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Home My WebLink About0020 LANTERN LANE - Health 20 Lantern Lane EWE R Hyannis A = 307-201 e d 6 e k l 0 Town of Barnstable P01014 Health spector oFt t Office Hours P� o Regulatory Services 8:30—9:30 Thomas F. Geiler,Director._ 1:00—2:00 BAMSrAWZ 9� MAS& Public Health Division �fnMp'ta Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644' Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT=SEPTIC QUESTIONNAIRE 1. General Information: Size of Property: Address: 101,1 Map(.Parcel O� Name: �/�/C' �� (�/L Phone #: D _ Q 2a. How many bedrooms exist at your property now? 2b. Are you planning to add.any bedrooms?_ If yes,how many? 2c. How many bedrooms total are proposed at this property(including the amnesty unit)? 2d. Please include a copy of the floor plans for the,entire property- showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please label . each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or NO If tlerdwelling=isyconnected to4pnblic�sewer,skip qucstions#4 e ough#9below5 4. Location of dwelling is INSIDE or 0 E a Zone of Co ion to public supply wells? 5. Is the dwelling connected to an ' ONSITE WELL or to UBLIC WATER? 6. Is a disposal works construction permit on file? YES or NO 6a. If yes,how many bedrooms were approved according to this permit? Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? YES or NO- 8. Is there an engineered septic system plan on file at the Health Division? YES or NO 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO ------------------------------------------------------------------------------------------------------- - OFOR OFFICE USE ONLY � ,.�---_7.�1 The Public Health Division has no objection to bedrooms at this property. Special Conditions: Signed: fl2 Date: 40 ,r O;/health/wpfRes/amnestyapp i pA 1 I REV WAIL SPACE KNEE WALL SPAU SECOND FL06P, CM 0 bW Room KOM oo STUDIO Mimi { STEP 44�'��4`dp �NING RMR&A a F1P.ST Ftr P, IcKean, Thomas From: McKean, Thomas Sent: Friday, April 15, 2005 12:01 PM To: Dillen, Elizabeth Subject: Septic Questionnaires/New Amnesty Applications 20 Lantern Lane/Applicant-Eric Hubler This application is approved. The dwelling is connected to public sewer. 55 Blueberry Hill Road/Applicant-Faythe Collins-Azevedo This application is disapproved. The dwelling is limited to 5 bedrooms per the 1999 permit#99-501. Six bedrooms would violate 310 CMR 15.214, State Environmental Code, Title 5. 96 Camp O echee Road/Applicant-Joshua Leonard We do not have any septic system records on file for this address. Please require the applicant to hire a certified septic inspector to fill-out a 16 page septic system inspection report. �v LOCATION SEWAGE PERMIT NO. VILLAGE 1-N3T-AtL-ER'S NAME �gi A D D R E Smay R F G+��v'/ v ,95 ��'o�v1.�� y�Tri I d U 1 L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED t .s k{ j �o '^ v ' � O M s� '0 s o � � ro 4 113), No................_........ < Fim...........s................ THE COMMONWEALTH OF MASSACHUSETTS t--'v'. , BOAR® Off` HEALTHY-` ..... .........................O F......................................--------------------..........__..._..:_........... App iration for Uiipnsal Workii (foustrurfinrt Vamit Application is hereby made for a Permit to Construct ( ) or Repair (. ) an Individual Sewage Disposal System at: ........ ®...... ... ?vv.... ....... `....... ] Y1:1 ---------------------------------•--------•------•.....-----•----- ` Ica - ddress or Lot No. \..11 e �nn:1.Y.CdS.a..... - Y4[� .......... ��`�,/ Owner 77 Address Gt --------------------- Installer Address UType of Building Size Lot............................Sq. feet ., Dwelling—No. of Bedrooms.................................Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------------------------•-•- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trenc N0. .....I.............. Width..Q... ...... Total Length......... Total leaching area-_-_HC1_.e ft Se Pi No--------- ---'?a---- Depth below inlet.......--........... Total leaching area..................sq. ft. Z Other Distribution box Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_-________-___---_-_-- 1� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ............................................................................................................................................................. 0 Description of Soil.................................................................... .-----------------------------------------------------------------------------...-•-----•-•-•. x U -•-•--•-•••-••••-•••---••••----•••-•-----•---•-•-•--•-•-•-••-••--••---•--•------•-•--•---....-••------•---•--------•••-•----•••••-------•-••-----•-•-•---•---•--••-•----------------•---•-•-•.......... w --------------------------------------------------............................................................................................