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Home My WebLink About0116 WARWICK WAY - Health 116 WARWICK WAY CENTERVILLE A= 148 051 s TOWN OF BARNSTABLEe/' `'� LOCATION / - %}iC-`✓1 SEWAGE # cl:S 7 VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY l LEACHING FACILITY: (type) NO.OF BEDROOMS Lend f BUILDER OR OWNER 0 n-7 C6 J / n PERMITDATE: S—/��/�G COMPLIANCE DATE: T 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 In � �� 14 0 6- No. 7 Fee 6710 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: / s PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipprication for Migooar 6pztem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System 0 Individual Components Location Address or Lot No. 116 C e,7 Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. .J P rCil .►.�-''Q�a�r S Type of Building: Dwelling No.of Bedrooms Lot Size yQ'rsq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures y ` S_ Design Flow �J d f gallons per day. Calculated daily flow �3� gallons. Plan Date Number of sheets .Revision Date Title Size of Septic Tank �� ' Type of S.A.S. a Z Description of Soil tpl / �S Nature of Repairs or Alterations(Answer when applicable) 5 x 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 been issued by t 's Boar alth. Signed Date /';/` Application Approved by Date Application Disapproved for the folWwing Asons Permit No. 91 . 3- ._ Date Issued No. 7 - e..� Fee!� # Entered in comp THE COMMONWEALTH OF MASSACHUSETTS uter: s 'PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS Z(Vurication'for Miopozar 6pgtemc Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. C p Y,f Z Owner's Name,Address and Tel.No. Assessor's Map/Parcel ` �'`� TB .� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 3 Type of Building: Dwelling No.of Bedrooms Lot Size 7 ��0 J7 sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) ' Other Fixtures ew Design Flow C) X 7`� ' / 5 gallons per day. Calculated dailyflow S.�d / gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank .Type,of S.A.S. Description of Soil de"/ .Sy 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 Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by t is Boar -of ealth. Signed / �" Date /7/k Application Approved by Date '�'�— Application Disapproved for the fo wing Asons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired (kW)Upgraded( ) Abandon(d( )by at 1 �� A hS`( A _ M r t_/Z Y � �� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Perm �] Permit No.�/ R..\/ dated Installer R, Designer The issuanc of rmit shal o 4e con/ as a guarantee jthat lthe system will,functions as designed. / Date Inspector X �i (, t.f PI &I'l,141 _ _ { No. � ---------------------------Fee 15 y THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS -Mi5pogar *pgtem Construction permit Permission is hereby granted to Construct( )Re air(k)Upgrade( )Abandon( ) System located at_//C0 \}/ u ` h 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: — 10 — c/ Approved by '* / 116/99 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) I, hereby certify that the application for disposal works construction permit signed by me dated �,�a // /S , concerning the property located at 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. • The 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 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 maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] • If 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) To of Ground Surface levation(using GIS information D P ( g ) B) G.W.Elevation +the MAX.High G.W. Adjustment. I f = Q DIFFERENCE BETWEEN A an SIGNED : %'— — DATE: [Sketch ro sed plan of system on back]. q:health folder:cert L" y l w � (l `6v�� TOWN OF BARNSTABLE LOCATION %q,, -`✓9 SEWAGE # c1:5 7 VILLAGE ASSESSOR'S MAP &LOT f INSTALLER'S NAME&PHONE NO. FfF—J�F SEPTIC TANK CAPACITY LEACHING FACILITY: (type) L (size) �3A' C e.n NO.OF BEDROOMS rw BUILDER OR OWNER O �i PERMUDATE: II�/ICI COMPLIANCE DATE: Separation Distance Between the: f 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 ./ r �`\ . f /•` � � V� + ' i �/\ � 3� ,�., i � ice' • � / i �- � i h � i �l G7�1 .� b- �a � ��' �� r r� ��i �So 11 TOWN OF BARNSTABLE DI fj IIA('//}7 `7 LOCATION Gv/ 17 V &,-U. A-"X" I LK- SEWAGE # -oJ Y I VILLAGE C�Pw ��,� 1,'f ASSESSOR'S MAP & LOT - b INSTALLER'S NAME & PHONE NO.Q�fS� S �y� pa�j,,� as SEPTIC TANK CAPACITY Ino V BEACHING FACILITY:(type) (size) ISO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER ,/yw eo Z DATE PERMIT ISSUED: /p DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �� ell 39 5, i