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HomeMy WebLinkAbout0196 SHOOTFLYING HILL RD - Health 96 Shootflying Hill Centerville A = 214- 033 S M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR SUSTAINABLE RXEMY MR RECYCLED iNmAAVE CONTENT10% GrtitisdFborSc=inp POST-CpNSUMER wrwifipropram.wg 1"MO MADE W USA ORGANUD AT SMEADMM t No. V 03 Fee ��� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplitation for Misposal *pstrm Construttiun 3pPrmit Application for a Permit to Construct( ) Repair(.Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address 8 Lot No. f6 ShcUW/y,;)S Ati// Ra Owner's Name,Address,and Tel.No. Assessor's Map/Parcel J/tf .5-5 /41u-L 114 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size 7p,$3-y6' sq.ft. Garbage Grinder( ) Other Type of Building /psrdpn/17o f No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 41,4/() gpd Design flow provided gpd Plan Date /f'laic�i /5✓2cx9`� Number of sheets / Revision Date Title Size of Septic Tank /"0 Type of S.A.S )AJ CAm befj W W`5 i&v Description of Soil Nature of Repairs or Alterations(Answer when applicable) / Ros&/mac a itq $/iCsYNr4 3 boa 9�/lam-✓ /e g</i r/i�r►��rr�'� �.o/'1' �/r 5�n/r � ���- ,�la-J Nate 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. Sj ed Date 40—2 —�O2 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Za2,0 Date Issued ' No. �/7 /7 /� Fee / a ,�' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:_7 a PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 4plica.tion for Misposal 0psteta Construction 3permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Shall'y�,� Owner's Name,Address,and Tel.No. ,M �E'r'Fc'fJol �t Assessor's Map/Parcel or rC 44P,,,ej Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: DwellingNo.of Bedrooms i/ Lot Size sq.ft. Garbage Grinder.( + Other , Type of Building T?3�o�s,Ld No.of Persons Showers( „) Cafeteria( ) Other Fixtures Design Flow(min,required) gpd Design flow provided gpd Plan Date�.j „ , ', Number of sheets Revision Date *;.. Title Size of Septic Tank /5]f2o Type of S.A.S.- t n_n I/ �, a a ups{suuro Description of Soil .. Nature of Repairs or Alterations(Answer when applicable) .12 4/� A/P e^SV!f A re, r >9ate last inspected:r " " Agreement: { 'y 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. �l Signe y - Date f Application Approved by (_ r, Date Application Disapproved by `�% - t ; Date _ for the following reasons Permit No.�/o.2e) ? Date Issued Q�/ ��e2 � �Y a.-- . THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance rksN` THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by ,. at ,, (i /_ r has been constructed in accordance t with the provisions of Title 5 and the for Disposal System Construction Permit No p o— Q 3 dated Installer-- L,,,/C Designer \, . D^ I e ,t'i #bedrooms d/ Approved design flow, G/s� Ark t n, gpd `• The issuance of this permit shall not be construed as a guarantee that the system wil e Inspector �l function as designed. s Date f a IA, /1f A y_ No. ♦ Fee THE COMMONWEALTH OF MASSACHUSETTS r y "' PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS ' Misposal 6pstem'Construction 3permit Permission is hereby granted to Construct( ) Repair(y"}� Upgrade( ) Abandon System located at 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. jr- Provided:Construction must be completed within three years of the date of this permit. f r - Date y �n 1 C} Approved by � .... ^. l Town of Barnstable tIME rower Regulatory Services Thomas F. Geiler, Director MASS. • ' Public Health Division rFo 39.E a Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-796-6304 Date: y/0'.?000 Sewage Permit# 00a0-0 Assessor's Map/Parcel / .-035 Installer &Designer Certification Form Designer: �, � Installer: D, o Tat, Address: ��� c'�`'�J�'� Address: 'aOKIq$-. On q' G `gip 2D ID 6t A fC1,W 0C was issued a permit to install a (date) (installer) ll septic system at s 41 m( based on a design drawn by (a dress) dated (designer) / l certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stnpout (if required) was inspected and the soils were-found.satisfactory. I certify that the. septic system referenced above was installed with major changes (i.e. greater than 10'-lateral relocation of the SAS or any vertical relocation of any component of the septic system).:but in accordance with State & Local u '^tions. Plan revision or certified as-built by,desiIgner to follow. 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