HomeMy WebLinkAbout0030 STUDLEY ROAD - Health (2) STUDLEVROAD
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TOWN OF BARNSTABLE Cc
LOCATION y 4 CIL K J SEWAGE # Ca
VILLAGE ASSESSOR'S MAP & LOT 3°6—
�? 1 INSTALLER NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: .(type) oZ% (size)
NO. OF BEDROOMS 43 /l
BUILDER OR OWNER 2)2/2, `y
PERMIT DATE: '. =— — p -2— 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
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s
14
No. fe 2/ Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Nplitatlon for Misposal *pstrm Const rtion permit �
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon(X ❑Complete System ❑Individual Components
Location Address or Lot No.�)V S-ro pt+Gy "AD Owner's NaZ,,,Adcjress,and Tel.No.
P 3O (� WANIJiS t.4N� k gf TONA6
Assessor's Ma /Parcel b d AUC FM 1ALTERMC6, L,
Installer's Name,Address,and Tel.No. 509—477—S�5-7-7 Designer's Name,Address,and Tel.No.
CAPaorDes bvTGZD¢.Ise2 L4-e— v eG �JIA
Type of Building: g 3 Q" D
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 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 Healt
d Date 3
Application Approved b Date `; f
Application Disapproved by Date
for the following reasons
Permit No. cO-1 `y' Date Issued c'
� � �Y
L_ _ _
No.J � �/ � - Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01pplication for Bisposal *pstrm (Construction Vermit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon(X' ❑Complete System ❑Individual Components
Location Address or Lot No. ' O S-TUpuCy P-,C 'b Owner's Narpe,Ad ess,and Tel.No.
Assessor's Map/Parcel 3 p(o 0(g �YANUI S In�fv� a k Ao Fm tAoD (1=LFL,
Installer's Name,Address,and Tel.No. 50g'4-n—8 5S 77 Designer's Name,Address,and Tel.No.
CAPeA-)I®E 6V-r l sc+D NJ R
Type of Building: 3.La - o </lo�G
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 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)
8A"i) o 3-Emc 0STac4
Date last inspected:
Agreement: `
r
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 Boar of Healt a
'3_ar _ 13
r d Date
Application Approved bye Date /
Application Disapproved by Date
for the following reasons
Permit No. �� j Q q `t Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TOCERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
Abandoned( ()by C A Peta..)l O C E- 1Z
at_�O ST U L 3 4 Rb An H*OJ(S has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit N�o��0 7`f dated
Installer NOGTWIDC- G-)TE2,NKS3 U-4z- Designer WA
#bedrooms Approved design flow i gpd
The issuance of this pe= it shall not be construed as a guarantee that the system will&ttion esrfinedDate Inspector r•// �f I /�1 ,
tt . -
No. 2C)/ Fee C9
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
bisposal *pstem Construttion permit
Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon
System located at 3 y .S. 7 V-U LEY RoA-t> H Y4wrJl_(;
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:Construction 'ust be completed within three years of the date of this permit.
Date �j / Approved`by_