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Home My WebLink About0094 SEAGATE LANE - Health (4) L ATE LN CENTERVHLE 034 Slll 1400afth UPC 12534 No.2 '` T HASTINGS,MN C No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0ppYication for Mizponl 6potem Congtructiott 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 a' �p ,o� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. SIZ 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 Flows gallons per day. Calculated daily flow �JO gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ISOb Type of S.A.S. '% t..� Description of Soil SY U Nature of Repairs or Alteratio when applicable) ®—�a ns Answer !n .S!OT--_�=t (y11 (I 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 ha Signed Date Application Approved by 144 Nc�) Date Application Disapproved for a following reasons Permit No. Sl a Date Issued TOWN OF BARNSTABLE LOCATION 2Y A6A L �/ SEWAGE # �C� TE ✓ Jf VILLAGE_�y�( .,�� c ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /S a d LEACHING FACILITY: (type) r ,14 A671 J (size) (Q NO.OF BEDROOMS � BUILDER OR OWNER n PERMI 'DATE: / �' / COMPLIANCE DATE: { �-' Cl 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 No. Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V ` Yes PUBLIC HEALTH DIVISION - TOWN OF BAFNSTABLE., MASSACHUSETTS Zfpprication for �Biopozal *p!gtem Cowaructiou Permit 'Application for a Permit to Construct,( )Repair( )Upgrade( )Abandon( ) ,Complete System ❑Individual Components Location Address or Lot No.q� 5%p� � — L ♦ Owner's Name;\Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. q r .4 ' tt ` ` ! Designer's Name,Address and Tel.No. Type of Building: s 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 S So gallo S. Plan Date Number of sheets Revision Date Title , Size of Septic Tank kS 4Z) Type of S.A.S. ;�\CS.L Description of Soil &,ec_ Ott Nib Nature of Repairs or Alterations Answer when applicable) 6 r C l 1 /lJ =t �11rr !/!2 Ca, (tik e4ZLkl! ' 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:�mtri B Signed Date 60_�� "l Application Approved by Date G• .2 7 - ¢Q Application Disapproved for e follo ing reasons c, Permit No. 3 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( I t)&aired Irgraded(i/) Abandoned( )by at TA J c� — GV 24TVF V,( has been cons' ated in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. l y� _dated Installer 1 Designer f A G c The issuance of this t sha n tq construed as a guarantee that th s, t will functio as d sinned. /y Date " l InspectoLIX r y �' � i1 l /A , 1 t No. Feet THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 'wi.q pogar *p5tem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade*,`')Abandon( ) System located at 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: 1 — ^ ! 9 Approved by . 1/6/99 NOTICE: This Form Is To Be Used For the Repair Septic Systems Only, p Of Failed CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PE MIT WI'I' IOUT DESIGNED PLANS l I' hereby certify that the application for disposal works construction permit signed by me dated to— concerning the property located at R q 5,�4 -_.,e L Bit meets all of the following criteria: G-ev1 "• The failed stem sy is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. G/The soil is classified as CLASS I and the percolation Pe rate is less than or equal to 5 minutes per inch. /There 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 maximum adjusted groundwater table elevation. [Adjust the an five feet above the �metthod when applicable] groundwater table using the Frimptor ✓• if the S.A.S. will be located with 250 feet of any vegetated wetlands, leaching facility will not be located less than fourteen(14) feet above the maximum ad'ustedsed groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation / +the MAX High G.W. Adjustment/ + = r DIFFERENCE BETWEEN A and B (710' (� 7L_ SIGNED : DATE: (Sketch proposed an of system on ba q:health folder:cent eel v