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Home My WebLink About0524 PRINCE HINCKLEY ROAD - Health (2) 145 ZENO CROCKER RD. CENTERVILLE A=170-145 No. 42101/3 ORA ESSELT E 1o�ro O O O may, f 3 INo. �® � Fee$50 %I J� .. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppfication for 30igpogar *p5tem Construction Permit Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No J a.me s Dunn Cent and Tel.No. Centerville , MA Assessor's Map/Parcel� t ., �� // J G. , lrstaller' N A dress,and Tel. o. Designer's Name,Address and Tel.No. m. � .az`§'o�inson eptic Service P 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) new Title 5 leaching system consisting of a B-box and 2 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 Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this az of Health./ n 7 Signed Date Application Approved by Date may/_1 rf Application Disapproved for the ljollowmg reasons Permit No. — Date Issued �J TOWN OF BARNSTA,B,L"qE LOCATION la �� /��.vG ,'- f R.ckIL7, SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S'NAME&PHONE NO. I0 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) — —9—,Z Z-C (size) NO. OF BEDROOMS.3-- BUILDER OR OWNER PERMIT DATE: .35 A<7—2 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching F i ity Feet Private Water Supply Welland Leaching Facility (If any we exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetland's exist within 300 feet of leaching facility) /, Feet Furnished by f �!. GoCi .. -V J c %� No. •< .L l 1 D — / l ✓ Fee 1 5 0 — THE COMMONWEALTH OF MASSACHUSETTS' + Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for ;i-4pogar *p.5tem (fow5truction Permit Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.524 Prince Hinckley game sa L Uddress and Tel.No. Centerville , MA Assessor's Map/Parcel `0staffer' N A dress,and Tel. o. Designer's Name,Address and Tel.No. m. k. o`binson Septic Service P 0 Box 1089, Centerville, MA Type of Building: Dwel'ing 1 Nyo.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) new Title 5 leaching system consisting of a B-box and. 2 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 Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this ar f Health. �J Signed Application Approved by Date Application Disapproved for the MilowIng reasons ;w Permit No. — ) S7' Date Issued - THE COMMONWEALTH OF MASSACHUSETTS Dunn BARNSTABLE, MASSACHUSETTS (Certificate of QCompliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired (X )Upgraded( ) Abandoned( )by Wm. E . Robinsoh Septic Service at 524 Vince Hinckley Rd.. , Centerville, MA has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer / n ' A The issuance of this permit sh 1 not b• construed as a guarantee that the system will function as desrgPned. Date r �� q Inspector r..s ��-ram - - ��. -c,r�✓ . - _ u --------------------------------------- Fee ti jj THE COMMONWEALTH OF MASSACHUSETTS Dunn PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS P,igpool 6pgtem (Construction Permit �~ Permission is hereby granted to Construct( . )Repair( X)Upgrade( )Abandon( ) System located at 524 Prince Hinckley Rd- , 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: — 9 9 Approved by .` NOTICE: This Form Is T® 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��`/7` °! concerning the property located at 524 Prince Hinckley Rd., Centerville, MA meets all of the following criteria: ere are no wetlands within 100 feet of the proposed leaching facility. . �� */iThere are no private wells within 150 feet of the proposed septic system. ahere is no increase in now and/or change in use proposed. where 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) 3 B)Observed Groundwater Table Evaluation(according to Health Division well map) SIGNED: X.-I L G `/e� 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). �� •... f +^ �.. L y �G �� '. a . �v�u/ � L� � � ,