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Home My WebLink About0016 PINEY POINT DRIVE - Health 16 PINEY POINT, CENTERVILLE A=2 S-009 s UPC 12534 No.2 HASTINGS,MN TOWN OF BARNSTABLE C5 . (2, tqLOCATION / .f/ / SEWAGE # VILLAGE � '!7"e�.� ll��l� ASSESSOR'S MAP& LOT —0 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1� d U LEACHING FACILITY: pe) �.y�i L7%LfO/L�' (size) NO.OF BEDROOMS BUILDER I WNERvp z PERMITI) 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) „a< '' Feet Furnished by r / /3 a .J 2 3 2 ,��. 132� No. 9T^ 3 1 w Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE. MASSACHUSETTS Yes Application for Zigpogar *paem Congtruction Vermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ;M-Complete System ❑Individual Components Location Address or Lot No. ` �E I ��(�� Owner's Name,Address and Tel.No. Assessor'sMap/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 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 3�� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 00 19 Type of S.A.S. l Gi 7 sc<<QQs Description of Soil Nature of Repairs or Alterations(Answer whe applicable) SS 19. ^n L—t(4(A-C 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 ' d Signed Date '/'-T Application Approved by Date Z, Application Disapproved for the ollow g reasons Permit No. 21 fT— Date Issued No. 1 3 Y 1. l Y Fee / i THE COMMONWEALTH OF MASSACHUSETTS ' Ent eredinldmputer;� 4,_ I. Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 'Zipplication for ]Digozar *pgtem Cowaruction Permit 4 µ Applicatiotfo a Permit to Construct( )Repair( )Upgrade( )Abandon( • ) omplete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. —�Assessor's Map/Parcel C�O G �r`�� t QQ IoCJM�. .~- 50auV Installer's Name,Address,and Tel.No.r Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) ;. Other Type of Building t No.of Persons Showers-( ) Cafeteria( ) g Other Fixtures ! " r Design Flow, �3C1 gallons per day. Calculated daily flow �� gallons. b Plan Date Number of sheets Revision Date 'Title _ Size of Septic Tank 00 C i4 t Type of S.A.S. Cc Description of Soil Nature of Repairs or Alterations(Answer wtief appli able) (1�-c 1 Kl,� , C l.1 C 4 C rt f4ti Date last inspected: h `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 beenisstted-byt ' d Signed Date — ` _ Application Approved by Date Application Disapproved for the olio Ai g reasons 4 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(//f Abandoned( )by t at A: {it c has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer J The issuance of this permit shf 11 of b g y g /e o f ed as a uarantee that the s ste w'ltfunction as design n Date p 1 t ` Inspector No. f Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS &000ar *pztem Cow5truction Permit Permission is hereby granted to Construct( )Repair( )Upgrade Abandon( ) SystFpi located at t(,I_ r ! G 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 permit. Date: `z -- f 7 y y Approved by 1/6/99 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, hereby certify that the application for disposal works construction permit signed by me dated ]a,—\'— , concerning the property located at 0 (-)n;*:),Z— C'Qt>W � meets all of the following criteria: V• The failed system is connected to a residential dwelling only. There are no commercial or business ` uses associated with the dwelling. 1� The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. tzThere are no wetlands within 100 feet of the proposed septic system (/• There are no private wells within 150 feet of the proposed septic system (/• There is no increase in flow and/or change in use proposed "• There are no variances requested or needed. V. 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] • 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 czz+the MAX.High G.W. Adjustment . !�� _ ,C/ DIFFERENCE BETWEEN A and B SIGNED : DATE: V 4-9 S [Sketch proposed plan of system on back]. q:health folder:cert .- .,,. � � �.��- �� r' i G 0 ! TOWN OF BARNSTABLE LOCATION / % SEWAGE # VILLAGE „_tG!_T,�,s� 1 /J- ASSESSOR'S MAP & LOT '�l� INSTALLER'S NAME&PHONE NO._ /51/a—Aeo e SEPTIC TANK CAPACITY LEACHING FACILITY: pe) !�r/Yi T/L./f��/L�' (size)`/ NO.OF BEDROOMS BUILDER OR OWNER PERMUDATE: 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 LT/ TF/ T El