HomeMy WebLinkAbout0136 TANBARK ROAD - Health '136 Tanbark Road
Marstons Mills
A= 100-016 - 002
TOWN OF BARNSTABLE
_ LOCATION f 3b --rAv/&ffZ.1{. 12O SEWAGE# 2011 ' 400
&VILLAGE/'AI)TdAd h1LU ASSESSOR'S MAP&PARCEL 1CV -0&-c;i2
INSTALLER'S NAME&PHONE NO. eq6/-V'✓S S W-
SEPTIC TANK CAPACITY C VCX>
LEACHING FACILITY: (type) 13J7b c.,e-L S (size) e32 IZ s 69L
NO.OF BEDROOMS 3
OWNER -N — d„t j lry ►
PERMIT DATE: 4 D 117!� COMPLIANCE DATE: X 17
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) 4 Feet
FURNISHED BY
22'
2 26'3• Z3
3S- A Att'
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t No. i v v Fee d ✓
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
21ppliLatlon for I8 1 sa' 6pstrin Construction 3pffmit
Application for a Permit to Construct(K) Repair( Upgrade( ) Abandon( ) ❑Complete System [Individual Components
Location Address or Lot No. '36 Rk Xy Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel A pm` �17A
Installer's Name,Address,and Tel.No. ``c So.? 43 2 Designer's Name,Address,and Tel.No.
S, Aj,,N (�dl/A7fN5 SST�S nr ,� S QE' N1��v
is —4 , h J DA
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size ))� 7 tF sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures'
Design Flow(min.required) 330 gpd Design flow provided 38.6-4 gpd
Plan Date LAZ 11�j Number of sheets / Revision Date
Title SJ%E'•I064N OF )tdPOSCJ:)
Size of Septic Tank J (2)q SPK Type of S.A.S. flJ�ywC-tis
Description of Soil ,j6f
Nature of Repairs or Alterations(Answer when applicable) ��Z,:5,0 G^ -AN"y(p-(S
i
re'
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 Titl vironmental Code a lace the system in operation until a Certificate of
Compliance has been issued by this Boa of Healt .
Si Date 2
Application Approved by Date a
Application Disapproved by Date
for the following reasons
Permit No. lt� Date Issued
' old ' �/0d
No. 4
e a Fee /
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ' Yes
2ppYitation for -M7oii,,al fps PIn ConBtrUttIOIl ertnitApplication for a,Permit to Construct(�') Repair( pgade( ) Abandon( ) ❑Complete System Q Individual Components
�.
Location Address or Lot N 3 j;
) 7 6 'j Ls rl, -1 i?!< j h 2 Owner's Name,Address,and Tel.No.
Assessor's Ma /Parcel ' ( ` *, 4 B a-'A (j 6 jv� ` "V�i't�
P JUu — O 6 0U2 '1 !?'7 J
Installer's Name,Address,and Tel.No. Su 2 4 3 Z Designer's Name,Address,and Tel.No.
if QA
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
r Other, Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(mtn required) - 0gpd `Design flow provided 1 3 6- G gpd
Plan Date `'t r//Z /! Ci Number of sheets i Revision Date A//4-
Title �i%( o'c."v G r~ r�l i r>f'D S 7 Coo'Cs'?I?tj C
` '`• Size of Septic Tank /00 U 6-n S r w Type of S.A.S. Il yt;,jC--lL S
Description of Soil 10 ?4./A/V
t
F Nature of Repairs or Alterations(Answer when applicable) -i
Date last inspected:
s.
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 Titlp-5 of the=Envim ronental Code and-not-to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health) / / '
Signed ,• f f s• Date /
s
Application Approved by 1 1 A J Date
Application Disapproved by Date
for the following reasons
l
t Permit No. ( � " �w Date Issued 0/
g e,+.d+aa+-:'-..-..4._t�^.•.—_x-....,ova; ,�_ j-i _ _,' r , :�,`...._. .. .. .. " .
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�> //l / �ltC,CA C.�AT//V�� Z—I— . {
--- at 1 j G { /7 A��f /zCo- — • -has been constructed in accordance /
with the provisions of Title 5 and the for Disposal SystemConstruction Permit No.1 dated
Installer 1���'% !-(�Cj���///?� ,�[.C Designer
v
#bedrooms 3 Approved design flow !� gpd
The issuance of this permit slhall not be construed as a guarantee that the system will funct 1 as designed.
Date ;� Inspector
No. o.t�9 -Ll 0 0 Fee �D U
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
' ]Disposal *pstem Construction J)ermlt
Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( )
System located at / ZA— 0)&ARK R0_ met% All.
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 0 ( ��� _ Approved by f` .
.��1:-�
. .
Town of Barnstable
Inspectional Services
% • Public Health Division
BAMBrnst.e,
163 � Thomas McKean,Director
Argot° 200 Main Street,Hyannis,MA 02601
Office: 508-8624644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: 22 11 Sewage Permit# 2011- 4 OU Assessor's Map\Parcel / 00- O1(,- 002
Designer: DW A SYZ-AW AN C"—
t- Installer: E /"tAni �l.4Vi17iNf
Address: 1S S1AEA&<► CU 4-1 Address: /S SPE,4bf W 4y,
"VA-)I CM H11AL))C Al
On to 117 /1 9 Cp !� Jr/4sxy P4CAVItINA� was issued a permit to install a
(date) (installer)
septic system at 13,6 'TA4n11DAfLk R175 based on a design drawn by
(address)
�f�4N SPEAr1&),%t/ CrwJ-r dated �l�lT-
(designer)
I fi' that the certi septic stem referenced above was installed substantially according to
p
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Strip out (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. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the system referenced above was constructed in co m liance with the to rms of
the RA approval letters (if applicable)
OF M,�ss9
o� DAVID
� G
(Instil ler's Sig re 8.MASON r;�
0 9�N0.1066GQ r�y
/STER
e gn ignature) (Affix D ere)
PLEASE RETURN TO BARNSTABLE 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.
Woa\deptAHEALTH\SEWER connecMEPTIMesigner Cerli6cation Form Rev 8-14-13.DOC
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