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Home My WebLink About0097 HIGHLAND DRIVE - Health 97 HIGHI D AVE. CE TERVILLE A = 190047 llll � UPC 12534 No.2 1,3L R ,�s HASTINO8.YN I // f/ TOWN OF BA #NSTABLE LOCATION �7 �ic�i1 36 SEWAGE # VILLAGE CE�Q+i;�2UiI(� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO, W M & (2c bcuy iJ &a SEPTIC TANK CAPACITY 1 S o LEACHING FACILITY: (type) 12 t:�ttq .(size) IO7C aS',,t Z NO.OF BEDROOMS Z BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: H- 7— F9 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 i 0 { 1 No. 7o - D 9 -7 Fee $5 0 _ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS V/ 0(ppYication for aigpogal *pgtem Construction Permit Application for a Permit to Construct(K )Repair( )Upgrade( )Abandon( ) 0 Complete System O Individual Components Location Address or Lot No. wner's a Addresg and Tel.No. 97 Highland. Ave . , Centerville , MA �av . a1 orrill Assessor's Map/Parcel � ller'e—T, shand Tel- e Pt is Service Designer's Name,Address and Tel.No. I sonP 0 Box 1089, Centerville, MA 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 Title Size of Septic Tank Type of S.A.S. Description of Soil Sand. Nature of Repairs or Alterations(Answer when applicable) install a new Title-5 Septic system, 1 , 500 gal. tank, D-box and. 2 leach chamhPr. 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 this Board of Health. Signed z�. — Date Application Approved by Datea - g Application Disapproved forte following reasons Permit No. F 2— Date Issued N.. IA 9' +. it•3,`. Fee $50 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSE `TS ZIpphratton for �Btgaaf *pgmem Con!5irurtton Vermtt Application for a Permit to Construct(x )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑lndividual Components Location Address or Lot No. caner'$ am Addres$ d Tel.No. 97 Highland. Ave. , Centerville, MA $av1 G�orril1 Assessor's Map/Parcel taller' am A res and Tel. o. Designer's Name,Address and Tel.No. n. o lkson eptic Service P 0 Box11089, Centerville, MA Type of Building: Dwelling No.of Bedrooms 13 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures �..ti Design Flow gallons per day: Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Sand ~Nature of Repairs or Alterations(Answer when applicable) install~a' new Title-5 Septic system, 1 , 500 gal. tank, D-b.oi and.,2 Udach chambers I %J Date last inspected: i Agreement: t 1 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 this Board of Health._ ✓ ` cc Signed Date Application Approved by �. a `Date - I -919 Application Disapproved for thYfollowing reasons 6 � 3 ' Permit No. - ')9 Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS Gorrill BARNSTABLE, MASSACHUSETTS (fertiftrate of Compitance THIS IS TO RTL�I~Y, Ko hiriOson eMye 1DCsp erviceConstructed( )Repaired ( X )Upgraded( ) Abandoned(. )by at 97 Highland. Dr. , Centerville, MA has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. - dated / Installer > Designer The issuance of this efrnit, l n bbe construed as a guarantee that the signed: /P ( / / g ys em,.�w,11�/fp`not, s de ' Date "7 �c// Inspector / / t// - l/ ---------------------------------------- No. - Fee $50 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Gorrill Mtopont *p5tem Cow5trurttou Vermtt Permission is hereby granted tg Construct( )Repair( )Upgrade( )Abandon( ) System located at 97 Highland Ave . , Centerville, MA 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:- 2 9 ` - �1 Approved by ^� 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 ENGINEERED PLANS) I, William E. Robinson, Sr ,hereby certify that the application for disposal works construction permit signed by me dated /c'` 9 9 , concerning the property located at 97 Highland Dr., Centerville, MA meets all of the following criteria: Zlrhere are no wetlands within 100 feet of the proposed leaching facility. *'There are no private wells within 150 feet of the proposed septic system. �4here is no increase in flow and/or change in use proposed. /here are no variances requested or needed. * the proposed leaching facility will be located with 250 feet of any 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 Elevation(according to the Engineering Division G.I.S. map) 6 B)Observed Groundwater Table Evaluation(according to Health Division well map) 31-51— . SIGNED: DATE LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 60. (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). �� n ��C.� /�'�Lc.� � s c+ j 1�� r m TOWN OF71BARN/STABLE LOCATION 9? �/i�hnJ _(J�/U SEWAGE # VILLAGE QrJ+CtZUI I(C- ASSESSOR'S MAP & LOT D`0 INSTALLER'S NAME&PHONE NO. WM6 &6,,)vsatJC ? - ? 6 SEPTIC TANK CAPACITY I a c� LEACHING FACE ITY: (type) DrLq LJC- (size) 10 Z V 1t Z> NO.OF BEDROOMS 2-, BUILDER OR OWNER PERMI TDATE: _ `�-19- °� COMPLIANCE DATE: 7 s 79 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 r3gck a N6vs� 1 r � 0 Sp/ 1 b! ) NN 7� 0