HomeMy WebLinkAbout0119 SHEAFFER ROAD - Health 119 SHEAFFER ROAD
CENTERVILLE
A= 172 - 067
S M E A D
KEEPING YOU ORGANIZED
No. 12534
2-153LOR
fORESATRY 9LE MIN.RECYCLED
WITIATIVE CONTENTIO°k
CertlfiedFber'a""N POST-CONSUMER
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SR12M
MADE W USA
GET ORGANIZED AT SMEAMOM
TOWN OF BARNSTABLE
LOCATION 119 Shco_-9'cr RJ SEWAGE# ZOZI - OyZ.
VILLAGE Cc�lct-c� 1 Ic. ASSESSOR'S MAP&PARCEL /;.2, — 0 G 7
INSTALLER'S NAME&PHONE NO. Hn'1. OG53
SEPTIC TANK CAPACITY
LEACHING FACILITY. (type) (size) t�
NO.OF BEDROOMS
OWNER
PERMIT DATE: Z- 1 G- Z 1 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
A lz ri
AV i$ G
8Z' ZG,3 n
A3. 22,/�,,
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QCAR a I
a
No. Wvt F Fee `6
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
`Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ZippYication for -Misposar 6pstem Construction permit
Application for a Permit to Construct( ) Repair(./) Upgrade( ) Abandon( ) ❑Complete System [Individual Components
Location Address or Lot No. III V a (e(kQ(0,k1 Owner's Name,Address,and Tel.No. Nr iCip.. tH e_
Assessor'sMap/Parcel 0 �� S�1QafFe t Rd. Ce,)j(ru,j1(
Installer's Name,Address,and Tel.No. b V 6 'Ex ravc7tioN I nC, Designer's Name,Address,and Tel.No.
3a4 V_Q,ge 1�o; Sand„w,_� rank 04
Type of Building: � rr
Dwelling No.of Bedrooms Iv Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) WA gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Koo an 0,, Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) 1 1_01C2 �SUn aaIl or, Se o\(, 4a(l only
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 Z I
Application Approved by Date -7 1Z
Application Disapproved by Date
for the following reasons
IL
Permit No. 2ARA —0 L(Z Date Issued
Fee r 6
�t THE COMMONWEALTH OF MASSACHUSETTS Entered in computer=r
PUBLICALTH DIVISION - TOWN,OF BARNSTABLE MASSACHUSETTS Yes
a
LO
Y1catI0YC fOr18 08aY 8tetn �onstruttfon Permit p
'r{ Application for a P mit to Construct( ) Repair(/) Upgrade( ) Abandon( )" ❑Complete System 0 Individual Components
Location Address or Lot No. E Owner's Name;Address,and Tel.No.
�m � 11� �allec� cr 6'�.d (eCttc�rj% Pntr,c,C. �amc he
Assessor's`Ma /Parcel
P 'Z cl `�' 01�1 SheGFFri( 1�c1• e��cr u,l I� !
Installecis Name,Address,and Tel.No. rf,\up(, i AL Desigiier's Nairie;Address,and Tel.No.
Ilk
: 4 �au1c 110, StAr,OLLLV 50t' iB'06 Tank 0(0
t "�l ''TYPe of Building:
^ t Dwelling No.of Bedrooms 0 A_ Lot Size sq.ft. Garbage Grinder( )
a�
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow, N'(min.required) A gpd Design flow provided ' '� j gpd
Plan Date ) Number of sheets Revision Date
_ Title
Size of Septic Tank � 11(1 n�a�Sn Type of S.A.S. `~
Description of Soil _ -
Nature-of Repairs or Alterations(Answer when applicable) R0 ltore 1 (lo Arillnn 1.:�PA.y -L/\L rink,
,
t
;. Date last inspected: s
-� 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 7
Application Approved by r""`" > Date '? 1Z I
Application Disapproved by Date
s for the following reasons
' Permit No. 4 1 Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
(Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(V) Upgraded( )
E Abandoned( )by
at- Q A (v Me r,1,0 e, has'been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No-ZL ,bq Z• dated
Installer 4,1 r A.J rx�,1i N �A r , Designer +,
#bedrooms ""r r,,h1r t F Ol c,c c m o 1 5 n 1... Approved design flow +, gpd
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Date /�j ! ? Inspectors
_____________ ______ _____________ _ _ _
f
1
No. L/(Ji/�` �' ,�— s r� Fees I.
THE COMMONWEALTH OF MASSACHUSETTS
/�rO,,k PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
BispoSal 6pstem ConSttuctlon Permit
: Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( )
System located at 1 Icl Q A ;. r
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.
Provided:Constru tion must be completed within three years of the date of this permit.
Date 2 7) (P J 7 Approved by