HomeMy WebLinkAbout0010 RED LILY POND ROAD - Health 10 Red Lily Pond Rd.
Centerville
A=227-058
IN s
UPC 12543
Now. 5� 3_.LOR g�*so►�'��
HASTINGS, MN
TOWN OF BARNSTABLE
LOCATION 6,0 4;�y OO n1,':Q RI, SEWAGE # (7 1 r— d /
VII,LAG ASSESSOR'S T,&LOT
INSTALLER'S NAME&PHONE NO. C,',[YI tS Gnu(C 5T?- 00/8
SEPTIC TANK CAPACITY Gc`I.
loe
LEACHING FACILITY: (type y L'�avn��s 7r (size) 3S/
NO. OF BEDROOMS. =BUILDER OR OWNER 6 t rQ t e)ZSA�/�� Si``l/
r►'
PERMIT DATE: ,'5"'Z — COMPLIANCE DATE: S"—/y
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S: 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 f t of leaching ff c� Feet
Furnished by -�t�
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No. 7 Fee
THE COMMONWEALTH OF_MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE. MASSACHUSETTS es
0(pplication for Mi!6poar *pgtem C0115truction permit
Application for a Permit to Construct(<)Repair( )Upgrade(X)Abandon( ) XcompleteSystern El Individual Components
Location Address or Lot No./Ma p 4 i may'Pqv® AP Owner's Name,Address and Tel.No.
Assessor'sMap/Parcel / �/ F-70A S7— A ®'O
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
CA1
eV!A- Ons95IA.1sae
)po col/ OPVAJP Ba1 F_.�gr /701v`Vis FAM
Type of Building: 9*"9 Ste®7 1
®2-Co-740
Dwelling No.of Bedrooms .4= Lot Size sq. ft. Garbage Grinder( /,./®
"Other Type of Building No. of Persons Showers( ) Cafeteria( )
yy Other Fixtures
Design Flow .4 *40 gallons per day. Calculated daily flow !4¢® gallons.
Plan Date # 6 _Number of sheets Revision Date
Title r`�iy'�
Size of Septic Tank � '�® Ca .L Type of S.A.S. �1plB�S P�.vs S�iti�
Description of Soil _<a,L l IP44f./
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"BQard of Health.
Signed CAAeAate 5--/ - j_7
Application Approved by Date
Application Disapproved for the following reasons
Permit No. CM —7,9q Date Issued
g 9 d
No. Fee �.
THE COMMONWEALTOF MASS CHUSETTS Entered in comps er:,,. t
PUBLIC HEALTH DIVISION - TOWN OF,BARNSTABLE., MASSACHUSETTS
0(ppYication for Migpogaf *pgtem Congtruction Permit
Application for a Permit to Construct(X)Repair( )Upgrade(X)Abandon(' ) Complete System ❑Individual,Components
Location Address or Lot No.'/*Ago /L/LY PAVp Ap �Ovwner's_Name,Address and Tel.�No.
M Le
HYAAIAIIIC g W JOA O�+�i, </,L I..
Assessor's Map/Pazcel .W / xjpR X70 6A-0N
V G nl o Installer's Name,Address,and Tel.No. 1 t Designer's.Name,Address and Tel.No.
�/�u(-t7 7i:' C 3ax.�ri/G "� po .Q W Mo�+c�vacZ
a ga per..-4
p, �9-cam/� GI I.. OA/61"ATGe$R
G Type of Building:
lO Thu/Dwetliing No.of Bedrooms Lot Size, 2.0 sq.ft. Garbage Grinder( 140
f Other Type of Building:. No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow A4 gallons per day. Calculated daily flow 4 440 gallons.
Plan Ddte * Number of sheets Revision Date
Title "-fit-Ar ALAAd _55W,17-49.)e XYk_7__mM Pam✓/ceola
Size of Septic Tank Type of S.A.S. CMMAMS AL MS .SFW9 _; '
Description of Soil�<'owr Ama�,I AIt.A"
' . Nature of Repairs or Alterations(Answer when applicable)
f
4
r ,
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-
!' cafe of Compliance has been issued by this Board of Health.
Signed CA'',,""'D♦♦�►►
ate ,r—/%-
Application`Approved by Date -r Z/
" - Application Disapproved for the following reasons
-z
Permit No. !"t Z ! Date Issued s~' Z I'/F9j
——————————— -- — ——— ----------'="—}-= -- — X
THE COMMONWEALTH OF-MASSACHUSETTS
- 1 t:k ate.k�._ •
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO E TIFY,that the On-site Sewage Disposal System Constructed(X)Repaired ( )Upgraded(Y)
Abandoned( )b 4►V1 �/tcLG. - �'' '"
at A hha's been const cted in accordance
with the provisions of Title 5 and the for Disposal System ConstructionPermit N,o. 99 Z/ dated S- /"9 Y
Installer Designer
The issuance of this pe t s all not be construed as a guarantee that the syst will function s designed.
Date /y 0 / Inspector`'
No. ---------------------------Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Migogal *pgtem Congtruction Permit
Permission is hereby granted to Constmct No)Re air( )Upgrade()<)Ab ndon( )
System located at M Agz> Al /V/.9-
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her d y to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this .- it.Date: z�/// Approved by `
TOWN OF BARNSTABLE
LOCATION J d 4,0.D L y oO�I ��. SEWAGE #
VILLAGE s ASSES)SOR'S MAP & LOT Z Z _05 ;
INSTALLER'S NAME&PHONE NO. T o l t S C �u CC Sog 5539 a0/�
SEPTIC TANK CAPACITY 1S00
"00 7rsnc% .o /
LEACHING FACILITY: (type (size) k 35
i
NO. OF BEDROOMS
BUILDER OR OWNER t I e54nr.tlz
PERMIT DATE: COMPLIANCE DATE:
" Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 7'S:" 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 let of leaching f c Feet
Furnished by21 t
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