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Home My WebLink About0018 NORTH WEST LANE - Health 18 NORTHWEST LN., CENTERVMLE �1 i �I ,f I� I' f S E k M� Sllll__JI �J�a�'cl�n�ay� 111�1�0 2 llll UPC 12543 %� so- No. 53LOR Pon•coN$l HASTINGS. MN TOWN OF BARNSTABLE LOCATION Aleff PV' L ,A-, -AC SEWAGE # VILLAGE, r-7�IV?wey/Gl.L' Y� �SS ASSESSOR'S MAP & LOT�Zfj-,05 INSTALLER'S NAME&PHONE NO. 'o 4/4/-ra A✓` 77sr (F77, SEPTIC TANK CAPACITY /.SAD- ) Cf- �- 130 l LEACHING FACILITY: (type),<,-C.4 c-N- HX-wj��(size) NO. OF BEDROOMS 3 i BUILDER OR OWNER C A R Q 4-- PERMIT DATE: COMPLIANCE_COMPLIANCE DATE: ;3 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility r 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 C4 � r C r n ► s a X No. Fee $5 0 . 0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ' Yes PUBLIC H LTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppCicatton for Miopooal *potem Conaructiou Vermtt Application for a Permit to Construct( )Repair(x)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 7 71 —0 5 70 Owner's Name,Address and Tel.No. 7 71 —0 5 7 0 18 Northwest Ln, Centerville Mick & Lisa Carlon Assessor's Map/Parcel/ 917 z::71�d 18 Northwest Ln, Centerville, MA Installer's Name,Address,and Tel.No. 7 7 5 8.7 7 6 Designer's Name,Address and Tel.No. W E Robinson Septic Sry PO Box 1089 , Centerville, MA 0263 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( no) 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/gravel Nature of Repairs or Alterations(Answer when applicable) Title 5 Septic System consisting of 1500g tank, D-box and 2 500-gallon precast leach chambers 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 E ironmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this ar f Health. Signed r Date —."9d Application Approved by Date `' L�`�- Application Disapproved for the following reasons Permit No. Z Date Issued r Fee $50.00 Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS . - f :Yes' PUBLIC H LTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ; x ZIpprication fdr IDi4po.5af *pgtem Cow5tructton Permit Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. 7 71 —0 5 7 0 Owner's Name,Address and Tel.No. 7 71 —0 5 7 0 18 Northwest Ln, Centerville. Mick & Lisa Carlon Assessor'sMap/Parcel / � 18 Northwest Ln, Centerville, MA Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. W E Robinson Septic Sry PO Box 1089, Centerville, MA 0263 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( no 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/gravel s Nature of Repairs or Alterations(Answer when applicable) Title 5 Septic System consisting of 1500g tank, D-box and 2 500-gallon precast leach chambers a. 4 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 t�Enironmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this h. 7 9 Signed Date 3 0`d v Application Approved by .- Date Application,Dsapproved for the following reasons Permit No. Date Issued lvr' --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Carlon Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired (X )Upgraded( ) Abandoned( )by at 18 Northwest Ln., Cantervillp has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No dated / " ' !! """"- '? Installer W E Robinson Sept Sry Designer The issuance of this permit shall not be onstrued as a guarantee that the system will function as designed. Date .�3 9 Inspector KZ --------------------------------------- � No. t1 �� / Fee $5 0'0 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Carlon lwtgotal *pttem Conotruction Permit Permission is hereby granted to Construct( )Repair( X)Upgrade( )Abandon( ) System located at 18 Northwest Lahne Centerville, MA Installer: W E Robinson Sept Sry 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 rmit. Date: Q_�? °~ l F Approved b.. ;' 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 �� _ concerning the property located at 18 Northwest Lane, Centerville., MA, meets all of the following criteria: * There are no wetlands within 100 feet of the proposed leaching facility. ASSESSORS MAP NO• _ * here are no private wells within 150 feet of the proposed septic system. PARCEL NO: * ere is no increase in flow and/or change in use proposed. * Th re are no variances requested or needed. * If th proposed leaching facility will be located with 250 feet of any wetlands,the bottom of the propo ed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted ground ater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) — B)Observed Groundwater Table Evaluation(according to Health Division well map) 02� V SIGNED: DATE LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 20-1998 (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan.should be submitted). w 4: 6I� J W