HomeMy WebLinkAbout0051 SCREECHAM WAY - Health 51 SCREECHMAN WAY, COTUIT
A=022-130
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TOWN OF BARNSTABLE ;
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LOCATION Ly'A-V SEWAGE #.y �
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VILLAGE CCO'tO ft //.4 ASSESSOR'S .MAP & LOT
INSTALLER'S NAME & PHONE NO. <rlyL
f
SEPTIC TANK CAPACITY /c676C) G.9L,
LEACHING FACILITY:(type)� r&H/AlG /i�yc4.(size) q,'j
NO. OF BEDROOMS -� PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED: ��/% Am
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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No. ` Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
3pprication for Zigoear 6petem Construction Vermtt
Application for a Permit to Construct 9qRepair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. i Sr1jZb—=GV A,144 Owner's Name,Address and Tel.No.
5T_Iwkor Hllr tM i q,&W
Assessor's Map/ParcelZ 1I1 ��j 9/� M�`"L--A0 V�
Installer's Name,Address,and Tel.No. Designer's Name,Addres§and Tel.No.
Tb-Y7_ -N,/W t
&YZM,+a atd 4;7
Q-7,b
Type of Building:
Dwelling No.of Bedrooms Lot Size �00 sq.ft. Garbage Grinder
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow S4f:> gallons per day. Calculated daily flow �� gallons.
Plan Date 3 'CI Number of sheets 07— Revisio Date
Title L L L 0 � I —4C9` cwv 1 we aAq
Size of Septic Tank 95�c Type of S.A.S. t>C4v (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 a t t lace t e system itfoperation until a Certifi-
cate of Compliance has been issued by Boaz of a <
Sig .�ned - _ Date
Application Approved Date '" �
Application Disapproved for the following reasons
Permit No. n Date Issued '�
No. 9f Fee /oD
THE COMMONWEALTH IOF,MASSACHUSETTS Enteredincomputer: Yes
!' l PUBLIC HEALTH DIVISION~- TOWN OF BARNSTABLE., MASSACHUSETTS
01pprication for Xkgoml *pztem Construction Permit
Application for a Permit to Construct(Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. ` so j Owner's Name,Address and Tel.No.
Assessor's Map/ParcelZ� �� j` Z0 Q. A W P57ti
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
M ti Type of Building:
Dwelling No.of Bedroomsr� Lot Size <Pa sq.ft. Garbage Grinder
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures •
Design Flow gallons per day.` Calculated daily.flow(:�. gallons.
Plan Date o� ' 3 ' W Number of sheets - /v � Revisio Date
Title C � v I U COT" I,,=�U' U2 S A-em 4 wv I W,
.Size of-Septic Tank Type.of S.A.S. t om, 6 A
Description of Soil
Nature of Repairs or Alterations(Answer when appf'11 able)
~ 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 at} t t pla t e system in—operation until a Certifi-
cate of Compliance has been issued by Boar .o a e (/
Signed , Dat
Application Approved Date ^'
Application Disapproved for the following reasons
Permit No. f Date Issued
---------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CERTIFY th the On-site S wa tm P!:pos 1 System Constructed X Repaired( )Upgraded( )
Aband d( by R L,
at �a "�if 4-!w / V P s been constructed in accor nce
with the provisions of Title 5 and the for Disposal System Construction Permit No. �f dated "
Installer Designer
v �
The issuance of this t s all of'be construed as a guarantee that the sy e will function d�Igned
Date �°� Inspector
No. / r./ �'f --------------------------Fee
THE-COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Miopoza pttem (Construction Permit
Permission is hereby gra d to onstruct( Rep it( )Upgra e )Abandop ',�---
System located atG: `
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 dust be co pleted within three years of the date of this pefmit. _,
Date: /D l Approved by
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TOWN OF BARNSTABLE
LOCATION ' /I (iu 4 SEWAGE #
VILLAGE Ce / rT A4 ASSESSOR'S MAP & LOT ljt
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) ZE,&.-t-i;.tJG %c n'c {,(size) i
I
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER� ti'
BUILDER OR OWNER i rzJr� ' YirU� '
DATE PERMIT ISSUED: q hi 5
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes . No
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