HomeMy WebLinkAbout0058 JENNIFER LANE - Health 5 ByPJenri1 fern mane;,i� ��
Hyannis'
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TOWN OF BARNST�9A��,BLE
LOCATION ��, " ` LI�Ul',� SEWAGE #
VILLAGE
ASSESSOR'S MAP& LOT -
INSTALLER'S NAME&PHONE NO. J'/�/���I /ILI / �
SEPTIC TANK CAPACITY < d 0 }
LEACHING FACILITY: (type)� �I0 CAL L. C (size) �� •— ��
NO.OF BEDROOMS `
BUILDER OR OWNER
PERMITDATE: d 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-
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No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIV10101H - TOWN OF BARNSTABLE, MASSACHUSETTS
Tipplica.tion fOr igpO$al 6p$tem Construction Permit
Application for a Permit to Construct( Repair( )Upgrade( )Abandon( ) Complete System ❑Individual Components
Location Address or Lot No. l Owner's Name,Address and Tel.No.
Assessor's Map/Parcel , r-L1�'PAVO
Installer's e,Address,at Tel.No. Design s d Tel._No.
' �I,LE AND ASSOCLATES
42 0ANTERSURY LANE
EAST PALMOUTH,MASSACHUSETTS 02s36
Type of Building: 008/540-2534
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 21!0 gallons per day. Calculated daily flow 2 A 92 gallons.
Plan Date A41d , Number of sheets Revision Date �Q`•�Z
Title j
Size of Septic Tank Type of S.A.S. Ci4sA A ` -TX=V 4
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 C rtifl-
cate of Compliance has been issued by this Board of Heal
Signed Date
Application Approved by Date
Application Disapproved for the following reas
Permit No. Date Issued
.--��-+ jai ;1 � �a _ ✓-ti4yJSw+',++3:^;•-,I�wy -t.� y:K ♦ �:� ..- _r-y'�"�--• ...=;: "'�
s" ,;:✓No:•' U - fj Fee
14
�..., THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
. ..:� !� �' '1� w�'�, , '' Yes
7y EPUBLIC HEALTH-DI-WSIO�1�;-'TOWN-OF BARNSTABLE MASSACHUSETTS `
`µRA w•( ' � � � `yam "' a �-'� ..-'"" � .�
` rication for ie;pogar *Pmem Congtruction Permit
Application for a Permit to Construct( . �Repr( )Upgrade , ti Abandon
�( ) ( ) �omplete System O Individual Components"
Location Address or Lot No. T _ Owner's Name,Address and Tel.No.
Assessor's Map/Parcel
j Installer's Name,Address,and Tel'.No
DesignFs'15 q,•Adgress and Tel,No ASSOCIATES
42 CANTERBURY LANE
EAST FALMOUTH,MASSACHUSETTS 02638
Type of Building: s '"`°
` Dwelling No.of Bedrooms 3_ Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
F`M` �Design Flow l► allons er da Calculate"d dail flow 34, gallons.
�«0 g p Y Y
_ Plan 'Date _ "� Number of sheets -.-Revision Date in
- Title 1 J
Size of Septic Tank Type of S.A.S. G4�4^T%cF-2
Description of Soil _ mg !! >M p - N !!:5 \,k
Nature of Repairs or Alterations(Answer when applicable) t
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 C rtifr-
{
` -cate of Compliance has been issue
this Board of Healt
Signed Date
Application Approved by M211 LE—Date
Application Disapproved for the following reaso61
r: n` Permit No.
� •n 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 I&J, Il,
at C _ ha b construct d in accordance
with the provisions'of Title 5 and the for Disposal System Construction Permit No dated /� 7 0
Installer Designer
'The issuance oft s pe t shall not be construed as a guarantee that the sy tem i Itfu ction as Aesigri�ed.
Date I 1 Inspector J.
No.ion,
Fee
`T_i E-,COMiNIONWEAL—TH-OF,-.%I lSSACHUSETTS _
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
[\�q
Mig onl bpztem Cottgtruction Permit "
Permission is hereby gr ted to Constru t�/ Repair( )U gBrg"�de( ) bandoon( ?/)r ,
System located at �/ - 9 V701��1//
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply withpTitle 5 and the following local provisions or special conditions.
Provided: Construction musy be co pleted within three years of the date of t ' e .
Date:_ Approved by
Jes
Town of Barnstable
Regulatory Services a
• Thomas F.Geffer,Director
• rw� s BEAM �� Public Health Da vision
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-8624644 Fax: 508-790-6304
Installer&Designer Certification Form
l��y-y-dla�- •z.°��� ��-T
Date: 10(t17 0 — i�s2,rLW1, zc90
Designer: STEPHEN J.DO VLE AND ASSOCIATES Installer.
Address: EASTFALMOUTCH9,,MCAASSACHUSETTS 02636 Address:
On o-- =v was issued a permit tomstall a -`
(date) (ins ler)
s septic system at LAVATJ based on a design drawn bye U.
(address)
co
; .
T,
a-
_s 7.rl, SyoG, dated . to -�`-t. (�J� co n
(&signer)
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.
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
c ed as-built by designer to follow.
BRUCE
G.
(III 's S ture) MURPHY
No'
749
`c �EeISTEa`�°
(Designer's Si ) =:(Affix Designers Stamp Here)
PLEASE RETURN TO BARNSTABLE:PUBLIC- AI3DLVISON. .CERTIFICATE
OF COMPLIANCE WILL NOT BE. [SS D:m _ 0 _ [S:F0RM'AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLEPL:IC:=HEALTH DIVISION.
THANK YOU. -
Q:Health/SeptidDesigner Certification Form
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