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Home My WebLink About0129 ASHLEY DRIVE - Health 129 Ashley Road, Centerville A=172-124 No. 42101/3 ORA n IQ 0 SK ESSELTE 10% (D 0 0 0 0 r Q f l FZ-i- 2 y No. r fJ ee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 0[pprication for Migaal *pgtem owaruction Permit ii Application is hereby made for a Permit to Construct( )or Repair( )'an On-site Sewage Disposal System at: Location Address 0, L t No. Owner's Name,Address and Tel.No. G ze ent/i Ile ,.-W 1 Z s)le Inst er's Name Address and Tel.No. 7 ' a Designer's Name,Address and Tel.No. J /� Type of Building: Dwelling No.of Bedrooms _ Garbage Grinder(/ ® Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 4 gallons per day. Calculated daily flow �yv?� gallons. Plan Date Number of sheets Revision Date Title Description of Soil " Nature of Repairs of Altera�ons�knswerwhen plicable) 3;1,5 e 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 b this f lth. . Signed Date Z/_2 Application Approved by Application Disapproved for t e following reasons Permit No.�l� — � Date Issued No. Qe THE COMMONWEALTH OF MASSACHUSETTS PUBLI`C'HEALTH DIVISION=TOWN OF BARNSTABLEs MASSACHUSETTS ZIpprtcation for �Oioo!gat *pztem Con.5tructton Permit �i Application is hereby made for a Permit to Construct( )or Repair( ✓)an On-site Sewage Disposal System at: Location Address o L t No. Owner's Name,Address and Tel.No. 1Z, � .sM7e / / Zeo G ere tihll Ile /Z. 9 Inst let's Name Address an ®.N _7 7�,y a Designer's Name,Address and Tel.No. jt �o/rd� � 7 ✓ Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder(/ (� Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow ✓� Q ;gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations nswer when oplicable) 3l5.1.,711 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 thisar—d'of Healt� Y- _ Signed �� `�/� � Date Xle, Jc� Application Approved by r Application Disapproved for Re followmg reasons Permit No. �L� — c� L� Date Issued ®---—. —_—� .----- l 7 THE COMMONWEALTH OF MASSACHUSETTS Z PUBLIC HEALTH DIVISION - BARNSTABLE. MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )o�repaired/replaced(V )on by Xer / C.ees , for d�a as S e- �'�J f r' �� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. —aW 7 dated Use of this system is conditioned on compliance with the provisions set forth below: ' 7Z .1 No. —� 0 / ~/�� Fee / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS �Digaar *pJ6tem Construction Permit Permission is hereby granted , r/OG D !/ G-04�_,5171. to construct( )repair( > n On-site Sewage System located at /,-7 4/ 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. All construction must be completed within two years of the date below. Date: 1 Approved by CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WURKS CONSTRUCTION 1'Eltlltl•l' (IVI'1'I1VU'I' DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated �'f Z�/�� . concerning the property located at ee tle-rymle- meets all of the following criteria: / i � There arc no wetlands within300 feet of the proposed septic system here arc no private wells within 15o lbet of the proposed septic system The observed groundwater fable is 14 rcet or greater below the bottom of the leaching facility /There is no increase in flow and/or change in use proposed . There are no variances requested or needed. 000, SIGNED: bATB: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan or the proposed system. Also irthe licensed installer posesses a certified plot plan, this plan should be submiltedl. S ,.r #kF;' t�?u�f r °,�� ` �I'.� �l.r.�r� s Y c- L r" b •, ,d,µ -� a �,_ lout kv \)lye b ��,tb TOWN OF BARNSTABLE f T.,OC ii TION I Z g x,5) ey rW SEWAGE # VELLAGE CP�rI rI/1�� o � ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY I LEACHING FACILrI Y: (type) 5&1 641L&y-4 C&n6e Le— (size) NO.OF BEDROOMS 3 BUILDER OR O R. Z� PERMITDATE: 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 facility) Feet Furnished by , v 37v / d'v THE COMMONWEALTH OF MASSACHUSETTS BOARD /®F HEATH -- -------- OF .......1 'tl�-- -. Appliration for Ubpasal Works (fonstrurtion Vrrmff Application is hereby made for a Permit to Construct ( k<or Repair ( ) an Individu 1 Sewage Disposal System at: .........../,� ......9.....'44A.& -.....-z?:.ty:c....................... ................ .... .......... ., ocatiod-Addres or Lot No. ............. .. �7.. ....: r.............................. !?:::.......................... r Add ss .. . q Installer Address UType of Building Size Lot.._.__BS_0-6v._.._._Sq. feet Dwelling—No. of Bedrooms.......................... ...............Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ..`Si .t .No. of persons______________ .......... Showers ( ) — Cafeteria ( ) Otherfixtures ---------------•--✓✓----------------------------•------...-•----------------------------------•---._...-.-•---------------------------------••-••-••--- W Design Flow........................_S12____._.__.__gallons per person per day. Total daily flow.__._.___.______.__®°_._.__.__.___.gallons. WSeptic Tank—Liquid capacity. ( -gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No_____________________ Widi__ ..__________ Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No....•---------------- Diameter-----_- Depth below inlet.................... Total leaching area__.?°_ ...... ft. z Other Distribution box ( ) D it's nnk ( ) aPercolation Test Results Performed bv.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water___________________-___- Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ...........................C,-,............. ODescription of Soil...........;!