The URL can be used to link to this page

Home My WebLink About0020 PADLOCK LANE - Health 20 PADLOCK LANE, CENTERVILLE A= ll • UPC 12534 .2.1 MIR MAITINGS.VN No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpprication for 30igpo.5af *pgtem Construction Vermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System f Individual Components Location Address or Lot No. v Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. l Designer's Name,Address and Tel.No. 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 C7 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date 'Title Size of Septic Tank ee,,c. `/� t a `fG1- v✓ Type of S.A.S. _yv�c, ca Description of Soil �h2 iG S Nature of Repairs or Alterations(Answer when applicable) S� 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 be e y this Bo o ealt . Signed Date Application Approved by 0 Date r l0'P� Application Disapproved for the folio 'ng reasons Permit No. Date Issued TOWN OF BARNSTABLE LOCATION O 4A9SEWAGE # VILLAGE ASSESSOR'S MAP-& LOT Y� INSTALLER'S NAME&PHONE NO. ,/1716!'J dh SEPTIC TANK CAPACITY /,ga d LEACHING FACILITY: (type) Jd,4Z ZZ &;r00P (size) NO. OF BEDROOMS BUILDER OR OWNE .V PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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) s " Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 30O feet of leaching facility) Feet Furnished by o � ' �6 1 e• Y A�aza �� cI&- pig I No. 1 Fee -� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pprication for Migool *p.5tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System .individual Components Location Address or Lot No._:)C C Owner's Name,Address and Tel.No. Assessor'sMap/Pazcel 1 _� ,6 r Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 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 t Title Size of Septic Tank �r�.. `�j► tC cl' W G �Type of S.A.S. C(; Ci7 Li Z-vliC L Description of Soil Nature of Repairl or Alterations(Answer when applicable) ��iti��`t tA-A\ t 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 beeApn s ue by this B o Healt . Signed Date C_ Application Approved by Date r z'G Application Disapproved for the follo ing reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded Abandoned( )by -e -N at CM,L t has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.97'q 2 y dated Installer Designer r The issuance of this peril' shall no be c nstrued as a guarantee that the sy t will fun do�s de igifed.0 b Date Inspector /�' 1 No. /'�-7�y----------------------------Fee yo�0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migo!5af *p6tem Construction Permit Permission is hereby granted to Construct( epair( )Upgrade(tom Abandon( ) System located at 1U� ,- �.C e 1/ 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 ermit. f Q Q Date: Approved by ` •� /� /—'- 1/6199 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) hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at w meets all of the following criteria: C4 The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. i �- e 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 ere is no increase in flow and/or change in use proposed Thre 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. [Adjust the groundwater table using the Frimptor method when applicable] ,4 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) B) G.W. Elevation '3-90+the MAX.High G.W. Adjustment DIFFERENCE BETWEEN A and B t SIGNED : DATE.- (Sketch proposed plan of system on back]: q:health folder.cent . � 0 J TOWN OF BA.RNSTA.BLE LOCATION nQOaacl lan[''.//� N / SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. ZV1,l94,e2 is SAP C SEPTIC TANK CAPACITY y LEACHING FACILITY: (type) ZAZ/- /,KQ Zare (size) NO. OF BEDROOMS BUILDER OR OWNE PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 i Trio _ f� IVFo ' 9 ,9 No. Fee `=5 — THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Migpogai *pgtem Congtruction permit Application for a Permit to Construct(_: Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Ad ress 9;of No. Q(e® 4.om f, V/4(� 0/+s Owner's Name,Address and Tel.No. �r /.�/9 or v C°C!!� Assessor's.Map/Parcel Installer's Name,Address,and Tel.No.4f-71 +034(J' Designer's Name,Address and Tel.No. .43 4,04 Ae- doew s d7.,- 600N-40s Type of Building: Dwelling No.of Bedrooms y 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 Nature of Repairs or Alterations /R(Answer when applicable) aQZdwL Q,,* /9 — k 4f SA91rl 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 by this Poard of Heal . Signed Date Application Approved by Date �2//,OW Application Disapproved for the following reasons Permit No. ly 9 ce Date Issued Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for ]DkSpo.5al *p!gtem Con,5truction Permit Application for a Permit to Construct(,,,*)Repair(( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Ajoressg Lot No.14 60 L ryHf, Y i,Lv Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No.L/j f—O�r 4e9 Designer's Name,Address and Tel.No. �\ Jvse,04 De- /. oevvs V.._ /3.`or�•-cs Type of Building: Dwelling No.of Bedrooms 4/ 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 Nature of Repairs or Alterations(Answer when applicable) F421,gC � a,,j k 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 oard 9f Hea th. Signed Date_? Application Approved by Ir Date gen .�- Application Disapproved for the following reasons Permit No. Date Issued ---------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (tertificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed(4-}rRepaired%( )Upgraded( ) Abandoned( )by 471 at Z60 i- . has been constructed in ac ord'' e with the provisions of itle 5 and the for Disposal System Construction Permit No. '°' dated M " /��: ° Installer Designer >ti r p v / The issuance of this permit shal not b �jons ued as a guarantee that the sys ' vill function as designed.l� p Date �y l {%l Inspector A 1 ._. ✓ > � /� / C . -------—------------------ No. Fee""✓ . THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS liolugar *pgtem Construction Permit Permission is hereby granted to Construct( 44-Repair( )Upgrade( )Abandon( ) System located at 2G0 Losyi V—, 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 pe Date: tf " /�'�' / / Approved b t/ • I I Y • 1 i I , 8t1MWACX=WAQs� ZC Mr FAA4M �Ip�TlpPl�aoetl�uedj I SJU ncerOf-WWAG&sUPaOa.Ste:' bamb"M eo ileac tot peace ,kO*Mlo a bcwbmWM Lwa 41M wd i lbw too IraL 1 } 4 9L Ole I I ' 1 AtpQcbBva�rlpoleir. a�preei vrAppaocfe�wu� � u 1 f TOTAL P:m9