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HomeMy WebLinkAbout22, 22A HANNAH CIRCLE - Health 22122A HANNAH C _ COTUIT - A = 022 134 - -- -- - - - No. Fee lo�� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 21ppYication f�or�Migpont bpztem Construction Permit Application for a Permit to Construct( ")Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. g O,—t wner's Name,Address and Tel.No. Assessor's Map/Parcel � `�- l 3 �4_)Ia Iq kc,41-e :�"C.�t 4CE Installer's Name,Address,and Tel.No. Designer's Name, .ddress and Tel No. C. l� Type of Building: Dwelling No.of Bedrooms �+ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building do No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 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) 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 issued by this Bpapof Healt -.-- Signed Date Application Approved by Date Application Disapproved for th following reasons Permit No. Date Issued ------------------- ----------1�►----- IL '1.'1, $.qE:..t t, r 22 Aopt,0 ;. 54 10c.0ir 4-4o ; 3 N � ../� *.R4t , TOWN OF BARNSTABLE d2� L3 -oaf— LOCATION \` L SEWAGE # VILLAGE ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO.CG-(\. `-l SEPTIC TANK CAPACITY LEACHING FACELITY: (type) NO.OF BEDROOMS_ BUILDER OR OWNER r r � PERMITDATE: 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 f i4'ty ;; U Feet Furnished ✓ % __Iry TOWN OF BARNSTABLE LLCATION Ccit ( )0LACE.SEWAGE # VILLAGE �C7 L, ASSESSOR'S MAP & LOT f' INSTALLER'S NAME PHONE NO. C&eZ P.Z*%7419 'G© SEPTIC TANK CAPACITY LEACHING FACILITYAtype) I—RmCH£s (size) d NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER - /Ul CA: .�-5 1U DATE PERMIT ISSUED: 9 98 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �- BACK 1 c - 33 53 TOWN OF BARNSTABLE m22,l3LL LOCATION '# t-1L- SEWAGE # r `ILLAGE �c7 ASSESSOR'S MAP&LOT*12" �f3'e`er INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ��a LEACHING FACIL=: (type) 1 k �A size) NO.OF BEDROOMS BUILDER OR OWNER a PERMrrDATE: 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 f ili _ Feet Furnished yG+�' Y_ J_ V a0 4610 tea"°•s. / ♦�,' / w!1 , ^� 91 w r No. / r 2.7 Fee ` -- Entered in computer: THE COMMONWEALTH,OF MASSACHUSETTS - - � Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 01pphration for- ioogar *pgtem Cowaruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. "t' p�. ner's Name,Address and Tel.No. Assessor's Map/Parcel """" 13 kck GD4 VC 4V Installer's Name,Ad ress,and Tel.No. /f Designer's Name,/Address and;TeNo. Type of Building: „ {�` Dwelling No.of Bedroomslrll��Zl Lot Size �r r/sq. ft. Garbage Grinder( ) Other Type of Building No of,Perso'as Showers( Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. ' 7 Description of Soil \ t Nature of Repairs or Alterations(Answer when applicable) : Date last inspected: r 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 ofiCompliance has been issued by this B f Healt . Signed Date Application Approved by _Date tf .c1; . Application Disapproved for the following reasons Permit No. Date Issued ---------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed(x+) Repaired ( )Upgraded( ) Abandoned-( )by at 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 1 W Inspector -—— — ——— — f—————— ————————————— No. 9 - a a`� J Fee l� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION,- BARNSTABLES MASSACHUSETTS ligpogar *pgtem Congtructton Vermit Permission is hereby granted to Construct( ,/)Repair( )Upgrade( Abandon( ) System located at 1 'Z 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 E FATil.`{ 3 F3E�aZ�K E PLA ON BAG1C. uEdzEo� .I :;.,I n-1 GA¢t3gl.'� C-.rLIi.1D E•�. •- 7A4LY FLOW - 3 X Ilo - 5Zpnc- TANt s 33o X ToO%s (i(oo U 6AL. W /Z I S� 1500 �act}tuG 5�(sT�.�t �sl�ss . I T�n•'O - 4' . 40's Z ' T2Eucr1ES •� '' ..• � . 4 fit C.ATI ON•, A2FA 2W'A. •' 3 3 o GPD 4 o:-1 4 PD 5F 4 5o 7o a (o(o`1 I I ,cPPuC.�'r�oN atzs�, �F5l61.1 ' i I 511.7,Ey,/ALL. A2E�4= 552 S F 32oSF ITT o," �. = r w=mm m Pum �.�• i��u NTH 1 X. (o�12sF W=ABU YAm44 To MUM IM y, • ►o+r'-$X,4o rA OAAM, �� .� L PE2GoL.&TLN IA-M L S MIWJ/IMC14 310 our�au� - yaw r � i SOIL. Cld I r `, W If rETER I DETAK.LEACi1 FACaIiY I SULLIVAN END SECTION S. I e..�U�e r�,�Tz� -1 ����INL• No. 29/33 N. T. 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