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HomeMy WebLinkAbout0061 BAY LANE - Health S M EAD KEEPING YOU ORGANIZED No. 12534 2-153L©R SUSTAINABLE INI�IVE UCQ K NT SENT 109DL Certified Fiber Sourcing POSi�DNSUb1ER® www.,4fQgnmorp 1"12W WIDE IN USA ORGANWI AT SMEADJ= No. c -l` / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppliCation for 0spo8al 6pstrm Construction i3ermit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (1/` (r�! Owner's Name,Address,and Tel.No. C.e���esu�l le . Assessor's Map/Parcel CMG Installer's Name,Address,and Tel.No. Designers Name,,Address,and Tel.No. .tk 1&D',Zf1a t -7f t ' 11�et5 \ Type of Building: Dwelling No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) tjy(�j gpd Design flow provided gpd Plan Date . Number of sheets Revision Date Title Size of Septic Tank EX 1,5h*'U5 Type of S.A.S. 3 SW JJ(y,k�W Description of Soil Nature of Repairs or Alterations(Answer when applicable) '� C c, ,3 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. Si Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. �� Date Issued U r. 'No. �kF " Fee / ry = s THE OMMMONWEALTH.OF MASSACHUSETTS Entered. computer: Yes - — PUBLIC HEALTH - TOWN OF BARNSTABLE, MASSACHUSETTS , RoUration for Nsposaf:6pstem Construction Permit Application for a Permit to Construct-( ) Repair(6,<Upgrade( .S Abandon( ) _❑Complete System ❑Individual Components : i Location Address or Lot No.C�l�/ (,"1 !Owner's Name,Address,and Tel.No. a d Cr Assessor's Map/Parcel ( LG LO Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 1�. 1 A (ow� o - Type of Building: Dwelling No.of Bedrooms t.� Lot Size sq.ft. Garbage Grinder( ) Other Type of Building �(( abe► s f t No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) !j u gpd Design flow provided L' S gpd Plan Date Ll }�1 Number of sheets ` Revision Date y' Title Size of Septic Tank E ,-6� ,_ Type of S.A.S. IIG P,C Description of Soil Nature of Repairs or Alterations(Answer when-applicable) ' > > C 1(�� s . ���.nn�(��t 1✓� N � 51-vnt�o 4��6,�,� � l 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 lace the system in operation until a Certificate of P P Y P Compliance has been issued by this Board of Health. Signed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. =T� Date Issued o ------------------------------------------------ --------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certifirate of Complianre THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( V� Upgraded( ) Abandoned( )by at u, ,3 CPAZIW(wflip has been constructed in accordance with the provi ions of Title 5 and the for Disposal System Construction Permit No. dated �/ ek Installer (� ,j gin,,��� _SC Designer �Zc,o,r) #bedrooms L.\ Approved design flow L4 y O gpd The issuance of this pe it shall not be construe'.d as a guarantee that the system will ft c con as designe8. Date Ll }� Inspector,.¢ J ------------------------------------------------`--------------------------------------------------------------------------------------- No.y �l [35- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTWDIVISION-BARNSTABLE,MASSACHUSETTS �I8�108a� �pste �DnstrULtion �Prltt°[t Permission is hereby granted to Construct( )j Repair( Upgrade( ) Aband n( ') System located at t Ij P 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 nbe completed within three years of the date of this p rme i. Date 7�v�a�Lc Approvey s Town of Barnstable THE to Regulatory Services Thomas F.Geiler, Director BAMSTABLE. ` Public Health Division '�sbw,mrA Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: r Sewage Permit# -1CJ9L( Assessor's Map/Parcel "L, - - Installer&Designer Certification Form Designer: <� / � � Installer: . 