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HomeMy WebLinkAbout0041 HAVILAND WAY - Health LOT 4-A & 5 B. HAVILAND WAY, CENTERVILLE LI A=193.242 I Pao,12543 3LOR HASTINGS, MN /� ��/ -- /dd• V No. t� ;;-� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipplication for Mi-4pogal *pgtem Construction Permit IZA IJI_ Application for a Permit to Construct(K)Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. t�.l-G,A AV I LAB WAY Owner's Name,Address and Tel.No. CtSorsa✓1 Assessor's Map/Parcel , Installer's Name,Address,and Tel.No. Designer's Name,Addre�ess and Tel.No. 13AX -M►+ /Jy Ilia 617, il/l 4W s'T' a"U1^ 3 Type of Building: 'J Dwelling No.of Bedrooms Lot Size 4- sq.ft. Garbage Grinder( ) . Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 4.40 gallons per day. Calculated daily flow Z-40 gallons. Plan Date 40V ro . 19 9 8 Number of sheets 'L Revision Date 7 Title Co(RP, tW CcIJM"V_VILA C- F0,L V-te-¢ Lw►lts/ OILX.141-4c, , rirrL i-lyya �lC. Size of Septic Tank istm Type of S.A.S. &ALZZ- 1 12'x '5 ' Description of Soil 6-aTj. Sa44 0 Nature of Repairs or Alterations(Answer when applicable) i4.stala c l/L., Of 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 Ti 1 o the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been Z uedWtisoard ealt Signed Date Application Approved by C� n Date Annlicatinn i)isannrnvPd fnr the fnllnwinn reacnnc -rr Permit No. _ 7 Date Issued • r r i 1 TOWN OF BARNSTABLE G C LOCATIONLT 1h -+ 'T 6 gAu o I a �via ` SEWAGE # VILLAGE- ^emr e,,r y►It c.:r,e ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. 7,66N A o j+o SEPTIC TANK CAPAcm /SD O G a LEACHING FACILITY: (type) v j', j(size) f/ �''� `/©`1 k OL,r) NO.OF BEDROOMS BUILDER OR WNE PERMTTDATE: ���S� `1� 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 13 Of f O:jl y7�� yv° 17' V�611 �^ ih a :+ VU V •,.- � `�,..� Fee ��. THE COMMONWEALTHTH OF MASSACHUSETTS .Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETI'S Zipplicatiou for�M -qtogar 6p5tem Cot'gtructiou Permit Application for a Permit to Construct(K)Repair(`�\Upgrade( )Abandon( ) O Complete System ❑Individual Components !� Location Address or Lot No. 4 /4+ AV J L,4 UD Nay Owner's Name,Address and Tel.No. I.I.Zr V_ , A!�i*U 2 'Wt C►(,I r t�s 'Assessor's Map/Parcel MAE , \ `1 1 3 pc.L..�llZ v � — r 0. &)<%/`. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. SAY TM-°+ n�y U 1 u c_,.. UIZ MAIN S^r- �p7�Yrg13) 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 ¢40 gallons per day. Calculated daily flow gallons. Plan Date 401/ 6 , 1419 S Number of sheets 2 Revision Date Title C-PP. IN CEN'fb-V_Vit-t.M r2 0KAILj I. 1Q_1A1,w5 Size of Septic Tank 1­SDQ Type of S.A.S. 4AL4Zj 12' K 35' Description of Soil b"` S A h)D Nature of Repairs or Alterations(Answer when applicable) .s 4 ./ I Date-last inspected: Agreement: e f The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions ofaTiA5 o the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been i uedis oard oA ealt Signed 1� Date /'"�✓�—�g Application Approved by C- w Date - 'Application Disapproved for the following reasons Permit No. — 7 61 Date Issued ------------------------- 11. -- --- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THI I T S S O C ER TI , that the On-site Sewage Disposal System Constructed Repaired ( )Upgraded( ) Abandoned( )by Uj at to-Q-A.