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HomeMy WebLinkAbout0035 OAK STREET (CENT./W.BARN) - Health 35 OAK ST., CENTERVILLE A=173.018 Sllll ___/� J�.REGVC[F�Cp UPC 12534 No. 2-153LOR HASTINGS, MN Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION —TOWN OF BARNSTABLE., MASSACHUSETTS 0[ppYicatton for Mtopual *pgtem Con6truchon Permit Application for a Permit to Construct( )Repair Upgrade( )Abandon( ) /Complete System El Individual Components Location Address or Lot No.assl Kok ST Owner's Name Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building rid/ Geef2�',No. of Persons Showers( Cafeteria( ) Other Fixtures Design Flow `4� gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank C ®0 ,0 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 TitlV 5 of the En ' on mental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss y is B of ealth. Signed Date Application Approved by Date a. 7-0/% _ Application Disapproved for a following reasons Permit No. g- 5''! Date Issued i Rom' b6 3Y b r9 i 00 TOWN OF BARNSTABLE LOCATION 3 ✓� ���C.ter' SEWAGE # VILLAGE ell 7"'e1 1/11e ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1f uo 4 L 1 LEACHING FACILITY: (type) .G,J.,o�� S1 (size)/D�4 ,2J J NO.OF BEDROOMS 3 BUILDER 0R0v� 'T PERMITDATE: g"'Zl—�� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Sfi Feet Private Water Supply Well and Leaching Facility (If any wells exist A/ on site or within 200 feet of leaching facility) /v '� Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) V 9 Feet Furnished by �= o TOWN OF BARNSTABLE `0 LOCATION 3 ®?fC✓�'� SEWAGE # VILLAGE Dell Afll Ilf/e ASSESSOR'S MAP & LOT f73�/d INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /$00 ll LEACHING FACIL=: (type) (size)/D NO.OF BEDROOMS 73 BUILDER OR(O��NV�F$ PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility rf Feet Private Water Supply Well and Leaching Facility (If any wells exist A/ 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 �f yy bb 6 �y° 00 r,l /73 No. 9 .���( Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for Oigooal bpotem Congtructton Permit Application fora Permit to Construct( )Repair( Wupgrade( )Abandon( ) L4 Complete System ❑Individual Components Location Address or Lot No.3_!5-01^k S r Owner's Name Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �o�foLo�i G©�6� Type of Building: Dwelling No. of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building GS/ G,4!2f No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow J�J�� gallons. 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) ri"'o- e ,5 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 Titl 5 of the Env' onmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is y is B of ealth.. Signed 1-- Date Application Approved by Date 3,17 -�St Application Disapproved for t e following reasons Permit No. ��i- �i'�f Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certtf irate of Compliance THIS IS TO CERTIFY, that the On-site Swage Disposal System Constructed( )Repaired ( LAUpgraded( ) Abandoned( )by All-�JGD /? o S, at S`-- ate S G�h °/l// / has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. - dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date T- .3- 2s Inspector S . --------------------------------------- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Otgaai *pztem Congtructton Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at 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. Provided:Construction must be completed within three years of the date of this permit. Date: Approved by