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HomeMy WebLinkAbout0040 ROSEMARY LANE - Health L40semary Lanele — 007 - 021 �II SMEAD No.2-153LOR UPC 12534 smead.com • Made to USA c YCRO firs NO , �nusmNnas�aaxrua OFMSRPWGM WAUSMROGMOP Y TOWN OF BARNSTABLE LOCATION e �{ �'\) � SEWAGE VILLAGE l��kyK�i���( ASSESSOR'S MAP&PARCEL p© 7-1 INSTALLER'S NAME&PHONE NO. 4,re vI iG _SEPTIC TANK CAPACITY U L LEACHING FACILITY:(type) d 96t (size) 7— NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: j C3 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility I1/ 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 Z--,1 l",V / � aci • f 'E_ � � - 7 �•. �� 79. � � " yz "I" TOWN OF BARNSTABLE g 2 F.3 ' ,COCATIONL&7 11- /16 St/V)aA4 tty SEWAGE # A I I VILLAGE� .�, ASSESSOR'S MAP & LOT 1V 7.607 b -/ INSTALLER'S NAME & PHONE NO. ( 1,�,Ii%f6 &CfC "oy&' SEPTIC TANK CAPACITY LEACHING FACILITY:(type) Pit (size) NO. OF BEDROOMS .3 PRIVATE WELL O UBLIC WATER t BUILDER OR OWNER � ,'r ✓ � DATE PERMIT ISSUED: i DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No � 1 �� Z ��u� f � ���r 0� �n�`3 � ` — ; � �� �� t � / r 1` ` ` ./ /� � i � � �. �� �� � � �; , � � � � � � � � . i � 1 �� ;. � . s y� �-� �� i No. ODD o> ' Fee !�� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PAJBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppliLatlon for ;Disposal 6pstetn Construction i3ermit "Application for a Permit to Construct(Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Lo tion We Ad� `ess or Lot No. �-,rm� ' Ayj. Owner's Name,Address, Tel.No. S—� 2 �( �vo ssessor's Map/Parce � Q7-61/ Installer's Name,Ad ress d Te}•.No. Desi er's Name ddress and Tel.No. 7 /9 + �7 Type of Building: Dwelling No.of Bedrooms 2j Lot Size -17 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons S Showers( ) Cafeteria( ) . Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title �411 a a-1 ;f Size of Septic Tank /d Q Type of S.A.S. Description of Soil C> i _l 9 3 2 O7 Z /� 7IZel Nature of Repairs or Alterations(Answer when applicable) -T - -f' d r?,P 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. 7 2 Signed Date I Q Application Approved by GCJ , Date P(o `2G O l Application Disapproved by Date for the following reasons Permit No. ong 0 J S Date Issued 3 1 fo 2a® Fee No - THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes fication fo�J�l r ZiSp08aI *pstellt COltBtrU"ctiDn Permit J fo r or a Permit to Construct( Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components ,.. ; f Y Location Address or Lot No. ,� Owner's Name,Address,an Tel.No. S ? %( ssessor's Map/Parce G v sel Installer's Name'Ad ess d Te.No. Designer's Name,Address,and Tel.No.�,�-o (y 6 7 9 ��<..� mot., 1,�� r-1 A Type of Building: ''� �] Dwelling No.of Bedrooms_ `� Lot Size /7 C" 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 t's., Q ke U G t Size of Septic Tank /6 a Type of S.A.S. Z G. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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:beenssued by this Board of Health. Signed Date a Application Approved by �, , Date No I ZG O 1 Application Disapproved by 4 » Date for the following reasons U Permit No. d J Date Issued J1(o Zaoi THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposa system C nstructed( ) Repaired(�) Upgraded( ) Abandoned( )b �� /� � C ( ' J at 1 C 4 has been constructed in accordance with the provisions of Title 5 and We for Disposal System Construction Permit No.2wq 05_�r dated M A V-G-H It., 2oo.j Installer G r.��i /1�r (C �rJ Designer e #bedrooms 2i Approved design flow �,"� � � gpd i The issuance of this permit shall of bye co'strued as a guarantee that the system will function/(as de zsi ed. Date / Inspector 0?/• , ��! - - -- No. G©�' C�,Sj Fee X�� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS ]Disposal 6pstem Construction j9erntit - Permission is hereby granted to Construct( ) Repair(Y Upgrade( ) Abandon( ) System located at (( 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 be completed within three years of the date of this permit. /" Date ! 4 44 A/ A �;>r9 0 q Approved by Town of Barnstable �pFIHE lam, Regulatory Services Thomas F. Geiler, Director M " AS ' Public Health Division MASS. jDJEn rna�" Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: (J Sewage Permit# ®6 61_�_ Assessor's Map/Parcel 17 60 [�2 Installer& Designer Certification Form Designer: _ , -D 0 Y L c Installer: G.-- a-�r` Address: 7o C����,eFiE�t� /3` Address: ��. X �(� 7 E: Fi 4,00 ark/rIA, dZ936 t 3 On /G� O / �/d'�/ /�//C� �i was issued a permit to install a (dat ) (installer) . septic system at �- (� e I?�s C based on a design drawn by (ad ess) L F ,4 s S O c i 9 ZC-s dated -,I,#N< 7 ZD09 (designer) V/1/I certify that the septic system referenced above was installed substantially 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 system) but in accordance with State & Local Regulations. Plan revision or, certified as-built by designer to follow. Stripout (if required) was i ted and th soil's were found satisfactory. N OF MAC ✓ N ( s 11e s gnature) MEYER No. 1140 �1 0 II �FGISTSPF' �� 1 \ (Designer's Signature) (Affix Designer's e) PLEASE RETURN TO BARNS ABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND 'AS- , BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice forms\designercertification form.doc il OF BARNS fABLE 2009 APR - I PM 2: 40 .11 ION wr .. p F!M PL ono 9 E'G..X/. 74 SEW,rtc E sY5 TEN! 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