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HomeMy WebLinkAbout0123 CURLEW WAY - Health _ 123 CURLEW WAY, COTUIT I i TOWN OF BARN=SEWAGE # LOCATION — VILLAGE ( �-'e-�—t i-- ASSESSOR'S MAP&LOT LIT 9 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY I6Z?D P i LEACHING FACILITY: (type) i i (size) K NO.OF BEDROOMS BUILDER OWNER DR ry PERMTTDATE: —Ty COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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) r4-- Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by A'3 .3 3 31 T-J7 O j No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS 2pplication for Migogat pgtem Con.5truction Vermit Application is hereby made for a Permit to Construct )or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. /v Owner's Name,Address and Tel.No. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder( ) Other Type of Building Al eloeC' No. of Persons Showers(Z) Cafeteria( ) Other Fixtures Design Flow 12)3 0 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date J Title Description of Soil /9! 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 issue th' d f Healt — Signedy7� G� Date ll Application Approved by �L.•.,. "�� Application Disapproved for the following reasons I Permit No. Date Issued 0.2 No. Fee ©� THE COMMONWEALTH OF MASSACHUSETTS K PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pprtcation for Mizpogal pgtem Cougtruction permit Application is hereby made for a Permit to Construct )or Repair( }an On-site Sewage Disposal System at: Location Address oeLot No. /.p Owner's Name,Address and Tel.No. x Installer's Name,Address,and Tel.No. Designer's Name,Address and TeL Ni Type of Building: t `.Dwelling No.of Bedrooms Garbage Grinder( ) 'Other Type of Building / / Gam[` No.of Persons Showers(Z) Cafeteria( ) F Other Fixtures Design 'Flow ) ��p gallons per.day. Calculated daily flow 67 gallons. Plan Date Number of sheets Revision Date 5 Title ' � r Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: f _ Agreements 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 issue th' and f Healt - Signed Date // 2 Application Approved byd,�,,,. Application Disapproved for'the following reasons Permit No. -- / Date Issued THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION.- BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CEIFY that e O -site Sewage Disposal`System installed(�r rep red/re laced( )on by / 7• -- for �e-Ar � d1,V as Z 7 ifC"K —&-7" L�7"-/� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated P P Y Use of this system is conditioned on compliance with the provisions set forth below: ------------ No. l ei..)(, Fee 3 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE, MASSACHUSETTS Migpogol *p!6tem. Cougtruction Permit Permission is hereby granted to �� t,�/�� / to construct(>C)repair( )an On-site Sewage System located at /,.,T r fp'..�8//• 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. All construction must be completed within two years of the date below. Date: Approved by C 1:)'E516 N -PATA 51�16LS F-AG11L`( $EDRrx�Ms A Igo 6,AMAGE 600E �A1 Lam( FL W 3X 1►D•33D AP CURLEW t�tlAY 5E?r1 c TA►JIL = 330 x I-Q0'Zk 401G4A0 uss Ivwo AL- �38 PISFMAL PIT �- LrtvG,�• �3�STo►Ja ti� , �' 511.)EWdlL AJai54 : 131- SF I zsF,c 2.5 C.1306prim, BOTTOM AgrA It 3 SF 13 TODNL br:616u = A4$ 6M• 1 �d ''TOTAL RAIL My/ = `3qD� / Y „ 1 5c t lac. PE!?GDLATION ¢ATE t ►►d UNJ W3 t�OF )b aOF �' 7ag2 d3►aGl ... �. MMARDA. BAXTIM Lo PETER No a�ae SULLIVAN No.29733 � I&T It AL EM�� T�5 T _ TF LAW �,;.� M �, Ito I vafl mw . . 4ay vKT ,w�. ,w►',• Gal. ,•g t�ISu 1 �av' BoK SeFTIC Goo wv �•7 T N r `4AL. AA CoAtzSE 3,4.•I/za WiK�IF� a ALL,5rcvTW SET sAb � I44W 4 'PEW Aysl s %L 4. yT0►1� 541AU- -gE 14-ZD 3 `, 3 E(aG7 - pFr'®�-�aa c7 uwSn�T><3� SEA Pow IA.-2 & _ IZ' CezTIF�®`` Pcd1J 'MELOPE7 T)V-Cr-ILZ-- LpeoTiow 1 �t.• ►J o GA SG�Lam- 4 LL'o ('' ;. DATA t M 2 9 4 M Riep�s PLAN P-e� RF�JCEr w 1 cGMT-`/ T*tr TI•IE frovNaATlo�d ( :.. G �ow N NE�Eo�N��°�'Pcy�Swib�WN I u, tli TNT rCnac iu. pcAf� ta. d4P 15 Ar'Ira4aTE �1 9.1 ,9G ? 551"L LAUD SUFVEYC95 `TEAK FLA 0 15 140r T01,E) a&l AN (441Vi9AEOr r��i L C-- 1GI►J wts Supvczy AIJD THE OwieTs 41 001.) U M 'us SJ'Erz ILLS MA44 , uSe� To e%ABLKI� ftzoPetzTy la NHS " 1PPLICA WT s .��. P'+_TsaeY