HomeMy WebLinkAbout0406 LAKE ELIZABETH DRIVE - Health I 406 LAKE ELIZABETH RD. , CENTERVILLI
_ MAP-227 PAR-023
104 L"•c- Z-t , TOWN OF BARNS TABLE -
LOCATION ® C'� � � �`�-- ► SEWAGE # I'�®
VILLAGE ASSESSOR'S MAP & LOT d- —
INSTALLER'S NAME&PHONE NO. J?b b i w_��-$..,z. 7 S 7?`
y
SEPTIC TANK CAPACITY /-$� 6`a
LEACHING FACILITY: (type)
NO. OF BEDROOMS �1-- J
BUILDER OR OWNER 6C.J•4 / 5 IY
PERMITDATE: 0 —/S'Z `7 COMPLIANCE DATE: �l --� G 7
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Ching Facility Feet
Private Water Supply Well and Leaching Facility (If y wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wit ands exist
within 300 feet of leaching facility) Feet
Furnished by
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No. T7—Sd -S Z 2 / 0 2� Fee $5 0 .0 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS es
Zipphration for Miopool 6raem Construction Permit
Application for a Permit to Construct( )Repair( x)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 406 Lake Elizabeth R owner's Name,Address and Tel.No. 61 7—6 6 5—7 3 4 4
Centerville, MA Margret Walsh
Assessor'sMap/Pazcel 34 Perkins St, Stoneham, MA 02 80
Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No.
Wm E Robinson Sr Septic Service
PO Box 1089, Centerville, MA 02632
Type of Building:
Dwelling No.of Bedrooms 2 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
Nature of Repairs or Alterations(Answer when applicable) We will install Title 5 septic
system consisting of 1500g tank, D-box, and three stonepacked
high capacity infiltrators.
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 Co and not to place the system in operation until a Certifi-
cate of Compliance has been issue by this d ealth.
Signed a Date
Application Approved by Date
Application Disapproved for the following reasons -
Permit No. ^ - dS Date Issued
fob L � C..Q.•.CY. � TOWN OF BARNS TABLE
LOCATION C7 p lei f SEWAGE #
VILLAGE L/�j ASSESSOR'S MAP& LOTa2 7—6 2
INSTALLER'S NAME&PHONE NO. �0 6 i a- a 7 7 s 8
SEPTIC TANK CAPACITY .S G O
LEACHING FACILITY: (type)NO.OF BEDROOMS �--
BUILDER OR OWcN�ERL.2�t)
G /S J
PERMITDATE: / —/S`�1 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of ching Facility Feet
Private Water Supply Well and Leaching Facility (If y wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any w ands exist
within 300 feet of leaching facility) Feet
Furnished by
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CV
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n p9 %�
No. O 2-� Fee $5 0.0 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
s
" PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
1, 4[pplication for �Bigoga[ *p5tem Construction Permit
Application for a Penh t to Construct( )Repair( x)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 406 Lake E 1 i eabeth downer's Name,Address and Tel.No. 61 7-6 6 5-7 3 4 4 -
Centerville, MA Margret Walsh
Assessor'sMap/Pazcel 34 Perkins St, Stoneham, MA 02180
Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No.
Wm E Robinson Sr Septic Service
PO Box 1089, Centerville, MA 02632
Type of Building:
Dwelling No.of Bedrooms 2 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
`"
Nature of Repairs or Alterations(Answer when applicable) ;We Will install Title 5 septic
system consisting of 1500g tank, D-box, and three stonepacked '(
High capacity infiktrators.
f
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 Co and not to place the system in operation until a Certifi-
cate of Compliance has been issu�by is ealth. ^r/�
Signed Date 7J
Application Approved by Date
Application Disapproved for the following reasons
Permit,No. �/ �J�� Date Issued
Permit,
/
THE COMMONWEALTH 4F MA46CHI9ERS
Wa`]sh BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Dispo4l'System Constructed( ) Repaired(lgyj Upgraded( )
Wfn E Robinson Sr Se t5i'ct Service
Abandoned( ' )by ,.. P
at Lake Elizabeth()R , Centerville has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. CT
_ - o.� ated
Installer Wm E Robinson Sr Septic Sery Designer
The issuance of this permits all not beconstrued as a guarantee that the system will function as designed.
Date Inspector
----------------------------
No. v� Fee $5 0.0 0
THE COMMONWEALTH OF MASSACHUSETTS
Walsh PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Walsh
&.5pogar *pgtem Construction Permit
Permission is hereby granted to Construct( )Repair( x)Upgrade( )Abandon( )
System located at 406 Lake Elizabeth Rd
Centerville, MA
` Installer: Wm E Robinson Sr Septic Service
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:Construc 'on must be completed within three years of the date of thispermr /���
`� 5 �',�
Date: 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 DESIGNED PLANS)
I,William E. Robinson, Sr.-,hereby certify that the application for disposal works
construction permit signed by me dated 9 -7 , concerning the
property located at 406 Lake Elizabeth Dr, Centerville MA meets all
of the following criteria:
* Mo e a no wetlands within 300 feet of the proposed septic system.
* rei' no private wells within 150 feet of the proposed septic system.
* ` obseved groundwater table is 14 feet or greater below the bottom of the leaching facility.
Ze
re�'s no increase in flow and/or change in use proposed.
re r n are o variances requested or needed.
SIGNED: `/� DATE J 5'
LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 60
(Attach a sketch plan of the proposed system. Also if the licensed installer proposes a certification
plot plan,this plan should be submitted).
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