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Home My WebLink About0023 HEATHER LANE - Health (3) 23 Heather Lane Centerville A=•149— 130—008 S ME A D No. H163OR UPC 10259 smead.com Made in USA 2J� c�i m No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitatlon for Disposal 6pstrm Construction Vertu Application for a Permit to Construct( ) Repair(,b Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. 3-a. t c—A—t &—e�Lj" \ re Owner s Name,Address, Tel.No. Assessor's Map/Parcel 49 (�O �� '�'� 331, f' _ Installer's Name,Address,and Tel.No. " 'I j 77 Designer's Name,Address,and Tel.No. � OCC,tt�ST MAC N �� Type of Building: 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 providedAl It 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) TbS--1xLk, &IM i) b4—(cr 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 Healt Signed _ Date Application Approved by A Date ' I Application Disapproved by Date for the following reasons Permit No 0 Date Issued v mil. D VtA A No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered m computer: t PUBLIC HEALTH-DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS` Y es 01pplicatlon for Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair* Upgrade( ) Abandon( ) ❑Complete System 4 Individual Components Location Address or Lot No. a 0EA-H&-V_`419" Ow i r'ss Namme,dd�`ss,Iand Tel.No. >, Assessor's Map/Parcel t 49 (3Q Jogs 3--a, t( i,,,N Installer's Name,Address,and Tel.No. ,SASS-({7 J--4S177 Designer's Name,Address,and Tel.No. z ` l cD ee.QlA-L_s-r A4 PecE 44 Type of Building: r' Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures A � Design Flow(min.required) gpd Design flow provided - gpd 1 ' Plan Date Number of sheets Revision Date 4 Title i Size of Septic Tank Type of S.A.S. Description of Soil t r Nature of Repairs or Alterations(Answer when applicable) TIJ S TAU., KI D L4-(E) u 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 cc Health. Signed Date" �D �-.7-0 t Application Approved by Date �� " �''r•n Application Disapproved by Date i for the following reasons Permit No. d'o 11 ..- ~� Date Issued ---_-------------p'- -__-_- __-_-----_- ---___-. _-_--------------------- --------------------- ---- ----- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the O�A- ite Sewage Disposal system Constructed( ) Repaired(,k) Upgraded( ) Abandoned(/ )by �xp w1-06: at C^/TMc--k LA1 JG <_fV( 4_C has been constructed in accordance - with the provisions of Title 5 and the for Disposal System Construction Permit No. dated A- Installer `(��6�J(j,� AJTi�.�5'itr-S Designer N 1Q #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will funcrio• as d si red---" Date (f:! '�/! Inspector—,__-._: *� , "'�--=-may""'""-",� ---- --------- - ------ - --------------- ----- ----- Q _ No. � O r � ----- } Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS I o ai� 8t1 � *pstem Construction Permit _ Permission is hereby anted to Construct( ) Repair(x) Upgrade( ) Abandon System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognize dhis/her duty toj comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be o 'pleted within three years of the date of this permit. Date _ f` f Approved by /^; �. I a �, lj i� e� _ ll It { No. UQ .► 1 ' 4' Fee 001 0119 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Mi!gpooal *pgtem Construction Permit Application for a Permit to Construct( )Repair( 7)upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No,,e_5 Owner's Name,Address and Tel.No. 7_V,0�� ,eev& Assessor's Map/Parcel ,r��,vl�/� Kj�, ' /::; ,o �4,41A /*✓�UsIH� � fe Installer's Name,Address,and Tel.No. '7 r �S9 Designer's Name,Address and Tel.No. .y,�� n5- Type of Building: Dwelling No.of Bedrooms 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 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 Certifi- cate of Compliance has been issued by this Board of Ifealth. Signed46, Ov,' J7;C C_ Date 3 OOa-07 Application Approved by Date Application Disapproved for the following reasons Permit No. 2 GJ? Date Issued s - y No. )G0 7 Fee �OQ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zippfication for Miq gar *p!5tem Conotruction Permit r a ✓ stem ❑Individual Components Application for a Permit to Construct( )Repatr( )Upgrade( )Abandon( ) ❑Complete Sy Location Address or Lot No. 9�? Owner's Name,Address`and Tel.No. ]�jQQ� Assessor's Map/Farce l /O(eNj// v J / � 11A �y�C C.• -fr /I �e N Installer's Name,Address,and Tel.No. r: Designer's Name,Address and Tel.No. Abe/, Type of Building: Dwelling No.of Bedrooms 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 t gallons. Plan Date Number of sheets Revision Date Title f y Size of Septic Tank Type of S.A.S. .,-Description of Soil Nature of Repairs or Alterations(Answer when applicable) 6 U 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- -xcate of Compliance has been isstied by this Board of pealth., Signed 00 1- c- Date 3?OL y U 7 Application Approved by Date 7 ! o-� Application Disapproved for the following reasons . t Permit No. ?- Date Issued --t---------- ----=------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Aban ned( b I at n.P 0�3 RA e- Ce"4?1` t has been constructed iji accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2 00.7 if dated '3 _2 2-0-7 Installer Designer The issuance of this permits all of be construed as a guarantee that,d a system wilI(u ctio as designed. Date � Inspelctor� ---� l No. )no -7— LI-! r Fee ( 00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mi0pozar *pztem Conotructton Permit Permission is hereby granted t Construct( )Repair( )Upgrade( )Abandon( ) System located at W 3 �( g7y`l'I l G.nm re r- i � . 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. us t be completed within three years of the date otlus Date: I a '"7 Approved by 1 rlHK—et)—CUu I rluly i i -c i n11 I uvi 11 Commonwealth of Massachusetts y Title 5 Official Inspection Form x s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 HEATHER LANE _. Property Address C/O MARK HANSEN TODAY f7EAL ESTATE 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner owner's Name information is CENTERVILLE MA 02632 3/19107 required for State Zip Code Date of Inspection every page. CityrTown D. System Informatior=.(cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks, Locate all wells within 100 feet. Locate where public water supply enters the building. 6- 23 G-35 2810LD MEETINGHOUSE•08106 TWO 5 01flual hspaciion FOMM Subsurface Sewage Diapoaal Sy*kam•Po9e 14 of 16