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Home My WebLink About0040 NORTH STREET - Health (3) y� N D2T#- S7-rZe��— Q�-c>o 3aq - iq� � � � �'� ., . I No. ��l / O l I ! Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes AUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS I'V -D ZIppYication for Migpozar bpacm Con.5truction permit Ap#lication for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location A ss or Lot�.,j I Owner's care TeAAO ]/I�� Assessor's Map/Parcel l C D J / Installer's NameiAddress,an �2 0� b signer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size 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 Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil c Nature of Repairs or Alterations(Answer when applicable) -0 O D Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenancAf the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmenfal Code and not to place the system in operation until a Certifi- cate of Compliance has been issued 1 thi�do�Health . Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. DcA2 . 3 J 3 . Date Issued ------------------- SONo. " "' Y CC THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: R Yes OUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Z[ppYtratton for lotgooar *Peu n Construction Vermtt Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location; ss o;Lot I�q.;J ��^ O�'s d es�an J Te1t1Go. G �D 11* Assessors Map/Parcel [,) tr Installer's Name,Address,arul Tel. o. _ �1 �r signer's Name,Address and Tel.No. Type of Building: k Dwelling No.of Bedrooms Lot Size 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 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) 0 0 U ✓ 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 d of,Health. / (� r Signed Date Application Approved by Date O y o Application Disapproved for the following reasons 04 Permit No. a—�Li — 3 J3 Date Issued Z THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (fertifirate of Compliance THIS IS TO CERT Y t the On-si /`.,` age D' posal System Constructed ( )Repaired ( )Upgraded ( Li) Abandoned( by �f _ at n as been construc ed`7i accordance with the pr visions�f3Title$and the or Di posal tem Constructio Permit 'o. �1 ��3 3 dated Wa ] t'( Installi Designer The issuanJe of this ermt �1�not be construed as a guarantee that the sys em it r ction a d�sagned�� Date l-'� `� Inspector No. �"�,'' ---------=--------------- �3 /3 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Miepoga[ *pftem Congtr j ion Verratt Permission is hereby ranted to construc (t�'))' 17� p p(- ) g'r�ade(t,� and 4 System located at i 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: Cons ction ust be completed within three years of the dat of this er t Date:_. � Approved by r loci f l,9 LP �w � ir 367-'-V7/:F W4-LI TOWN OF BARNSTABLE LOCATION `3 SEWAGE# � — VILLAGE ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY 1 v erv �� s '��•', tf� LEACHING FACILITY:(type) D w✓V ��t/, (size) NO.OF BEDROOMS `.OWNER 4Z,—V—&4 G � PERMIT DATE: COMPLIANCE DATE: 'd 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) _//a Fee". Edge of Wetland and Leaching Facility(If any wetlands exist within 3,00 feet of leaching facility) ieet FURNISHED BY r ,� � IeXf 367- TOWN OF BA.R�NSTABLE LOCATION L�/✓d h SEWAGE# VILLAGE /7,1,_��r/ei/>✓: ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY j LEACHING FACILITY:(type) 1✓ SJ?W,� (size) NO.OF BEDROOMSi , OWNER ;5741,40,q ��6P✓/9G v PERMIT DATE: 2--v c- COMPLIANCE DATE: �d _ Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility /Y 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) / 4111v 'Feet FURNISHED BY l 4/1 ------- ------- -------