HomeMy WebLinkAbout0037 CARLETON LANE - Health (2) -37 Carlton Road
Centerville
A= 190-234
S M E A D
No.2-153LOR
UPC 12534
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No. �"' 3,7-5 Fee VV
THE COMMONWEALTH OF MASSACHUSETTS
Entered in computer:
Yes
PUBLIC HEALTH:,DIVISION - TOW14 OF BARNSTABLE, MASSACHUSETTS
0[pplitation for Disposal 6pstem Construction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System individual Components
Location Address or Lot No. 3 G. �. �f� Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel V'e-jv-�\ 1 G3,
Installer's Name,Address,and Tel.No. Designer,'s Name,Address,and Tel.No.
Qj�� XMs y ICJ
Type of Bu dmg:
Dwelling No.of Bedrooms _Lot Size sq.ft. Garbage Grinder( )
Other Type of Building —No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
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 Certificate of
Compliance has been issued by this Board of Health.
Signed Date
Application Approved by (.,.. Date ^�� �(
Application Disapproved by Date
for the following reasons
Permit No. P J/IJ Date Issued —����
1 -
r
Y No. —_ �zS -- - _ Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
Rpplicatlon. for Misposal 6pstrm Construction permit j
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System Individual Components
i
Location Address or Lot No. 3`� C Owner's Name`Address,and Tel.No.
Assessor's Map/Parcel
Installer's Name,Addr—
ess,and Tel.No. Designer's Name,Address,and Tel.No.
Type of Bu dmg:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building _No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) N gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
1 Size of Septic Tank Type of S.A.S.
Description of Soil
.l
Nature of Repairs or Alterations(Answer when applicable)
'i
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 the Environmental Cod(;and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health. !
Signed Date / f
Application Approved by < Date — )
Application Disapproved by .Date
for the following reasons
Permit No. C9 01 Lr J.�- Date Issued rd`l��
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired v) Upgraded( )
Abandoned( )by
at �/'��,: \ P (�n �, has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.2Ot q 3 S dated /'—(
Installer C.c� Fr-Cn1`�( Designer
#bedrooms (/" Approved design flow /y gpd
The issuance of this permit shall not be construed as a guarantee that the system will function as designed. C
Date q— ! ' L) J 504 Inspector
-------------------------------------------------------------------------------------------------------------------------_--------------
No. L"O(y ��5 Fee �vV
THE COMMONWEAI;fH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Misposal 6pstP11� �OTYBtCULtlori Prlttit
Permission is hereby granted to Construct( ) Repair(,/) Upgrade( ) Abandon( )
System located at C C rV4U1\
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
l
Provided:Construction must be completed within three years of the date of this permit.
Date q —(b'� � Approved by <
TOWN OF BAR'1NSTABLE.` `.''%: -_
LOC 'PION �4(',-C,�CD� U SEWAGE#`-' C)r -:a
VILL GE , ASSESSORR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO. �c� \� `rC��'Z- S�nn�,' a�'l�06db�.j
SEPTIC TANK CAPACITY 5 `y'00
LEACHING FACILITY: (type) S �l (size) LY L (.D Vitr C
NO.OF BEDROOIViS c ��
OWNER (LA_U-S
PERMIT D COMPLIANCE DATE: 9
Separation Distance Between the:
Maximum Adjusted Gr6undwater Table to the Bottom of Leaching Facility
Private Water Supply Well and Leaching Facility(If any wells exist on
site o"r,with r 200 tfeet of leaching facility) Feet.
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility), Feet
FURNISHED BY
LAC. ' A Lf
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' 14 �, �k
L-0 C
,�aXVON� SEWAGE PERMIT NO.
I N S T A LA ER'S //NAME & ADDRESS
B U I*L D E R OR OWNER
o�
DATE PERMIT ISSUED
DAT E CO-MPLI ANCE ISSUED /-% -
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