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Home My WebLink About0127 SEAGATE LANE - Health 12 I SEAGATE LN CENTERVH LE A— 249 151 ll�/fllUllG UPC 12534 No.2-153LO R � HASTINGS,MN it TOWN OF BARNSTABLE 0 LOCATION /17 Ca 9' A LIL• SEWAGE # l tJ VILLAGE_��j�l_�C/IZ l/ ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. /Y!1 b 6W—C S'Pa Jz c SEPTIC TANK CAPACITY A'es LEACHING FACILITY: pe) /fflL�(, ( ' (size) NO.OF BEDROOMS T BUILDER OR OWNE PERMTTDATE: COMPLIANCE DATE: 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 A Q ' 3 No. �7 ^ �� FeeC> THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pprication for Migpogar 6pgtem Con6truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System Individual Components Location Address or Lot No/ .55;1Pa G Owner's Name,Address d T I.Ap 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_ 51 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow --zs3O gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank AFK`a s i q .� CD VJ Type of S.A.S. 1 PST �Lr Description of Soil N�e� l Nature of Repairs or Alterations(Answer when ap licable) � ��'� � t)c 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 ea Signed Date Application Approved by Date Application Disapproved fort e follo ing reasons Permit No. Date Issued TOWN OF BARNSTABLE LOCATION J�� (A U SEWAGE # VILLAGE ��if j -mil/�' ASSESSOR'S MAP & LOT' K ;v INSTALLER'S NAME&PHONE NO. M i b rxa SEPTIC TANK CAPACITY LEACHING FACILITY: ( pe) /-IJ r �' (size) NO.OF BEDROOMS BUILDER OR OWNE/ PERMIT DATE: ! COMPLIANCE DATE: 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 .A 3 , A 0�1 r3.2 No. t• / 3��i� ..�... ,.»�.• Fee _55 _p } Entered in computer: THE COMMONWEALTH OF MASSACHUSETTSJ � - Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 4•r. v. 2pprication for Digoal *p5tern Construction Permit Applicationffor a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System „Individual Components Location Address or Lot No/ S 0+ t!M�1, Owner's Name,Address d TelO.E( rt. �` rc�Assessor's Map/Paz i 231�cel � `( Installer's Name,Address,and Tel.No. , ` Designer's Name,Address and Tel.No. 6-,, -,- 12, Type of Building: Dwelling No.of Bedrooms 3 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 r Title f ,., Size of Septic Tank � 1L.d Type of S.A.S. T`r Description of Soil Y1hPX- •S Wr�L'�� Nature of Repairs or Alterations(Answer when applicable) V�-5 2 60-C-,&A S�"►� f � j t(tt 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 and not to place the system in operation until a Certifi- cate of Compliance has bgen.,iswe� Re—alm7�.-by- Signed Date -aS Application Approved by Date =5► Application Disapproved ing reasons Permit No. Date Issued f ---------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded((/f Abandoned( )by M-\ fl )kv�_= �.E- 4 t' at ��r? ESL�4C.+RCE l Ills. C C-,70Z t � has peen constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.;�F. dated Installer Designer ,- The issuance of hi'pe it shall not be construed as a guarantee that thele'will function as`desi' ed. Date i ! {�l (� Inspector ./ _ ,——————————————————————————————————————— p�j No. !/ g 5— Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Dfi5po!gar *pgtem (Con$truction Permit Permission is hereby granted to Construct( )Repair( )Upgradek(-�)Abandon( ) System located at C� e—tiT 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: -�5, Approved Approved by s� 116199 NO'TICF: This i:or Is To Be Used For the Repair pair Of Failed septic "Systems Only. _ CERTIFICATION OF SKETCH AIND APPLICATION FOR A DISPOSAL FORKS CONSTRUCTION PERMIT ITHOUT DESIGNED PLANS herebycertify ertify that the application for disposal works construction permit signed by me dated— 64� concerning the property located at C� � meets all of the following criteria: /- The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. L/ 6?e soil is classified as CLASS I and the percolation 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 ro sed P Po septic system � l here is no increase in flow and/or change in use proposed • There are no vari ances requested or needed. The bottom of the proposed leaching facility ma.'ttmum adjusted groundwater table elevati nll(p�jnot�lo�ceated less than five feet above the ethod when applicable] groundwater table using the Frimptor • 1f 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 �V,Q+the MAX. Nigh G.W. Adjustment."� f DIFFERENCE BETWEEN A and —JN SIGNED : DATE: (Sketch proposed plan of system on back]. q:health folder:cent a