Address and Tel.No. ;. Of ,",A".e /?4, !ram Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other,- Type of Building No.of Persons Showers( ) Cafeteria( ) O.tlier 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 Sio"i Nature of Re airs or Alterations(Answer when applicable) 2 -S /i ui,f-flc t�r��ur� � �' lei=lO .Srn✓�-G 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 Health. K Signed Date 5--4-"94 .c Application Approved by i Date r ' Application Disapproved for the following reasons Permit No. its Date Issued --------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed(L.a-Repaired( )Upgraded( ) Abandoned( )by s✓os e pti D._ /3i4+n a S at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No _ dated Installer ,/osr-p4 LdNro S Designer _ b . > !? The issuance of this permit hal/l/n/ot l e cons .ued as a guarantee that the sys�m ill fyu 1 �ncttion s desyg®ed /I'4'✓ t / Date v C/�f / `r Inspector --------------------------------------- No. Ap�_" /'// —"/:3 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS Mi5pofsal *pgtem Cowaruction Vermit Permission is hereby granted to Construct( tom-Repair( )Upgrade( )Abandon( ) System located at y5� 11/o1Ti no .arv, Or. r 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 thi emiit. Date: "p Approved b�' //TOWN OF BARNSTABLE LOCATION 4/S1 /(/o�ha/�ias� SEWAGE # 9�/-2`/9 S' VILLAGE egZr rV, ASSESSOR'S MAP &LOT/97-oi3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1600 (size) LEACHING FACILITY: (type) NO.OF BEDROOMS 3 BUILDER OR OWNER pv wry 8 r PERMITDATE: S 'G 91 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 leachingf�acii ty) Feet Furnished by I I i uwT 7� No17ay�l��? �r 116/99 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, ,fi,srpLi 0, &or S , hereby certify that the application fr,r disposal works construction permit signed by me dated concerning UP.- property located at_yyy f�T/�� Jar _ meets ail of the following criteria: • The failed system is connected to a residential dwelling only. There are no commercial or business ides associated with the dwelling. The soil is classified as CLASS I and the percolation rate is iess than qr.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 fect of the proposed septic system A---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 ngt be located less than five fe:;t above the maximum adjusted groundwater table elevation. [Adjust the groundwater table rising 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 nit be located less than fourteen(14) feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface EIevation(using GIS information} B) G.W. Elevation I� +the MAX. High G.W. Adjustment.,E, 5 DIFFERENCE BETWEEN A and B SIGNED :—VALI� DATE: ifs�t''19 [Sketch proposed plan of system on back]. q:heaith foider.cent FxiS yu 1000 r57�hy /000 Cx Mon, kow L O''C A`T- .ON SEWAGE PERMIT NO. f VILLAGE INS TALLER'S NAME i ADDRESS 2UILDER Crt OWNER jas -t>,Qo,,4,L-Z, DATE ,PE MIT ISSUED. 0 .� c DATE COMPLIANCE ISSUED r 0