+c,,8 AV 1 4d U D i.0 C GQ l LZ, has been constructed in_acc rda ce with the provisions of Title 5 and the for Disposal System Construction Permit No. nl 7 6 dated `� Installer Designer The issuance of this permi shll t e onstrued as a guarantee that the sy i.1 unctio s igne Date Inspector r i i �L3i v r v , } No. 76/ ---------------------------Fee �dU, THE COMMONWEALTH OF,MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNISTABLEs M}ASSACHUSETTS ]Diopozar 6pztem Cougtructton Permit Permission-is hereby granted to Constru` rrt(�C)Repair( )Upgrade( )Abandon( ) System located at- Lot- 4-Aa 59 N 1 1 L, )Jb t,U" 66 QTL42_vl L-L& L and as described in the above Application for Disposal System Construction Permit.The applicant recogni.es his er duty to comply with Title 5 and the following local provisions or special conditions. Y Provided: Cons tion be mpleted within three years of the date of this emit. Date: ' Approved by ( � _ ' �4�FET �tN�LE FAMtI.�{ 21- g�acr-vK E PLA ohl BAGK- u C T: ao GA¢vsA�c Gwr,.b�. LoT 4A �Aurt_Au� '�. - VA L.-j 4 x Ito ='46ro St7rc TAW L ` 4+0 r<?oo% S�C�6PD �LZ"Q,PvG PtPr& v i 5d� �' , 10 ���-Zu�.�t �'tci•1�¢L��330Cil�Aw�Bt�S�4�S(Otl� �rST. t� uco,TtON AAA 26L���• -sex 5F= 59S SF 10 6 ��� , ,�ppUGl.ZtoN A¢EA � PLAN VIt-=W - LfEAC4IrU cNAMBEeS 2L G �TTOM A¢" = IZ - F�ursN � ` -TOTAL AMA {7�¢GoL�►711 Pd� L 5'urv�,NcN Z 0 5rm4E q + SOII. l-ld�7 I �H�F M Ss� o a CuLTEC- a a p-rh� e a �,` s�•. p�'� STEPHENAL c�G�� 33o c 3TDNE CD 0.30216 v.. � `� pC(01 p �� �oFf�-SEGI'IDN 01= CF /�M9j s � — F�fSTER� �ti d A Fs! NG� ONAL E J F46-49:� T�-ao•� LA•►►t� SG •� o oiSG z LsA�,11 C►-NAME RS ,5' .'1 Fl=4-4-•5 ' 94 �Ja S!1ub S,S ; l 1 •' - N e se v ec>72c�c:�✓ �'VELOF'G� �¢OFtt� 8 -OeAT IOW CaN` `M I tom: ro, ScAL 1 �-o 'DAM i I. to•Q� p � t� E �AV fr:2fi,a8 �u.r sZt..i aJ l� St�owN P11�! I GF.=r--f TEAT 'Sf1E LAN A1� ta�-DA TUO q l5l45 Fo, � /IIzMwLUlru�arwi°i c�gI,GK -eWVi2EM&QT Dt= 'itils 'its►UN OF MAP I PAPC.N— Zd�2 A1X0 .l 5 AOT 1 LV-A' W BAXCC�- . NYE 1 NG �4L FIs�D HAZE 7XNE' UNJD 5V¢v�^ftti5 - G16iN6�S (9 oS TtQev�L MASS �FSi�^s /� �uic.UtNliS SNO�Xv NOT' Blz �►PPl-IG4NT: �/� It.i.iAw1� � AAA r u•SCb �b 6RTA�c.Is►.l PRD�EstTy Lr►JE'S. KIRK i'`r n� ICtrZ si, E+u iLj WiLLl4w11 40V fi, iq�8 Za�IE flG% P rLo /Id/ie; i� 3 ' -vim lZI 44 r04- i �e At vv.4 'AIL `' 1 / 1 t� �� & TOWN OF BARNSTABLE LOCATION �T �R i 8 4CkU t I a n� (��.i o.-r SEWAGE # qc� - 76/ VILLAGE (1 P AAS C c)1 21:5 e- ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. :1/)Vnn, A al 4-v SEPTIC TANK CAPACITY 1560 LEACHING FACILITY: (type) ✓ (size) -//'w x NO.OF BEDROOMS BUILDER OR� + 'e- PERMTTDATE: �' �5 �a 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 Feet within 300 feet of leaching facility) Furnished by i u9n rL� � 0/7 �9L! /— to i L7