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HomeMy WebLinkAbout0020 JOBY'S LANE - Health A=120.089 e { 5 4 l rt { k TOWN OF BARNSTABLE LOCATION �O �b���/-S L n SEWAGE # VIL -:V ASSESSOR'S MAP & LOT --®g INSTAI:LER'S NAME&PHONE NO. _ p.G o `7 —3 E55e' SEPTIC TANK CAPACITY I LO ci eL LEACHING FACILITY (type) SG cc 11:In,4or Uo%% , (size) 13 0( 25 NO';;OF BEDROOMS BUJLDER OR OWNER '?3rVAr, 1-1, -kS _. PERMTTDATE -COMPLIANCE DATE: 'Sepat-atiop 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 e_zist within-300 feet.of.leaching facility) Feet ' Ftirnished by I �3 3 1 4 Ote OS 5 4 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS u 01ppfication for �Digogaf *r6tem Con6tructfon permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. A0 ly rs G 6. er's Name,Address and Tel.No. \ yid-),g53 Assessor's Map/Parcel' t� C00%fSA U 2 0S-3TPU`A(< Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. +� )3 ft H7 cz a u\J c y 7-8 C Sr_Roc\lc, AA. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building b4jtttLi 0% No.of Persons oZ Showers( ) Cafeteria( ) Other Fixtures 11 Design Flow 39 gallons per day. Calculated daily flow 13,S6 gallons. Plan Date t-I `0,1t Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. S CJAi+V.% Q.aiCt-N'S`1� 330 Description of Soil bg 1,w n srwl� C&eWX_k� / &% 1-4 SAoJ1L O'l 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 thi and of alth. Signed Date Application Approved by Date -- "� Application Disapproved for the following reasons Permit No. l' Date Issued �— µ. r` Fee � THE COMMONWEALTH OF MASSACHUSETTS ' !Entered in computer: t Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for X3igpoga1 *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Ao ' �� ( {�. �� ; �'O� ner's Name,Address and Tel No C�9S y a U-"7 g 5 3 6 e;wo a K211�c� Assessor's Map/Parcel 1^ ln�� S� L'(�V�(�„1 �1 R Q�j'�P t� r1 OZLSS Insta ler's Name,Address,and Tel.No. '� _.,y1 Desi ner's Name,Address and Tel.No. ►��co CO(Z P , )_ M hvQ a U4 C_ y Z-B OS%rRj�\lc rvA. Type of Building: Dwelling No.of Bedrooms Lot Size i sq. ft. Garbage Grinder( ) Other Type of Building w_ tt� No. of Persons c;l- Showers( ) Cafeteria( ) Other Fixtures Design Flow 5� gallons per day. Calculated daily flow 33c� gallons. Plan Date L� Number of sheets . Revision Date Title Size of Septic Tank Type of S.A.S. Sul 'fef� Q,�e t+l\�t v-R, 33U Description of Soil �C i U R S nA)/� C&At1 y n y %-Ac,J IL p(Z Ui J f i 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 and of alth. Signed Date ` Application Approved by _ Date " Application-Disapproved-for,.the.-following-reasons Permit No. If Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by 1, "VCU COQ at *ay M d\�S t ('�J it ©5_'_V Q J t klC r1N• 02(.1S has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.9 dated ,�,�✓;�i�'�9 Installer Designer The issuance of this permit hall gnot be construed as a guarantee that the system will function as designed. Date 1 Inspector _ ____`_ r e THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migogaf 6Pgtem Congtruction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System`located at � �, Lf",Q r OSIKV R k Z \r)A-C)Z(o3 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 I� =---` �wEET ► �� Z .51 w4r.,LE FAti %l f 3 6IDRZK zr--E pLA" 01.1 BAGk uMMEOF Rio GA93A4z Z 4'7 PG• 13 7.PAIL-y Ftnw = 3 x 110 ='33oGPp LoT ZO P� sync TANr .330 X2oox=66o&D U�F l e,00 6-AL- d"PvC PIPiG iysE 3 CULTS,-- z 330 ieesi4 5�u� T>IST. ,&ppU GAT1oN A2F6A 260 V. 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BAD- >< NyE 1 NZ LA1JD SUeVI�Yt>zS • �ta1 A6E� 19/q g � ;.- v5'r�ev1LL.G MASS• owner, Nor D& AM04ANT: Pout_i tkor A5 6uiLDvQ- UStD Tb 6S'17l�US►� PROpE�T�J L►064. 3 SNIT Z t � — 20 LoT Zo 4'7, 2t, -� ` 16JZ73 5.F t l 6'+- - \ T LOT I `3Z ' � ►u I T�sr - Z � � 38�t i ZS�f i 16' I I ' �-- 12; Mw• �) � IEACN 3o I X h �I ( SoTE M 12, ►�N. 30I ' oo 4ts ` STEPHEN R ' ti TOWN OF BARNSTABLE LOCATION ��-�g�S L rx. SEWAGE # '3 VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. `'7n CQ y?�-30�56 r. SEPTIC TANK CAPACITY I7 06 ci..AC. LEACHING FACILITY' (type) Y6kD k 6yA (size) _13 K 7-5 NO.OF BEDROOMS BUILDER OR OWNER 1 RrQArn 4:C ICS PERIvMTTDATE: 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 r 1 V t 3 3 bd � 4 14 3o it 40) 3\ 3L