The URL can be used to link to this page

Home My WebLink About0009 STONEY CLIFF ROAD - Health 9 STONEY CLIFF,TCENTERVILLE-- A= 189-010 i llll ® =J UPC 12543 � N .5,. 3_ OR �r`bsy � HASTINGS, MN 0 TOWN O�F+�B^ARNSTABLE (� LOCATION 0� S40A e V(f I�'T" SEWAGE # Q VILLAGE ��fcr�Fl/� ASSESSOR'S MAP &LOT 16 INSTALLER'S NAME&PHONE NOAICA Caen v& VO-069 SEPTIC TANK CAPACITY15 CO LEACHING FACII.TI'Y:,.(typej 19 (size) > 1 X NO.OF BEDROOMS D^ I BUILDER OR OWNERa PERMIT-DATE: 0 ' Yq COMPLIANCE DATE: `7 Q • _ 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 n � 00 g 30 w ��` t / No. v 0 Fee THE COMMONWEALTH OF MA$SACHUSETTS Entered in computer: e� i YV PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppliCotion for -Migo al *pztem Cow6truction Permit Application for a Permit to Construct( )Repair( )Upgrade Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �, STC0 ee�-c *i V:,� Owner's Name,Address and Tel.No. Assessor's Map/Parcel y77 01T 'K�2. Installer's Name,Address,and Tel.No. V Designer's Name,Address and Tel.No. d1�t O--cw� S�pZ�L �Q G� �� t •--ems 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 'Z3CY gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank tnj Type of S.A.S. Vb c k Ca ac5l:=--Aw-KLTv--Na Description of Soil dV-e`.Q-S19-✓u-� Nature of Repairs or Alt rations(Answer when applicable) 14cC 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 nvironmental C e and nopto place the system in operation until a Certifi- cate of Compliance h o el�`Itha Signed .,-�' Date Application Approved by Date Application Disapproved for the following reasons Permit No. ,� s�O Date Issued - No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: � Y_e�/ PUBLIC HEALTH-DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS S Application for Migonl bpgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade ZK)Abandon( ) ❑Complete System ❑Individual Components e Location Address or Lot No. IF Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. S� b to-cW�_ p C.. Type of Building: Dwelling No.of Bedrooms �J Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures p Design Flow 37D gallons per day. Calculated daily flow 1 gallons. Plan Date Number of sheets Revision Date. Title ^, Size of Septic Tank 1�6Dv1a\ Type of S.A.S. t-+►.(� �)C_"I l Description of Soil 1 �- J�►4y� Nature of Repair or Al rations(Answer when ap licable) _�-�- C � (--`v t7 Date last-inspected: 1.4 Agreement: 4. The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system tin accordance with the provisions of Title 5 of th nvironmental C e and_ no to place the system in operation until a Certifi- .•i. cate of Compliance has`b n issue d o Heat a. Signed r Date Application Approved by _ Date �— i „ Application Disapproved for the following reasons !� �.� Permit No. yo Da Issued 7� JY THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS r'0 (Certificate of (Compliance THIS IS TO CER IFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded Abandoned( )by t O LA Oc-5-,- Z C_ at ST"C 1\1C_yG l -d M FF_ CC_'Nr(V l has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 0 dated 7—/— Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date `7 Inspector ' No. �00 5 -- -------------Fee _/ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mwi5pogal *pg;tem (Construction Permit Permission is hereby granted to Construct )Repair( )Upgra e( )Abandon System located at 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 thi Date: Approved by c 10/9/97 '.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) hereby certify that the application for disposal works construction permit signed by me dated /a-�0 7� , concerning the property located at 5 f®wea G I ;c�G meets all of the C'0 0-q— /ffollllo'wing criteria: b' There are no wetlands located within 100 feet of the proposed leaching facility There are no private wells within 150 feet of the proposed septic system There is no increase in flow and/or change in use proposed ere are no variances requested or needed. If the proposed leaching facility will be located within 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) L) - B)Observed Groundwater Table Elevation(according to Health Division well map) I SIGNED : DATE: feA- 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 - w r 3 TOWN OF BARNSTABLEU LOCATION I� k542)eVC1 ► Ac - SEWAGE # - 0 VILLAGE CCtn f�rt��'IIr ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. � �a�e SqL 22E066q SEPTIC TANK CAPACITY LEACHING FACILITY: (typej - T q (size) :)Ll 14 1 1 t _ NO.OF BEDROOMS 3 _ i BUILDER OR OWNER �cn�rY?cr PERMTTDATE: (,.. ' �°� COMPLIANCE DATE: 7 q 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 �, 15