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Home My WebLink About0158 SACHEM DRIVE - Health 158 Sachem ®rive 209-056 Centerville o TOWN OF BARNSTABLE fr LOCATION ✓` �Gh e"'� ` 2' SEWAGE # VILLA S ��/d�� ASSESSOR'S MAP & LOTRO Pf INSTALLER'S NAME&PHONE NO. Nee �-tL SEPTIC TANK CAPACITY ��a/� LEACHING FAC L=: (type) *7F//t02FFWS (size) NO.OF BEDROOMS BUILDER OR OWNER Of) V 1,0 /AJ/J 6X? PERMTTDATE: ��"M °'E � 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 facili ) Feet Furnished by r 1 O z�.No. � Fee d THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpprication for 30igpoga1 *p.5tem Conotructfon Permit Application is hereby made for a Permit to Construct( )or Repair( an On-site Sewage Disposal System at: Location Address or Lot No.15 S c ter —owner's Name,Address and Tel.No. Assessor's Map/Parcel a O Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 16 Type of Building: Dwelling No.of Bedrooms 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 Description of Soil j-7--f i✓f� Nature of Repairs or Alterati (Answer when applicable) ZC��w sub_ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenan of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the E ironme_n_tal Coe d place the system in operation until a Certifi- cate of Compliance has bee is o f e Signed Date 14� R Application Approved by Date Application Disapproved for the owing asons Permit No. 9,� Date Issued J v • i. - - , 'r'+!4('4.. I.ztir.t -. r r-r- '�� r'"y'"�... 4 ... .. 1i t•»'r F -.S Y,r•r _ .N. 1.,_. •a�wA, No. �s� � d / C Fee S THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS. 2pphration for &gw6ar *pgtem Conotruction Permit Application is hereby made for a Permit to Construct( )or Repair( an On-site Sewage Disposal System at: Location Address or Lot No. /J'`� �e+1( Owner's Name,Address and Tel.No. �S�C l� vet - Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 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 n Description of Soil_ ✓� Ala ►`J Nature of Repairs or Alterations(Answer when applicable) <:C--SrJ�'�(I / s ?4 , rc 70 " A Date last inspected: Agreement: r The undersigned agrees to ensure the construction and maintenanx of the afore described on-site se.,age,disposa system E r. s . �a- in accordance with the provisions of Title 5 of the ironmental Co a d n place the system in opera�tion until a Certifi- cate of Compliance has been is�,sued-by'this o f E 'Y N Signed Date Application Approved by Date L Application Disapproved for the f owmg asons i t Permit No. � - Datedssued 1 —— ————————————————— ——————————————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,-,MASSACHUSETTS Certificate of Compliance IS T9 ,that the On-site Sewage Disposal System installed( )or repaired/replaced(L�n /l-3 76 by` K 0 I�-r-�c As Installer � t I . d fs�l1 wok_" at j -has been constructed in accordance, with the provisions of Title 5 and the for Disposal System Construccti i -P t No. ,N.�4 dated Date /�-^ Inspector THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYS- TEM WILL FUNCTION SATISFACTORY. --------------------------------------- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS �Diopozal *pote_. Otruction Permit Permission is hereby granted to G to construct( )repair( n-site-Sew ge S stem located at No.# c Street and as described in the above Application for Disposal System Construction Permit. No. Date The applicant recognizes his/her duty to comply;with Title 5 and the following local provisions or special conditions. All construction must be completed within three years of the date below. Date: _ �o Approved by Board of Health 4 CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL 1VORKS C:ONS'FItUC'FION I'EItMI'I' (NVI'I'IIOU"I' DESIGNED PLANS) 1, hereby certify that the application for disposal works construction permit signed by me dated ', —`1r , concerning the property located at ��"� _qc � - e` ' meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system'. • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase inflow and/or change in use proposed • -There are no variances requested or needed. Ir <71 SIGNED DATE: LICENSED SEPT( SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER IAuach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. �� ,� f �c �- �7 -,, GPr;2A 6I!L i I , t q- Or Fir,Ly. Roo'M PI-OD r 7 a ; �r DAVID& LUCY BANNER 158 Sachem Drive y Centerville, NIA 02632