------• ............................................. U Nature of Repairs or Alterations—Answer when applicable.--___AQ(G_ � r i..t7_: w_.�� :e�l.c_�reU".... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal,System in accordance with the provisions of TH TILE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Complianc een is y he boa lth Signed ................... .. _..... --•• -------•- ................ �.�...�. Date �•� Application Approved BY --------------•--••-------•- N •-----------•-----------........-- --..._._ _ �1__. - --------- Date Application Disapproved for the following reasons J:................................... Date PermitNo....................................................... Issued..................=...........................c._------ Date i No.----..'. .......:... FEs........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH-- -------- --------- -----------------OF...................................... . Appliration for 13ispas al Works Tonstratr#ion nuti# Application is hereby made for a Permit to Construct .( ) or Repair ( ) an Individual Sewage Disposal System at: - �L7ocation�-(Address or Lot No. ......................tnvl:f 5... Z Gl.�'v�x.� ................... ......................•-�----•---•---......................---•--..............•...---•••------ Owner Address a......................... ---•--.. Installer Address Type of Building --^- Size Lot............................Sq. feet Dwelling—No. of Bedrooms......-��...............................Expansion Attic ( ) Garbage Grinder ( ) WOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures ......-•-----------------------•---------------••--------•-------••-••------••-•••-------••-•--••-•-••-•-----•----......... W Design Flow............................................gallons per person per day. Total daily flow._._...-:....-------------- .................gallons. WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trent,No.. .....It.............. Width:Q. .......... Total Length. ........ Total leaching area.' t40.._�:-ft � , �C SeQVgf—PP4 No.. iat ter .... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ---•-•---•-•••••••--••••-•••-•-•-•...-•---•----•--•----•-•••-•-•••..................•-•-••-••-_...•.......................................................... 0 Description of Soil......................................................................................................................................................................... U W U Nature of Repairs or Alterations—Answer when applicable___.. ___' '_ -:_.__ ?_.. �" .. .............. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T IT LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Complianas` eb en is"sid-W/the bo d of lea the Signed---... `�-�'°!_�" `....;, ..... .�...� ._._..._ Date Application Approved By-••------••-----••-•---•......•-_ -.._.. ....../I-- / _ ........................ Date Application Disapproved for the following reasons--------------------------------------------------•---------------•--------------•-------•---•--•--•--......-•--- .............................•---•---....----------------------............-----...------......----------•-•-------------------------------••----•--•-•--------••---••-•-••••-•--...---•••••-------•---- Date PermitNo.................................................... _ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH( ..............OF.-e.. !^.!!`!.,`Prt. `... Qla ifiratp of ToutpliFanrr THIS IS To CERTIFY, That_th nd'vidual Sewage Disposal System constructed ( ) or Repaired ( ) by----- ?-CC r --.—-,--- - ` .....................................................................................•............ �[�, Installer at...... ` t�~p. .> %� " �'.�.... t C: ...._..--•------.----------------------••------------------------------...._._.. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No-----C. el,I.L.......... dated-......... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................•--••--------.............-••--•......--....-•-- Inspector............ �' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .� '� ® � � ` No. S �- J � ...: ........... F.....� .. `G •............... 1-5 •..... ... .. FEE.. ................... %Vo al Works Tong t1ami# Permission is hereby ranted....... :....... .... to Construct ( ) or�Repair ( ) an Individu 1 Sewage Disposal System at No........ -0........ ^c .e^v'�c!._.... �:w Street as shown on the application for Disposal.Works Construction Permit No........ .......... Dated....................._..................... oar of Health d '.} DATE---- ` .`..� ----•---....... ---•----••----- B FORM 1255 A. M. SULKIN, INC., BOSTON