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Home My WebLink About0039 MARIE-ANN TERRACE - Health RRie AN) 39 �iN TERRACE, CENTER A=189 - 098 llll UPC 12543 % No.533LOR HASTINGS, MN d� zlf/Cirl No.........--•.. G j -- F>�s............30................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Apphralion for Di►ipwml Ulurlig Tomilrurtitun 1hrmit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: 39 MARIE ANN TERRACE CENTERVILLE .....................••-•----•------•--•---•------•-----•--------------------------•-•-----.-•-_.. ...---------•--•----•------••-------•-....--•------•------•--•--•--•--•----------•------------.... GEORGE AND 'ft9))P;j`TALWEIT SAME or Lot No. ......................_.......................................................................... ••--•---••--•----•-----•-•---•----••-•----•----•-••-•-----------•-•---------•-----..........--•••- W ARCH CONST. C8""er Address Installer Address UType of Building Size Lot............................Sq. feet ,..t Dwelling—No. of Bedrooms.......................................__-Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons-------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ........... W Design Flow.......1.1.0-............................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity..100 Ogallons Length................ Width.-..------------ Diameter...---------.--- Depth................ x Disposal Trench--No. .................... Width.................... Total Length..........--.......:Total leaching area....................sq. ft. Seepage Pit No.-------1.........-- Diameter-........ ........ Depth below inlet......Q............ Total leaching area..................sq. ft. Z Other Distribution box ( X) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ W Test Pit No. I----------------minutes per inch Depth of Test Pit........-.---.--.--. Depth to ground water........--.............. fit Test Pit No. 2................minutes per inch Depth of Test Pit--.................. Depth to ground water.....................--. a -•--------••----------------•-•----•--•-------•-•-------•-••-•-•-•••••••......•-•--•......................................................................... 0 Description of Soil..............................................................................------------------------•-----------------------------------------------.._......_....... "�x U -•.................•---••--•-------.....-•--- ---••-••••---•••-•-••••-•••--••---••--•----••--••-----------•---------------••------•-•---•-••--...------•-•--•-•-----•----•-•••-••----•-------...._••---• W ---••------••------------------------•-•--.................•----------------------------•••.......•----------•-•---------------•-----------•-•--•--•-------••• z . U Nature of Re airs or Alterations—Answe when app icable..---.....-TZ .... ..S.B.P. IG...S . .T.E�L...................... tAbQ�c.,<---. l�.l.) 00�9�.1a P� Wih..2 aet..�tmn -�Bl Agreement: g The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with �iuj' the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board o e t . Signe - .... ......................... ........................ ---_:.3.L14.f 9 5.:...... �a Dace Application Approved By .......... .......... ...... ........ . . . .. ......"'""".'. .................................. ................ .................. Dace Application Disapproved for the following season : ............................. .:.......................................................................................... ........ .................................................. ..... ............... ........ ....:.... a Permit No. .......... Issued ................ ... i. .....��...Dace...... ace TOWN OF BARNSTABLE Ci LOCATION3M7.oRiie Ava-762R19C6 SEWAGE # c�s 3 VILLAGE CI A/7 Ile— ASSESSOR'S MAP & LOT/8`_ a`?7 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACIL=: (type), (size) e k a j NO.OF BEDROOMS BUILDER OR OWNER GFo a6 F t r 3 �>�� PERMTT DATE:/ � 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 f 1 b oar - _ -------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . TOWN OF BARNSTABLE (fC1ti;fi atic of (gontplizinrE THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( x ) by ARCH CONST. CO ......... at .3.9...MAR.IE....ANN----TERRACE...CENTERVILLE......... ..................... . ................................_................................_.......... has been installed in accordance with the provisions of TITLE f T e State Environmental Code as described in the application for Disposal Works Construction Permit No. ..4��....' dated ............ THE ISSUANCE OF THIS CERTIFICATE SHA LL NOT BE CONSTREA/AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. _ 4 DATE................................._.........................._ .........._.........- Inspector .............................................................................................. .