� ___. . `t' •............................................................................................................... cxj -••••-••••---••-•••---•-.................................................................................. ••-••---•--•-•••••--- •-•---••-••----•-----•--•-•••••-••-••-••-••---••••••--•.....---------- W + UNature of Repairs or Alterations—Answer when applicable.............._................................................................................. ......................................................-..............................................................-.....---------•----------•-------•------•--------•-•------•..-----•-••••-•---•-•-- Agreement: The undersigned agrees to install the aforedescribed Individual-Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i ed by the boa f health. / igne ....... .................:... ...............•---.._....... 2d�--�� ,- Date Application Approved By=---•--•- • ---•..... ....... . ...f.�&� -- ----•- '�'��...� Da Application Disapproved for the following reasons------------------------------- -------------------------------------------------------------------------------- -•-----------•-•--•-----------------------------------------•------------------------•--•-------------------•-------••------•---•-------•••---•--••-----• •-••••--.--................................ Date- PermitNo......................................................... Issued........ • • 7 ...... ate -- -- - - -- --- - •__ �. --- --. _ WN OF BARNSTABLE // LOCATION ,} Wlaq�Sfill6ywv6SSEWAGE 1f # —2— L/ VILLAGE CEI\ / el'e l ASSESSOR'S MAP o"i LOT INSTALLER'S NAME Sz PHONE/ NO. . SEPTIC TANK CAPACITY LEACHING FACILITY:(gpe) ( (size) NO_OF BEDROOMS PRIVATE WELL O PUBLIC WATER BUILDER O OWNER DATE PERMIT ISSUED: DATE COUPLIANCE ISSUED: VARIANCE GRANTED: Yes No � ^ l7 1 101 ,1 too THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .yr. n Appfiration .for Biipooal 190irko Tnnotrurtion Vermit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: ........... :i ...............................� . ..,.....1.�!, :................... Pr�p,r{ ................................ LocatiA-Address or L of o. ......................................d •r.s.....•..d.fi•....e..•.....s......s...••. .......... ....".'.id......�... e..... .•..•......................................... F 9"r r AddFss ...as e.4f '• 12/' 1.... � .`.......................... . . .u:bs:. f:i.....#...•ie... y. r f Installer a Address U Type of Building T Size Lot------- ......Sq. feet ,.,. Dwelling—No. of Bedrooms......•................:::.°................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type of Building ' No. of persons............... ........... Showers — Cafeteria Other fixtures .........................................-•-----•----•••-•••-•-•---- ......................................... .................................. - ... W Design Flow......................... ..............gallons per person per day. Total daily.flow..................... E , ...............gallons. WSeptic Tank—Liquid capacity-44 .gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No..................... Width...,=............. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter__ `_ :.; Depth below inlet.....__........_.... Total leaching area_.s`G'. ......sq. ft. Z Other Distribution box ( ) DZIag tank ( ) Percolation Test Results Performed bY.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water----------:___--__--__-. f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •� O Description of Soil.............. ---•-----------------....._:__.----------•------ x W U Nature of Repairs or Alterations—Answer when applicable................................................................................................ -----•-••-----------------------------------------------------------------------------•••-•-•••..._..•-•••................-•--------•------------------•--•-•-•-•••--••------•------....._.........•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is'flied by the boa d8.bf health. ,Signed,_ ...................... x Date Application Approved By....... ..._.... . ------------•- = / > at ..: Application Disapproved for the following reasons--------------- ............... ........................................................................... Date PermitNo......................................................... Issued. ••••. - ----- --- ry''--.............. C THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ; l. OF.> �. ....... .. .. ............ ...fc` t...!.. ....-C:....r...................................... Tatifiratr of Tontphanre THIS I•S,TO CERTIFY, Th t the Individual Sewage Disposal System constructed (�or Repaired ( ) r (; . y /� . ..+�:a. iF�.S. i .a"rmS 4s..Y ��`.`, .................•--------•-•••-----. by.........••-- : ........•••.......-•--•_...... , In tape j r has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No---------------- dated..___. _ �• _---•-.-- /�•-{{ � THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS , i AR N EE To1AT THE SYSTEM WILL FU CTI SATISFACTORY. i DATE............. r .. . ' Inspector r.� ".tf.. ... . • ��' THE COMMONWEALTH OF MASSACHUSETTS BOARD` OF HEALTH (sa d� 1 . ` '.."sR.......... .... ..---.....OF. jy °�.� t ". .......... ................................... No.... ••••• FEE. ................. Diapatia�_ orki- To- itrurtion rrntit �. Permission is hereby granted....... > : = ": .-•-•-•-------•.................................... to Construct ( ) or Repair ( ) r•/Oi yidual Sewage Disposal System/ at No.......................�? ..........�.... ,. � �. ... .. .: ' _................... ........................................ .. ..••- ' .. ... -...fir• 'L __ ..... ..... ..... Street as shown on the,applicat on for Disposal Works Construction Pjermit No... �. ....... Dated__._ a. ......... / /64 ISoarld�a th DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS