HomeMy WebLinkAbout0050 JONES ROAD - Health C---30 aONLS ROAU,T NA S70NS lILLS
046-054
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TOWN OF BARNSTABLE
LOCATION .-U SEWAGE # —S�
VILLAGE_ ASSESSOR'S MAP&LOT -�/ Q5 l
INSTALLER'S NAME&PHONE NO. "� . 7 g—.aa' .
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type-)- � (size)
NO.OF BEDROOMS J
BUILDER OR OWNER17
PERMIT DATE: ^-9"2 3— 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) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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�. 17
ASSESSOASMAPNO,
No. PARCEL NO: — Fee
THE COMMONWEALTH OF IWASSACHUSETTS
PUBLIC HEALTH DIVISION — TOWN OF BARNSTABLE., MASSACHUSETTS
0(ppIfcation for �Digooat *pgtem Com5tructton 3permit
Application is hereby made for a Permit to Construct( )or Repair( an On-site Sewage Disposal System at:
Location Address or Lot No. Owner Address an Tel No.
Installer s Name,Address,a#Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms _ Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Description of Soil
Nature,of Re a'rs or Alterations(Answer when applicable) /� �
� ,L- �4
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 this Board of He lth.
Signed Date o2-a-S-9(p
Application Approved by
Application Disapproved for the following reasons
Permit No.2 495 Date Issued 7
—————————————————————————————— ----- - --- J
j��(
No. S Fee ` '"
THE COMMONWEALTH OF MASSACHUSETTS
i
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLEs MASSACHUSETTS
2pprication for Migaal *p.5tem Con!5tructton Permit
Application is hereby made for a Permit to Construct( )or Repair( an On-site Sewage Disposal System at:
Location Address or Lot No. OwneS�Ives an Tel.No. y
�(JJ G U S 7
Installers Name,Address,qid Tel.No. Designer's Name,Address and Tel.No.
:y
Type of Building:
Dwelling No.of Bedrooms Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Description of Soil -
.r'
Nature of Re airs or Alterations(Answer when applicable)� iti� :�P.P
�4- 0!1- - ��0 'e'er
Date last inspected: - `1
Agreement: 1t t
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 no, place the system in operation until a Certifi-
cate of Compliance has been issued by this Board of Health. i
l
Signed 00, 1 s Date,2- 2 3— S(v
Application Approved by -,
Application Disapproved for the following reasons
Permit No. 4-V � fir, Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS
Certificate of Compliance
THIS IS TO CE TIFY,that the On-site Sewage Disposal System instal d,�a-)or repaired/re laced on
by .� .n for
as has been constructed in accordance,
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Use of this system is conditioned on compliance with the provisions set forth below:
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS
x0i.5poga r *pgtem Con6truction Permit
Permission is hereby granted to
to construct( )repair(t-<an On-site Sewage System located at P740iP1 .
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: r-2 (i Approved b
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