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 2) TOWN OF BARNSTABLE NoFEE. ................. Dispafia1 Workii Tanntrutian "rrmit Permission is hereby granted..........ARCH CONST....... 0•--•-----•-------------•--•----------------......-----------•------•---...-•-.......•-•-- to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at No.......3.9---A—RA N-N...TRR-R.RCE.__CEhlT.ERAZ.T,T,T,TE--------- ------- Street O r — J7 as shown on the application for Disposal Works Construction Permit No�v�____:�_�_Dated____..�..,,d_._�.....................;�j Q .---•-•-----••--•-----•--...-•---- Board of�Hcalth ��-- DATE +�1•-1 f FORM 36508 HOBBS Q WARREN•INC..PUBLISHERS '✓ - V c t 2 1 {CI30 7 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Dig; wial Works Toutitrnr#inn Permit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: 39 MARIE ANN TERRACE CENTERVILLE •---•..................................•----•---._..._......-----------------------•------........ ---•-••-------•----•----••----••------•------------------••------•-----....._.._----...-•------•-- GEORGE AND 't°TiV"DA`j`jri ALWEIT SAME or Lot No. ARCH CONST. CV`.ter Address Installer Address t Type of Building Size Lot............................Sq. feet ►-t Dwelling—No. of Bedrooms..........3---------------------_.-..--...Expansion Attic ( ) Garbage Grinder (�) aOther—Type of Building --------------------- ------ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 04 Other fixtures --------------------------------------•--- d -------------------------- ---- ----------------------------- •................ ........_.. W Design Flow.......1.1.0.............................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity.l OOOgalIons Length................ Width...---_-_--.-. Diameter................ Depth................ x Disposal Trench--No. .................... Width....-............... •rotal Length.................... Total leaching area....................sq. ft. Seepage Pit No--------1........... Diameter.................. Depth below inlet...... Total leaching area..................sq. ft. Z Other Distribution box (X) Dosing tank ( ) Percolation Test Results Performed by.......... ............................................................... Date........................................ Test Pit No. I................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........................ rx ...............•--------•------•-----•----......__.....--•---•--._...---•---._..........--•---...............--•--•--•----...-----..._......_---••-----•••--- ODescription of Soil.........................................................................................................................---•------------------•---•------------•-•--- W V ................•---------------•---•-•------_..-_--------------...----------.._..-•------•--•-------------------------------..._.-_..--------•-• ---•----------------------------------•----------------------------------..-------------------------------------------------------------------------•-------_- S 06 u I< U Nature of Repairs or Alterations—Answer when applicable----- ___SE_ _• ICSSTEM ,_-.•-••---__�� 1Q t� '�- Dbos ar�d �1.)_ OOb. la }it__waYl. f`eestoX Agreement: I I •C ,��rt'� The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board qfhe�alth.� Signed/...... .. .... ......: n..._ ....� �� 4'�.................... ...30%4,4gQ5.:...... �� Lace Application Approved By ...... ,............... . .....aa...../.............. ................!' Dare Application Disapproved for the following ream ..I. --r.`�a ..... ....................... . ` ..... ....�-1;�.'. / Date.............................................. . ....... . PermitN .. . Issued -.......... ........ ....... ................ r , 1019ro1 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT ENGINEERED PLANS) hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at meets all of the following criteria: There are no wetlands located within 100 feet of the proposed leaching facility e There are no private wells within 150 feet of the proposed septic system e There is no increase in now and/or change in use proposed e There are no variances requested or needed. e If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will D1S 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) B)Observed Groundwater Table Elevation(according to Health Division well map) SIGNED: DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted], q:health folder:cert l f3 0 I �a � 1 I r� � TOWN OF BARNSTABLE Ci LOCATION. �/Maq i r SEWAGE# c/`L 3 YII,LAGE ��•�/i r��.y" //e. . ASSESSOR'S MAP& LOTfB7 INSTALLER'S NAME&PHONE NO.AAe-�wsT .SEPTIC TANK CAPACITY So cv G,9 LEACHING FACILITY: (type) ✓,��rn�a d 2 S (size) /D x 34' kQ NO.OF BEDROOMS ...BUILDER OR OWNER G,5o aC F .� LYE✓c» /.l� C i r- . :'PERMITDATE: COMPLIANCE DATE:T_bri L 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 1101 q'