HomeMy WebLinkAbout0080 RASPBERRY LANE - Health 80 Rasberry Lane
Marstons Mills
4
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TOWN OF BARNSTABLE
LOCATION C60 PAS WJ�-/ �4�J SEWAGE#
VILLAGE A0570/J ill kd. ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO. O LES QT0A1 r Q6 0
SEPTIC TANK CAPACITY 1!410 CeT;0 V4_5
LEACHING FACILITY: (type) (size)
NO. OF BEDROOMS
OWNER STT/� ®Z��•
PERMIT DATE: 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. (�1"► (� Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
4plitatlon for Bisposal *pstrm Construction permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System .zKdividual Components
Location Address or Lot No."%jo 0,,r,3C)��� Owner's Name,Address,and Tel.,lo.
Assessor's Map/Parcel M�"r Son �
Installer's Name,Address,and Tel.No. r Designer's Name,Address,and Tel.No.
S Lv �r � t3 0 lJ Xc. �o�'N'Z
Type of Building:
Dwelling No.of Bedrooms Lot Size 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
Size of Septic Tank Type of S.A.S.
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 been issued by this Board of Health.
Signed Date It O C 1
Application Approved bye Date 0
Application Disapproved by Date
for the following reasons
Permit No. Date Issued
Y i
No. o� Fee COD . —
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
01pplication for Disposal 4pstem Construction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System Vdividual Components
Location Address or Lot No. \�S(�bes�y Owner's Name,Address,and Tel.No.
Assessor'sMap/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
S C v ��t,,�k �3 0 l� X� rou�C1R
C
Type of Building:
i
Dwelling No.of Bedrooms Lot Size 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
Size of Septic Tank Type of S.A.S.
---Description of Soil _ t
`Nature of Repairs or Alterations(Answer when applicable) ` (y►/�
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.
Signed Date '7 If 0 r l
Application Approved by Date
u Application Disapproved by Date
for the following reasons
maw
Permit No. Date Issued '
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compiiance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(L1 Upgraded( )
Abandoned( )by
at has been cons ucte in acco ance
with the provisions of Til 5 and the for Disposal System Construction Permit N . �3 dated
Installer '�>C f_> \- c-t� Designer
#bedroomsA1/4 Approved desi flow gp
The issuance of p rmit s In,i be construed as a guarantee that the system wAl ct' n defigned.
Date Inspector
--------------------�-/------------------------------
No. � �I 4— l� Fee �C�t� �
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Disposal 6pstem Construrtion Permit
Permission is hereby granted to Construct( ) Repair(/ Upgrade( ) Abandon( )
System located at �T�� �rQ,"..Z M�
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 in t be completed within three years of the date of this permit.
Date Approved by _r k !��-G i