HomeMy WebLinkAbout0078 CEDRIC ROAD - Health (3) I y
8 'CEDRIC ROAD
WEST BARNSTABLE
j 172 2132
No " Fee 60 11
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
s
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
0[pplitation for biepos ii 6pstrm (Construction permit
Application for a Permit to Construct( ) Repair(�) Upgrade( ) Abandon( ) ❑Complete System [Individual Components
Location Address or Lot No.1 Wri<- Road \N. Owner's Name,Address,and Tel.No. Gf y ry 4ar+nM
Assessor's Map/Parcel 1717 132 -is ua(ick 9a. Cer`Ic(u�l�
Installer's Name,Address,and Tel.No.O30 txc")CAF on Int.. Designer's Name,Address,and Tel.No. avid • h�aSO n
3�4 Roc 13d Sp�dw��ti Sd8 o6S 3
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(!Jo)
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 33 0 gpd Design flow provided 3 Cl gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank 1600 Type of S.A.S. (2) 560 `d'olon Chatvlbacs
Description of Soil fie, p1a,A-%
Nature of Repairs or Alterations(Answer when applicable) �nS6kk nt w Ck—box anA SAS D h11ec Vtn0_Ja
Q.X%'tkoS 1000 nvJkoo t> 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 a Certificate of
Compliance has been issued by this Board of Health.
geed Date
Application Approved by Date I'10
Application Disapproved by Date
for the following reasons
Permit No. J Date Issued 4—1
d X
xP.
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: /J
PUBLIC HEALTH 0IVISI.0N- TOWN�OF BARNSTABLE, MASSACHUSETTS Yes
ftphcatlon for I µ p�tPtn onstructiot� PrttYit
Application for a Permit to Construct( ) Repair(,j Upgrade( ) Abandon( ) ❑Complete System .i Individual Components
Location Address or Lot No.'� ,G�c r i c, d Ni. {L r 1Gy1¢ Owner's Name Address and Tel.No.
r�' r�
Assessor'sMap/Parcel Wick QZA. C<er (t)"Illa-
Installer's Name,Address,and Tel.No. (b4.(� rG �+on ��e Designer's Name,Address,and Tel.No.
3�4 �Ouvt ��o Saw�G SaB:�l ob5
Type of Building:
Dwelling No.of-Bedrooms Lot Size sq.ft. Garbage Grinder(tjo)
' Other Type of Building No.of Persons Showers( ) Cafeteria( )
l Other Fixtures
Design Flow(min.required) !7)1 p gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title f
Size of Septic Tank 1(ffl Type of S.A.S. •..(..�•�,.. �„, n tt { ,, ,, r•
Description of Soil C.J,,, r,{„ � ` d vrT r
Nature of Repairs.or Alterations(Answer when applicable) cI It ,�,,., ou .- a c e rn Aogr 1 n r
r%or.
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,thols"ystem in operation until a Certificate of
Compliance has been issued by this Board of Health. >,y
Signed„ Date t i 1d 1_1
Application Approved by _ DateAllr�Ld
�
Application Disapproved by _ Date l
for the following reasons
Permit No. 'l /--''... _25 '_Date Issued
---------------------------------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
f Certificate of Compliance
THIS IS`TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( )
Abandoned( )by v G^ A
at 1 c,( (o A e r *0;I: has been constructed in accordance r
with the provisions of Title 5 and the for Disposal System Construction Permit No,�/"t*'j/`J' dated
"Installet# I�'� k rn.1n�'nn lnr Designer -..
k #bedrooms 7, Approved design flo ?�, gp d
The issuance of this permit shall not be construed as a guarantee that the syst" em will CctiongneDatensp �,.e...•
--- - ...-vNo. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal 6petem Construction J)trmit r
Permission is hereby granted to Construct( ) Repair O) Upgrade( ) Abandon( )
System located at 19,
r
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 � ' �l Approved by "'��
Town of Barnstable
" T Inspectional Services
Public Health Division
•APNnAMA
KAU
' Thomas McKean, Director
+ ° 200 Main Street,Hyannis,MA 02601
Office: 508-8624644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: t Sewage Permit# _'2 0 Q 1 "613.Assessor's Map\Parcel l
Design s Installer:
Address: Address: �� ...�
On 4 �as issued a permit to install a
(date) (installer)
septic system at � -� - QDOrD based on a design drawn by
r (address)
t 1j. U-%9 ay�--+^ dated '1
(designer)
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. 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 compliance with the to rrns of
the AA approval letters (if applicable) OF R14,
DAVID
(Installer's �riat -s--�� B. 0%
MASOf� 'r_ 11
LAI/
(Designer's ignature) (Affix. 4. A =1�% �Here)
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.
Vtoaldepu\NEALTMEWER conne6SHPTIC\Designer Certification Form Rev 8.14-13.DOC
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