61OWI� TAt _ Address: ! t l C '�� "/ Address: "�D.Q,�OK JL S' On qJnh-i- 0_4 'A f tv�r4"T� was issued a permit to install a (date) (installer) septic system at C i �Rc V L_„ ��� )s\-(,p based on a design drawn by (address) datedgh �� (designer) � I certify that the septic system referenced above was installed substantial) according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found.satisfactory. I certify that the- septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic systetn).but in accordance with State & Local u- '�tions. Plan revision or certified as-built by.designer to follow. Stripout (if rP acted and the soils were found satisfactory. N OF 4f d DAVID r t nstal er's ignitor __. M I `t - ., C il: TOWN OF BARNSTABLE LOCATION N . SEWAGE# 138 VILLAGE Cc,,J1 er,�1 .` e ASSESSOR'S MAP&PARCEL G 7y INSTALLER'S NAME&PHONE NO. _D,�A, j�t-oA cy SEPTIC TANK CAPACITY 1:x�5 F rN LEACHING FACILITY:(type) -:5W alik Cr'l T (size) NO.OF BEDROOMS OWNER- PERMIT DATE: COMPLIANCE DATE: 42 ' ll Separation Distance Between the: !VCR/�C�yCw/V�Pv'�V Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility CG2T IF'L(C- 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 I '10'y-�f 3`'` - z- 3y/ -3316 �� ,. _ ..x..�.^.u--�-r-..,,rr-+:-c-as.. - .. _.a "..q 7 -',-e x.•..--se:-"'fit.-.. ,.,p _... -.;.a,:v-•,-, .,.wr .:>,..xom:»...x.o•a•.+ ,wMw•...u-sal�Y!Aww:.VnNY+.� ;S:.dR'•.�;•-� ... _...,_..._,-w..:'_,I'--".::,+-ra,��3,'tX'9•xe!t1'"-ems.••: •_y.•. -.-,r y,�;���..,.. ..-a,JM..r.,e.Wt�.,.>r-•i,.y,,y,.a,�, ,.... -r; rSW.•`d�,AC -..,w,...,s,•... y +,x-- `o?•- -r..w,.�z_ ._...t—.�,r+s-.u.....k..+..-.b.,x.1'.i.n r �+•-_- -.r -.- .+----_- +..a .. ,r. ` r � ...`l �i+--•�� �` / �-,r-� � i' t rev' e �� '.:..` a a- �; R ice..`,.•.! � � c � � �� � _ inSta, �,ix, 1 .. ,.�l;. .. 4,iroftrr frtal .,, f=, �.. or _ :a= i , -•..�,P � ..I � -s yF�l?ti CQ'I"lI :, � f tr .�� Ut f��?:. ;!, ,, t:ie(�TOi,+V?l?r?�iZtl��L, 1. � ��t3' �'L 'e�,.� � (// l�! ' / .../'"�,..�„� � �� t:*►"r" .«. -_.. 7L, i.SVS Y4 II ty 1 . 1 t ` .?�We7 ippraval:intl ,mil,from the a4pf)i3_•P_ .. ovti! t: r ;r :ify r lve5, st�i.'ar iilt._ { � !"i'•-�"' in t II-i, n, F icc, i,- I �.•+ �r /(lam}y/� ,fj •/,,'/�J�/j to s a u •ia '- y e �t' L �„ ...,.. ) } ._. .�.... _ _ k - extstsrl,�r' septi::-Ui , $t3,1t7`clC.1!%', [ Ax VOL) OV Pal a`' '" ' -i' :. fi;$! feLa i 0.�` c:(:'I'•-�, � k ravit, sewte, i ie;,:�;�i` �e �s� ,•. edule� � = t':r`di5tr117iltiOtl box 5�1^;Ii ii' 1}drG,l, r 1, .-.:ping connections"o i � ` t "fiC �. i - —- •1�/►{ L G�.._.. . _ `, !ttl5 SF'.ptli:JPSI r1 furl? for property _;r for any other 119 d e4rr, o::er tf �. r G �� ':-`-king shall be tz:t)ttit. L3�i' _ 7a •s: _ -- - /, ' existing eac 1 ?3 .e. , ..d and - i..3 i.,F l� ` r F f R '• /„ - }, `/ ;-....' ( � St.l fink i t fl`,a7 �f .t :!I rs T4t- "r� �ii•.. >7 ,. ', 1L'Y•�f r u ► - >ti 1 A/W. V ndonment oroced i, i xul)3i1 �!r.d cesspoo!f Sl and ,rri$hil? the ,. P>Dposed SAS<t'ill be r E,.'i3C2r� sAfltti,_;far' Sa!! #?t 1#'_ iirai!C;n i. e+�! m11 Q E' - , .. v fei sevvire- title. e f,. ti -1: urea#F'4' I'.itN_ :fi•. -� .tic�t;t p � r t{3f•._ t 'a: t t+�e. :ie. e / i 7 sleeved a.ith an ap e:. ; :i : :-f,edule 40 PVC with qr;d4 xr cuter,, The water servlr.-�L cr.l,t ?irw I;the 51et''`!F' CIO ! '0449 t rarbac"e rri,ider px.:,. :, _ e it is to b(--: re mot: . :stem is riot lv� f (]t r �• ,.- FZ ,art r -;.;t �x,� 1:1.�E<3fl!'i i�f>-ir'•Lr ,._ + l"i 2T`r3s•r3r32.( c;, ii.�. y 3` / ... .-✓�`(dr,/ s �.x..,.-..-. 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