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HomeMy WebLinkAbout0155 GREAT MARSH ROAD - Health (2) C ,. 1 NoQr) r ra—v" q, Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplitation for 33isposal *pstrm ConstrurtiDii permit Application for a Permit to Construct( ) Repair(Y) Upgrade( ) Abandon( ) ❑Complete System ®Individual Components Location Address or Lot No. 155 CSC"k MA(Sh Kd Owner's Name,Address,and Tel.No. (ZjenoxCk C,orde(�o Assessor's Map/Parcel 0113S Installer's Name,Address,and Tel.No. 6�$b �(,Xw.vo�{;a� cx. Designer's Name,Address,and Tel.No. '�-+4 kAe• 030 Sound u Gh S o 471 o(�S 1.1 A 0-box o c� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building r No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd 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) kPAa(f0Ur} of d"bOK In 5a'r L, 10(,0,At0r\ I)r� 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 Certificate of Compliance has been issued by this Board of Health. Signed Date 111412t Application Approved by KLA44U414 Date Application Disapproved by Date for the following reasons Permit No. C Date Issued 324 `3- . ------- ---------- /--- - NoQ c) r �— 1 x ^b Fee i THE COMMONWEALTH DF`MASSACHUSETTS Entered in computer:� ��:+... Yes PUBLIC HEALTH DIVISION - TOWN OF'BARNSTABLE, MASSACHUSETTS application for Mispo8al *Ps-fen Construction Permit it Application for a Permit to Construct( ) Repair(„V) Upgrade( ) Abandon( ) ❑Complete System ©Individual Components Location Address or Lot No. mr c;:k (16 Owner's Name,Address,and Tel.No. bz t f�tac G C f C� Assessor's Map/Parcel Installer's Name,Address,and Tel.No. ly!�j x C a v6. .� ��c. Designer's Name,Address,and Tel.No. ,,J-,. J�' SC\hd Type of Building: Dwelling No.of Bedrooms 0 A Lot`Size sq.ft. Garbage Grinder( ) v e Other Type of Building N4Y`of Persons Showers( ) Cafeteria( ) Other Fixtures l Design Flow(min.required) gpd ''Design flow provided_ gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Typp of S.A.S. Description of Soil �i Nature of Repairs or Alterations(Answer when applicable) t;1' ro`a,,(* ol C o G( C�-�� <<\ `gin rYl C In((41 G{\ 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 Certificate of Compliance has been issued by this Board of Health. Signed ' Date )�. Application Approved by �"n�*q/,�,,,�,,,�� � Date �44 A ha Application Disapproved by 1 s Date ! o for the following reasons Permit No. � Date Issued 3 _QI l X'. THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate Of Compliance THIS IS TOCEIVIFY,that the On-site Sewage Disposal-system Constructed( ) Repaired Upgraded { ( ) Abandoned( )by -) L C co,_,C,�%o at \S`. (9k t a 1- 1,C\( S4. 9-�,06 ck has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.C," Q de ed Installer q�, t Ct')c,l Designer 4 �j A - Ct-boy i #bedrooms Approved design flow K 1./A.- gpd The issuance of this permit shall not be construed as a guarantee that the system will function assdesigned. Date "a r/ r -0 Inspector No. Fee 75, .�. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal .pstem Construction permit Permission is hereby granted to Construct( ) Repair(}C) Upgrade( ) Abandon( ) System located at \S c �;C e o k M c,c`_,t, lr\o c ¢�i� ,-f— t and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 (V-►�il jii 1��, f itJ f�(„_ / 3/29/22,8:51 AM ShowAsbuilt(1653x2338) Zfd TOWN OFBARNSTABLE F LOCATION'L S 6.9P41'-M ✓IIPSh RX SEWAGE VILLAGE, C'PA/7PC•V/11-e ASSESSOR'S MAP-&6OT ! INSTALLER'S NAME&PHONE NO. J•1' AI A'C-d,4 9f A+ 5 B*1 SEPTIC TAME.CAPACITY/•B od-fi P.,7 nb LEACHING FACILITY:`(type)x-AZOW CIIAMseR 15(size)., NO:OF BEDROOMS _3 B&X9MK OR OWNER PERMITDATE:.�"`.��a-'�f�d'�3 COMPLIANCE.DATE:'Ei ��I'��LS Separation Distanceletween the: Maximum Adjusted'GroundwaterTable to the Bottom of Leaching Facility Feet Private:Water Supply Well-and Leaching Facility (If-my weW:exist on site or within;200 feet of leaching facility): . Feet Edge'of Wetland and Leaching Facility(If any=wetlands ex{st 3ithin300 feet of leadhi facili ). -- Feel Furnished by l i i r ` . `tK .0. 1 _ 0 https://itsgldb.town.barnstable.ma.us:8431/Home/ShowAsbuilt?mp=210129002&sq=1 1/1