HomeMy WebLinkAbout0115 DEVON LANE - Health I15 Lot #10, DEVON LANE
A=057, 002-006
NO. � EE ✓��
THE COMMONWEALTH OF MASSACHUSETTS
g 7 t-7 Barnstable ,MASSACHUSETT
&ppxtcattun for Pispasal Sgs#Pm (fuustrurtion 1hrutit
Application is hereby made for a Permit to Construct( X) or Repair( ) an On-site Sewage Disposal System at:
Location Address or Lot No. ` Owner's Name,Address and Tel.No.
Lot #10 Devon Lane Walter & Carol Surniak
House #115 "Cotuit "
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Ferreira Associates
131 Spring Bars Road, Falmouth, M
508 540-3699 of Building:
Dwelling No. of Bedrooms 3 Garbage Grinder(n
Other Type of Building No. per Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 55 gallons per day. Calculated daily flow 330 gallons.
Plan Date 8—1 4-9 6 Number of sheets 1 Revision Date
Title Sewage Disposal System Plan prepared for Walter & Carol Surniak
Desc ription of Soil Test #1 : 0"-2 " (0) , 2 "-5 " (A) sandy loam, 5 "-24 " (B) loamy sand,
24 "-44 " (Cl ) sand, 44 "-120 " (C2) sand. Test #2: 0 "-2" (0) , 2"-5 " (A)
sandy loam, 5 "-24 " (B) loamy sand, 24 "-44 " (Cl ) sand, 44 "-120 " (C2) sand,
NO groundwater.
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the aforedescribed 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.
Signed ��� Date z�l
Application Approved by - , Date -� 7
Application Disapproved for the following reasons
Permit No. _ 3 17 Date Issued —Iy_ l
TOWN OF BARNSTABLE
LOCATION 1 n1s-.(JVWJ 4A SEWAGE # -39J
VILLAGE � 1�0 ASSESSOR'S MAP&LOT.S7_9"�
INSTALLER'S NAME&PHONE NO. k-LL 10E47 (b N S5 °7 7/ Y/L A
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) -79- N C-04 (size) �� �X Y -Ir-a/
NO.OF BEDROOMS .
UILDER O OWNER say n 26 (J-P p
PERMITDATE: '"� T_COMPLIANCE DATE: 3 6
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 7V�
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
g�oc�a
1
5
_,�� I 9J3 jd
No. _. FEE
THE COMMONWEALTH OF MASSACHUSETTS
Barnstable MASSACHUSETT
i -
� 1tration for its II$ttl �,5. steztt (gunstrurtion jJermit x
Application is hereby made for a Permit to Construct(X) or Repair'( .) an On-site Sewage Disposal System at:
Location Address or Lot No. t Owner's Name,.Address and Tel.No.
Lot #1 0 Devon Lane 1 Wal ter. & Carol Surniak
House #115 "Co-tuit " �+
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Ferreira Associates
131 Spring Bars Road, Falmouth., M
(508) 540-3609
Type of Building:
.Dwelling No. of Bedrooms 3 Garbage Grinder(.n
Other Type of Building No. per Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 55 gallons per day. Calculated daily flow 3 3 0 gallons.
8-14096 1
Plan Date Number of sheets Revision Date
Title Hewage, DisposalsSystem Plan prepared for waiter & Carol Surniak
'Description of Soil Test #I : 0"r2" (0), 2"-5" (A) sandy loam, 5 "-24" (B) loamy sand,
24"-44 " ,l ) sand, 44"-120" (C2) sand. Test #2: 0"-2" (0), 2"-5 " (A)
sandy loam, 5 "-24 " (B) loamy sand, 24"-44 " (CI ) sand, 44"-I20" (C2) sand,
NO groundwater.
Nature of Repairs or Alterations(Answer when applicable)
MN
Date last inspected:
Agreement:
The undersigned agrees.to ensure the construction and maintenance of the aforedescribed'on-site 'sewage disposal
system 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 ben issued by this Board of Health.
Signed a Date 2
Application Approved by — Date
a
Application Disapproved for the following reasons
Permit No. _ ` Date Issued_ 1pe-
,
THE COMMONWEALTH OF MASSACHUSETTS
��>rx y-I^ S �� i 'e MA,SSACHUSETTS
Certifi a e of C omplianee
THIS IS-TO CERTIFY, that the On-site Sewage Disposal System,installed( or repaired/replaced( ) on
by >�. ffIc- -� C ��SIt2J�. I--h for
at /7'C0G✓\ e a-an --� o�C�i� 'f" as been constructed in
accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Use of this system is conditioned on compliance with the provisions set forth below:
f
The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. This
Certificate expires on
DATE !% Inspector
r
THE COMMONWEALTH OF MASSACHUSETTS
NO. — ,MASSACHUSETTS FEE o
is IIsttY s#em Cons#rne#ion erxtttt
Permission is reby granted to L t o C w s-1 t?UC4_ !!o A. '+
to const uct( or repair( ) an On-site Sewage System ocated at
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.
All construction must be completed within three years of the date below.
DATE Approved by ��
FORM 1255 Rev.3/95 A.M.SULKIN CO.-BOSTON,MA
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