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Home My WebLink About0090 PINEY POINT DRIVE - Health 90 PINEY POINT DR., CENTERVILLE A=228-005 �III1� uro llll � UPC 12543 No. 5_ 3�2 a' HASTINGS, MN a TOWN OF BARNSTABLE �- LOCATION 90 PJVt y A14!f JUL SEWAGE # VILLAGE 6&14-21 // ASSESSOR'S MAP & LOTS) S? Do;� INSTALLER'S NAME&PHONE NO. 6,1 f 1,111i CINQ/,ye/10o 5�2 '62 E• SEPTIC TANK CAPACITY //i DOd of L LEACHING FACILITY: (type) SAD Ce Lye die s9 L (size) NO.OF BEDROOMS �-�.� BUILDER OR' I Rl Z--11I' PERMITDATE: X" - / cT Y COMPLIANCE DATE: G - 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 74)74 on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300.feet of leaching facility) Furnished by o �� a� �� o � a� � �,��. �� i—ia;�,z lz- 4 -U f 1.-D-E-R 5--tJ-/�,1vt:E-=� -" - ® "' { 1 ,. ..•. - _ .. ..,.. �... - ,. �.., ., ....r i q ��` F. . Y 3ci No.e Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppricatton for Migaal *p.5tem Construction permit Application for a Permit to Construct( )Repair(V)Upgrade( )Abandon( ) El Complete System eIndividual Components Location Address or Lot No. J d n� Owner's Name,Address and Tel.No. Assessor'sMap/Pazcel 7 C/ew Alle7— Installer's Name,Address,and Tel. v Designer's Name,Address and Tell..No. o. l�Pr��/69W_4�`. 7 71 e Type of Building: Dwelling No.of Bedrooms L3 4 Lot Size sq.ft. Garbage Grinder(0160 Other Type of Building tK No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow lId gallons per day. Calculated daily flow D!30 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. /Z.,;it'Z✓��" Z / Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 y�tisoXof.Health.SignedDate </ Application Approved by Date Application Disapproved for&d foll ing reasons Permit No. - Date Issued TOWN OF BARNSTABLE .::LOCATION P/wc y P0111y JIL SEWAGE # _ ;.;.�L: 'AGE C�W��^�/��- ASSESSOR'S MAP & LOTS 3 S _. Day' .;INSTALLER'S NAME & PHONE NO. ��o�/�i �vv3�rr�t^o� Val I 9yW :svp- IC TANK CAPACITY ACHING FACILITY: (type) 5, (size) A,2 �.e.2 :.NCB':OF BEDROOMS ; ' :':BUILDER OR qR lo•vf�� ,;.PERMITDATE: COMPLIANCE DATE: -,:Sdoar.ation Distance Between the: 1�!laz:mum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Privkte 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 j within 8 300 feet of1eachin facility) Feet F, Furnished by ' Is f I I O No. , •x l o Fee �.+.3 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pplhatfon for Mt!5pogal *pftem Conotructfon Permit Application for a Permit to Construct( )Repair Upgrade( )Abandon( ) ❑Complete System KIndividual Components Location Address or Lot No. 9 A 1 , Owner's Name,Address and Tel.No. Assessor's Map/Parcel C p y Installer's Name,Address,and Tel.No. Cy Designer's Name,Address and Tel.No. ADvzi,4D,7, i 771-g3 i9 Type of Building: ? Dwelling No.of Bedrooms J Lot Size sq.ft. Garbage Grinder('�0 Other Type of Building 2// No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow .30 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank X/57�ii63 Type of S.A.S. /Z 5`i�' 5_,1 7— Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 y t is oar of Health. Signed Date Application Approved by Date - Application Disapproved for tQ folloYing reasons Permit No. 2 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance � THIS IS TO CER IFY, that the On- ite Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( y I- /O ��`' . at 1/7c'- V / has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date -- '� Inspector —— �}ry No. / Ta — � -------------------- ��6 —D�S THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 3f 5po.9af 6pgtem Com0ruction 3dermft Permission is hereby granted to Construct( )Repair(Upgrade( )Abandon( ) System located at 9/�, //9G° ��%�"r 7� O✓• ell yC"�/r 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:Construction must be completed within three years of the date of this permit. Date: Approved by 1019/97 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 ENGINEERED PLANS) hereby certify that the application for disposal works construction permit signed by me dated A- , concerning the property located at f1-of/7— �� meets all of the following criteria: /There are no wetlands located within :00 fee:of-,he proposed leading facility /There are no private wells within ! o .`--t of:he proposed septic system V There is no increase in :low and/or:range in use:r000sed Iere are no variances requested or Needed. lr the proposed leaching faciiity •wiil '-e iocatec-.vithin ::0 eet of any wetlands. the bottom of:ne I11 ;e-t wove proposed !leaching :aciiity will p,Qr,�e :ccated rests:hap .'aurae-n �,. .he :naxnurn 2diustec. ;roundwater tabu elevation. Please complete the following: A)Top of Ground Elevation(according:o the Engineering Division G-l-S map) /✓� B)Observed Groundwater Tabie Elevation(according to Health Division well map) 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]. �Mait6 Ibfder.oat F �f= 0�,.' i 1 �Lev -► � �� Q� �a.