The URL can be used to link to this page

Home My WebLink About0244 ROLLING HITCH ROAD - Health 244 ROLLING HITCH RD. CENTERVILLI i 1 au UPC 12534 ' No.2-115.3LOR HASTINGS,MN TOWN OF BARNSTABLE LOCATIO KfrN N SEWAGE # VILLAGE ASSESSOR'S MAP & LOT� ,—A#' INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /" L— a � LEACHING FACILITY: (size L NO.OF BEDROOMS ' BUILDER OR,.OWNER PERMTTDATE: 3 2 COMPLIANCE DATE: . - , Separation Distance Between the: Maximu.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 leachingfacility) Feet Furnished by F d l� �9. Ll ' t THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for Digoml *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade((,/Abandon( ) ❑Complete System A4ndividual Components Location Address or Lot No. \� `` t Owner's Npa�me,Address and Tel.N kc c o.� Assessor's Map/Parcel \. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. V YU Type of Building: ,l Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �-v-ko gallons per day. Calculated daily flow �,"� \ gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank . a S`ri��c7Q�) 2)Ark�_Type of S.A.S. Description of Soil —c Q S �� Nature of Repairs or iAlterations(Answer when applicable) !X�A t�:-, `t teT rG,�k{i I4 S C.e-t �El O iti- 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 provisio e Co�andnot to place the system in operation until a Certifi- cate of Compliance ha een issued by this alth. !q Signed Date 7'F- 1' Application Approved by Date —7 24 Application Disapproved for the ollow g reasons Permit No.�, ��c6 Date Issued No. Ll THE COMMONWEALTH OF MASSACHUSETTS Entered n computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIPPrtcatton for Dtoozaf *pgtem Com5tructton Vermtt Application for a Permit to Construct( )Repair( )Upgrade((,/Abandon( ) ❑Complete System X�adividual Components Location Address or Lot No.2,-k A �(� Owner's Name,Address and Tel.No. Assessor's Map/Pazcel ,\9�� c ��. t C Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. S,e0�C 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 �V t gallons per day. Calculated daily flow (AAp\ gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank r_-x-c S—Ic�'TY�Q� �, Type of S.A.S.XAc ` ? c, Description of Soil t-° 1 Nature of Repairs or Alterations(Answer when applicable) O Sr 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 provision f le o€-ttr61giV t`armwAU not t Code and o place the system in operation until a Certifi- -cate of Compliance ha een issued by this alth.I Signed Date 7-1- 1q -9� --Application A -- PP roved by "_ _ _. _ 'a -.._. ;, Date":7 _.:'a,,o - 4'C. ._ Application Disapproved for the olio ' g reasonsy Permit No. ��,j a� Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certtftcate of Comphance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired ( )Upgraded(L_�� Abandoned( )by , at �. has been constructed in accordance with the provisions of Title 5 and the for Dispos 1 System Construction Permit No. z9,9 •!5-;4—dated Installer Designer d /I d The issuance of this pertW shall ndt be construed as a guarantee that they tem will func ion as de gned,� / Date J! N Inspector 0 I No. 7 7— Fee 15/`J THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mi5po5ar *p5tem Congtructton Vermtt Permission is hereby granted to Construct(0 Itpair( )Upgrade( Abandon( ) System located at " C 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 permit. Date: 7-3 a - Approved by � I l/6i99 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 PP P construction permit signed by me dated concerning the property located at a��-` �fl�\' �� \ v meets all of the following criteria: V• The failed ste i o i sy m s connected to a residential dwelling only. y There are no commercial or business uses associated with the dwelling. The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. XThere 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. The bottom of the proposed leaching facility will not be located less than five feet above the ma..,=um adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor ethod when applicable) • Lf 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 /SQL the MAX. High G.W. Adjustment . = G c DIFFERENCE BETWEEN A and B qL �� SIGNED : DATE: �� IC/ [Sketch proposed pi of System on back]. q:health folder.ccrt TORN OF BA�RNSTABLE LOCATION `S .I dHl SEWAGE # va.LAGE C ' V Ihe ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. i SEPTIC TANK CAPACITY LEACHING FACILITY: ( pe BEDROOMS NO. OF )�NV Di (size i BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE:— 4YZJ2� 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 � �41V V I