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Home My WebLink About0045 JUNIPER ROAD - Health 45 JUNIPER ROAD, CENTERVILLE _ A=210-113 No. 42101/3 ORA O W ESSEL E 10°/0 No. ` �a-' par Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for Migozar 6pgtem Con.5truction permit Application is hereby made for a Permit to Construct( )or Repair(Aej0'an On-site Sewage Disposal System at: Location Address or Lot No. /� j lOwner's Name,fA�ddress and Tel.No. �(1✓�1�� r �eNTGr(/111� �C4J1S �r®GI.L Installer's Name,AddressAWSI CANCO Designer's Name,Address and Tel.No. 350.Main Street W.Yarmouth, MA 02673 Type of Building: Dwelling No.of Bedrooms _ 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 Description of Soil Nature of Repairs or Alterations(Answer when applicable) ZA5fA / Ov q,4 e A41'c- -f.q A- u 7 `� c� a e�c et raoin r 11l /V Date last inspected: ,� -�— � L• "4, 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 Bo%=. Signed Date �'9 Application Approved by Application Disapproved for the following reasons Permit No. Date Issued L =-------------------- IS Flo No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpprication for Migaar *pztem Construction Permit Application is hereby made for a Permit to Construct( )or Repair(u4an On- age Dispol/System at: Location Address or Lot No. Owner's Name,Address and Tel.No. rf ()n ��e �� enfG�✓;Ili �cw%s roc�C -7�- gas Installer's Name,Address, 1 0�¢&BI CAiVC0 Designer's Name,Address and Tel.No. 350 Main Street '' N�p W.Yarmouth, MA 02673 8 � Type of Building: Dwelling No.of Bedrooms 3 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 Description of Soil Nature of Repairs or Alterations(Answer when applicable) 5 A/ /- /S d u A/. j a A4,,- 4 p,,k o ( ( J lac Gt rooA � X 1 1" Date last inspected: Agreement: The undersigned agrees to nsure 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 Bo d of H XS h. Signed Date `1• �' g Application Approved by Application Disapproved for the following reasons f Permit No. 9 Date Issued -------------- -- —————— —_�— ------ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE. MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced( V<on by for A eU,.s groCI4 y as has beerl constructed in accordant with the provisions of Title 5 and the for Disposal System Construction Permit No. Vnicl dated— Use of this system is conditioned on compliance with the provisions set f below: No. Fee Z U THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Diopogal *pgtem Construction Permit Permission is hereby granted to Al,-o to construct( )repair(vel an On-site Sewage System located at /1 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. All construction must be completed within two years of the date below. Date: `�` Approved by { CERTIFICATION OF SKETCII AND APPLICATION FOR A DISPOSAL WORKS CONSTItUC HON PE11MIT (WITHOUT DESIGNED PLANS) 7 CM�Od, , hereby certify that the application for disposal works construction permit signed by me dated ��' �� ' �ta , concerning the property located at �/,S U��►i�P r• 21�t de�v i fIe— meets all of the following criteria: i/• There are no wetlands within 300 feet of the proposed septic system ✓• There are no private wells within 150 fect of the proposed septic system U 5&-S ✓• The observed groundwater table is 14 feet or greater below the bottom of the leaching facility,3),I - 6 KA�g= ✓• There is no increase in flow and/or change in use proposed ✓• There are no variances requested or needed. SIGNED: DATE: 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]. a c3 C" 04�0 350 Main St. • W. Yarmouth, MA 02673 • 775-6264 Division of Canco Energy Corporation Septic Services • Pumping • Installation �l'0 Yl /&acA C`iAm be!s- o i I TOWN OF BARNSTABLE LOCATION S ��'' ' � SEWAGE# 4/2 ' VII,LAG ASSESSOR'S MAP&LOTE/0'`lam INSTALLER'S NAME&PHONE NO. /7'�,y✓� �G��G O SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) 'X 9 '� Z NO.OF BEDROOMS BUILDER OR OWNERa- PERMITDATE: `7 —/tf—P!4L' COMPLIANCE DATE: S� 7 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 Nor T O 1 � a� 3 r a