HomeMy WebLinkAbout2261B MAIN ST./RTE 6A(BARN.) - Health 2261 B_.Main Street/Rte 6A (Barn)
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TOWN OF BARNSTABLE
LOCATION SEWAGE# Q005` Tfig'
VILLAGE ASSESSOR'S MAP&PARCEL,�), `brl 0310 M)
INSTALLERS NAME&PHONE NO. ?KM �n�Sl� fS �r�� ��•5��3
__. .SEP_TTC.TA.NK_CAPACITY U300- ` 0,44n
LEACHING FACILITY:(type) ��c t ��of.S (size) J J`x 30`A a%"
NO.OF BEDROOMS I
OWNER i
PERMIT DATE: COMPLIANCE DATE: fnw lift
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
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No. / r Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ZIpprication for ;Di.5pooar *pgtem Cougtruction Vertu
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components
Location Address or Lot No. ,2-2 6113Gl.Gh Owner's Name,Address and Tel.No.
Assessor's Map/Parcel Pa4e, J V—a ai�^"
Installer's Name,Address,and Tel.No. SO?- 3l0.3-30®S Designer's Name,Address and Tel.No.
P'Xi"440
Zyt
Type of Building:
Dwelling No.of Bedrooms aZ 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 '3.FD gallons.
Plan Date ��'1•� Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Re airs or Alterations(Answer when applicable) Sb
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 iss Ldby thi oqd of alth.
Signed. Date
Application Approved b Datew— s "g�
Application Disapproved or the following reasons
Permit No. �" $ Date Issued —
TOWN OF BARNSTABLE
LOCATION 0a, SEWAGE # Z- O (�
VII.LAGE_ — ASSESSOR'S MAP& LOT
:INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type)_ r
(size) 6 Q
NO.OF BEDROOMS
BUILDER O<WNERe on
PERMTTDATE�: "1- -9 5�J 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)
Furnished by Feet
V
41
a CCC '
C
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IV
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2.
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9 _
No. ` 7~ Fee �Ga
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. j
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS
Zipprication for 30igpoe a[ *proem Con.5truction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System 1:1 Individual Components
Location Address or Lot No. a 6� L7.Gh Owner's Name,Address and Tel.No.
Assessor's Map/Parcel
F
` Installer's Name,Address,and Tel.No. so,?- 36 '300 S Designer's Name,Address and Tel.No.
Type of Building:
Dwelling ' No.of Bedrooms_ 2 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 �✓ �p gallons.
Plan Date /1/11+'y Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Re airs or Alterations(Answer when applicable)
S
Date last inspected:"
i
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 iss d by this Board of alth.
Signed Date _
` Application Approved b Date,:?—
Application Disapproved for the following reasons
Permit No. Date Issued — —
- ———————————— ———————————— —————————
�' THE'COMMONWEALTH OF MASSACHUSETTS
E BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( 'Repaired( )Upgraded( )
Abandoned( )by
at f-�I has been constructed in accordance
with the prov' io.s o itl45and the for •sposal System Construction Permit No 6 dated �Installer `z� Designer
The issu a of this perml not be con qued as a guarantee that the sys m will function as designed.
Date — 7 Inspector
No. 9 ---------------------------Fee
i THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
r Xiopogal *pgtem Construction Permit
Permission is hereby granted to Construct Repair( )U grade( )Abandon( )
System located at Z? 261/
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.
i
Provided: Construction must be completed within three years of,the date of t ' ermit.
Date: �'' ���' �,� Approved b �
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