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HomeMy WebLinkAbout0140 POND VIEW DRIVE - Health _ -�-9- ©9 N sMEA KEEPING YOU ORGANIZED No. 12534 2-153LOR i SUSTAINABLE MIN.RECYCLED INITIATIVE CONTI NT10% Certified Fiber Sourcing POST-CONSUMER w"+•sfiDrogram.org $K1390 MADE W USA GET ORGANIZED AT SMEAD.COM I No. ZV�1 —t (e p" .. Fee 7S— THE-COMMONWEAL-T-H O ,MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplitation for 3Bisposal *pstem Construction permit Application for a Permit to Construct( ) Repair(/upgrade( ) Abandon( ) ❑Complete System MeIndividual Components Location Address or Lot No. I�O O I Qhp5DR Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 2Z q p 3C� v� V�• 10 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. CaCr� Type of Building: ] Dwelling No.of Bedrooms Jr]- Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) f'r 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 L J 2 Application Approved by Date Is L Application Disapproved by Date for the following reasons Permit No._ / � J 3(,( Date Issued Z 'N, TOWN OF BARNSTABLE F c LOCATION I%0 SEWAGE VILLAGE ['��P�ji�� ASSESSOR'S MAP & LOT -� INSTALLER'S NAME & PHONE NO.J./-,l� �rltS�vo� SEPTIC TANK CAPACITY�l�� LEACHING FACILITY:(type) L�") (size) 46?i NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER fyl; JL�1t,cc-3 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED VARIANCE GRANTED: Yes No �� . � { /� '\� � /y ` . ., y9 ;� o , - ,��, ti r 5`� ti�� 31 TOWN OF BARNSTABLE A LOCATION /�� TOR6 \IkT-w �)C- SEWAGE# V VILLAGE e ASSESSOR'S MAP&PARCELe 2 q 6-2 INSTALLER'S NAME&PHONE NO. � 06LL� SEPTIC TANK CAPACITY C—X�S c LEACHING FACILITY: (type) (size) NO.OF BEDyRIOOMS T�I VSQ,�C .o r\ IV kA l b OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 �o A Lk � ° VA `No. 0 2,1 "1 .;j�..{� r ' Feed` THE COMMONWEALTH:OF MASSACHUSES TT " - Entered in computer: yj PUBLIC HEALTH,DIVISION - TOWN OF BARNSTABLE;MASSACHUSETTS ' 4 1110 0[ppYication for Misposar 6ps'tem Construction Permit Application for a Permit to Construct Repair Upgrade Abandon ❑Complete System Ind ividual Components Location Address or Lot No. 1 AQ Q � 4ev—) Owner's Name, (�Address, `and Tel.No. Assessor's Map/Parcel 2Z,e\/0I a (1_ �.f v,�� _ �.} a4 1 1,^ lG(�Y�.CC ►��a Installer'+s Name,Address,and Tel.No. yy•�r�, ,1�^��/ �j Designer's Name,Address,and Tel.No. Lb Type of Building: Dwelling No.of Bedrooms U f IA- Lot Size sq.ft. Garbage Grinder( ) ' Other 'Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) to gpd Design flow provided All A- gpd r Plan Date , Number of sheets Revision Date Title Size,of Septic Tank Type of S.A.S. ' Description of Soil s Nature of Repairs or Alterations(Answer when applicable) . >st Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described ow-gite sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place t tem 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. Date Issued (' ( R I THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS. Certificate of Compliance A THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( ){ ( by �`e�a � {L�S' ^t :�, �.• at , �� n_ `A 4n,,(,CWDt v% 4s,Cy has been constructed in accordance with the provisions of Title 5 and the for Disposal Syste Construction Permit No. j -1 It dated t /A f Installer Designer / { #bedrooms_ A�/,,A Approved design-flow, � gpd ,.0{ The issuance of this permit shall not be construed as a guarantee that the system will.function a designed. Date �,--)J 4.._'i Inspector /,-^� - - -_ __ _ --- _- _ _ - - -- ------ - --- ----- f . . No. /�tl .t � "�.4�� Fee THE COMMONWEALTH OF MASSACHUSETTS b PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction 3permit . Permission is herebyanted to granted Construct( ) Repair(�+'') Upgrade( ) Abandon( ) System located at X 4 and as described in the above Application for DiTosal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. r Provided:Construction must be completed within three years of the date of this permit. Date Z Z f Approved by /