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HomeMy WebLinkAbout0046 SCUDDER BAY CIRCLE - Health 46 SCUDDER BAY CIRCLE CENTERVILLE A = 188 100 No. 42101/3 ORA PG)n mo Q 0(w K 10%' o a o Fee No. / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,s MASSACHUSETTS te. ZIppfication for Migoml bpgtem Congtruction 30ermit Application for a Permit to Construct( )Repair(,/)Upgrade( )Abandon( ) 0 Complete System ❑Individual Components Location Address or Lot No. t�� 5 CV d di(f j uy C kCc%g owner's Name,,Address and Tel.No. Assessor's Map/Parcel C �'" V�`L r kv.,R—G 0 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. SC�Ac- V 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 Title Size of Septic Tank S�O Type of S.A.S. 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 Co e..and not to place the system in operation until a Certifi- cate of Compliance has been issu y this Bo d of r Signed Date Application Approved by Date Application Disapproved for the following real s Permit No. ZW l - 7 Date Issued l.�— f` � _. Fee Kv ••-�''_ +A P THE COMMONW ^IF MASSACHUSETTS Entered in computer: Y�es PUBLIC HEALTH DIVISION TOWN O F BARNSTABLE MASSACHUSETTS `Y - 0(pprication for �Digpogal 6potem Conotruction Permit Application for a Permit to Construct( )Repair(✓)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel hn p„ C �V ` "t v �C_k ,r ' `G 0 d S Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms D,— Lot Size sq.ft. Garbage Grinder(P `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) L n S P j C S 0 G ` ` 'C V,_ 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 andnot to place the system in operation until a Certifi- cate of Compliance has been issu y this Bo d of / Signed Date f C �j 0 Application Approved by Date Application Disapproved for the following reasets 4 Permit No. Z W 1 — 17 Date Issued G /5--0 THE COMMONWEALTH OF MASSACHUSETTS — BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(t -)Upgraded( ) Abandoned( )by C>ccc c— kN".-us a y S at C c�.2 Ct... t has been constructed in accordance with the provisions of Title 5 and the for isposal System Construction Permit No'Z.'U 1-1 -7 0 dated Installer r < C�G��" Designer The issuance of this permit/shall q°t be construed as a guarantee that tlf syste ill fun4eBesigndd , Date ,/2 /A/ Inspector /f L. 2'� ————— /O P '� —-------------- — No. � / � 1�d Fee ....•'""`' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Miopoe al *potem Con!5truction Permit Penrussion is herebyranted to Construct( Vr air( )Upgrade( )Abandon( ) System located at g 5 CC) J 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:Constructio mus be completed within three years of the date of this ;t. Date: �� G� Approved by 5/25/01 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. PERCOLATION TEST AND SOIL EVALUATION EXEMPTION l FORM hereby certify that the engineered plan signed by me dated S G , concerning the property located at 6C1`ecr C meets all of the following criteria: • This failed system is connected to a residential dwelling only. 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. The applicant may use historical data to conclude this fact or may conduct preliminary tests at the site without a health agent present. • 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 fourteen (14) feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation (using GIS information) ^ B) G.W. Elevation +adjustment for-high G.W. �•� _ � � (a DIFFERENCE BETWEEN A and B l r SIGNED : DATE: NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:percexmp -C-c.�� �°` Q ..� � � D -c-�,�,�,\.�, (� �� TOWN OF BARNSTABLE ,LOCATION .Sc- `tI - Ct" G(RSEWAGE VILLAGE �to� rJ ��_ SOR'S MAP & LOT "��0 ASSES INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 60 rc)&4 /-,e-461'(size) NO. OF BEDROOMS___ BUILDER OR OWNER _ c o a&C PERMITDATE i C(s C6 I COMPLIANCE DATE: -7 l�� 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�sute�or within 200 feet of leaching facility) Feet Edge,'&©f Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) _ Feet Furnished by _ J 0 A, r } "t1 r "4 - ' ._ t' u--f, `�S$�r�F,{ .�"'v 5• "xT_J'-+,-y.,�•- 1�"—fir Yt e "•`�-"' L, rSf '' ,,,� 5.:.-. ? u�' k.lff' Pik ^i� e TOWN OF$ARNSTABLE `.I LOCATION S r.- --SEWAGE # �U VILLAGE ���W \�\-o ASSESSOR'S MAP & LOT `/00 j INSTALLER'S NAME&PHONE NO. �—r c�-� 7JJJ��( 3 SEPTIC TANK CAPACITY LEACHING FACILITY: (hype) 4,,,,-n 6 size) NO. OF BEDROOMS BUILDER OR OWNER O Ql2C .—PERTv1TTDATE /' 6. COMPLIANCE DATE. z� st; Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feeh Pfwate Water Supply Well and Leaching Facility (If any wells exist og te e:or within 200 feet of leaching facility) � j Feet Edgf;VVetland'• d Leaching Facility(If any wetlands..exist - wi n'.300 feef.of leaching facility)--.Feet Furnished by �' f t f : ` _ / .� p G j r c- .. J L CATION : , 5EW-&C-4E _PERMIT U0. SUILDER.S ME.- �- ADDRESS _ DATE PER"1T ISSUED =- D ATE COMPLI &MCE ISSUED : 7� r s 30 .hiP� Pack or