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HomeMy WebLinkAbout0401 SHOOTFLYING HILL RD - Health (4) 1 ` o 0_5 -- f 1 No. �C Fee/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitation for Mispo$al *pstrm ConstrUttion Permit Applicaticn for a Permit to Construct Repair IV Upgrade( ) Abandon( ) ❑Complete System C/ndividual Components Location Address or Lot No. ({a( S DOf ,c��f11�(J� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel _ )!j �GBew;sLo SkQ Installer's Name,Address;and el.No. Designer's Name,Address,and Tel.No. Type of Buildin : 3 p f Dwelling No.of Bedrooms s Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 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 45-0 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Q 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 Enviro ental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar of Hea . r SignAd IF Date Application Approved by wv Date LT2 4i,a Application Disapproved by Date for the following reasons Permit No. a Date Issued —(p —. 2 e , 09 No. . U G7 � / Fee' ,/ 00, `-- r '"` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes` PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Ln Zipplication for Zisposal 6pstem Construction Permit _ Application for a Permit to Construct Repair IV Upgrade( ) Abandon( ) ❑Complete System U Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel )(4 / 0� r 0 A�41�n _ _ LTI Installer's Name,Address,and ffel.No. Designer's Name,Address,and Tel.No. Type of Building y Dwelling No.of Bedrooms 0 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) •' Other Fixtures Design Flow(min.required) ` gpd Design flow provided gpd Plan Date 0 9 Number of sheets Revision Date Title ' Size of Septic Tank Type of S.A.S. Description of Soil 1 Nature of Repairs or Alterations(Answer when applicable) / /,r�Tp ',o/2 6:_ 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 Bo of Health. .`r Signed_. - e _ § Applin,Approedby %v _ i - Date Application Disapproved by Date for the following reasons ' r Permit No. Q 7? d Date Issued .2 2 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS t (Certificate of Compliance THIS IS TO CERTTIIFY,that the On-site Sewage Disposal system Constructed(V) Repaired' 1) Upgraded ) Abandoned( )by has been constructed in accordance v -Y with the provisions of Title 5 and the for Disposal System Construction Permit No. 1)0,2;� 'If 0,tdated b/—r w ) �^ Installer //�[.(4t;, Designer Y rr - #bedrooms I- Approved design flow gpd Y The issuance of this permit shal'not tb.construed as a guarantee that the system will1inction as designed. Date t�� Inspector No. U J - 0 Fee f THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal 6 stem Construction Permit Permission is hereby granted to Construct ) Repair r(.V) Upgrade( )' Abandon( ) System located at: and as described in th e e above'A Application for Disposal System Construction Permit. The li e a cant'reco nized his/her du to comply w pP P Y PP g ty P Y rth 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 1 j a�-.. _- , .� � Approved by TOWNS OF BARNS TABLE LOCATION (Jd C - L6 SEWAGE# VILLAGE e-ry i� U1 . ASSESSOR'S &PARCEL r/ INSTALLER'S NAME&PHONE NO. �O SEPTIC TANK CAPACITY 1 � fit\'E'► l Yl `C LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER PERMIT DATE: 7 ��" �, 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 L, �`L WZ616P h,nw �->�� r