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Home My WebLink About0119 MOCO ROAD - Health 119 MOCO RD. WEST BARNSTABLE A 195 022 TOWN OF BARNSTABLE LOCATION 119 M 0 C.O RA SEWAGE # t�'t�� VILLAGE W, &04:56)4Q_ QQ ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. e D C� � —115'286d SEPTIC TANK CAPACITY CeSs p�� Rep LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNS PERMUDATE: 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 9, / 52-, Ci �poat. . CIO �� TOWN OF BARNSTABLE LOCATION I9 M OCCO RA SEWAGE # VILLAGE RGt►.15t14 F_ ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. c Ca)IrO -1-7 5- 2W) SEPTIC TANK CAPACITY CPS5 ab/ 2ep/�Vice ��e -� e is i LEACHING FACILITY: (type) (size) I NO.OF BEDROOMS BUILDER OR OWNE J,— PERMITDATE: OO 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 y' -Furnished by I . I i 07S No. & L Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zippfication for Mie;ponl 6potem Construction Permit Application for a Permit to Construct( )Repair(4uloopgrade( )Abandon( ) ❑Complete System El Individual Components "Location Address or Lot No. 1 `N\a C O '+CLO cm--Qk Owner's Name,Address and Tel.No. Assessor's Map/Parcel i\ �1 Who C_'S Z cQ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. iN a CG, 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 , Nature of Repairs or Alterations(Answer when applicable) Q5?=o a—c—g, L 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 issue of ealth. Signed AAA— Date 11- i 3 00 Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued No. Fee J THE COMMONWEALTH OF MASSACHUSETTS `Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZIpprication for Migooar *potem Conotruction Permit Application for a Permit to Construct( )Repair(✓)epgrade( )Abandon( ) ❑Complete System ElIndividual Components Location Address or Lot No. I` vhriCO `CLoacQ. Owner's Name,Address and Tel.No. Assessor's Map/Parcel tAl a To-,h i{c,4 & e- _ t1hW^oco CX Installer's Name,Address,and iel7NYDesigner's ame,Address and Tel. o. A3C_C;", C_ 0 N3 3 So .ivy�•� sT' Type o\H5`d Tg- V�.�.vv� 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) Date last inspected: v 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 Board ealth. Signed . Date _ Application Approved by Date Application Disapproved for the following reasons # Permit No. 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 �� at crv.c- o � has been constructed in accordance with e p ovis of nsFoFT1?1e 5 d$te for ispos"a�ystem onstruction (ertmt No. / .-l/) dated Installer Designer The issua ce t�permiFshall not.be construed as a guarantee that the system will function as:designed: C'I Date / Inspector ——————————————————————————————————————— No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS MiOpo5ar *pOtem Con0truction hermit Permission is hereby granted to Construct( )Repair( grade( )Abandon( ) System located at " 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. e= Date: Approved by Ck rA .