HomeMy WebLinkAbout0029 SUNDELIN WAY - Health 29 Sundelin Way
West Barnstable
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TOWN OF BARNSTABLE
CATION S W SEWAGE# aU
VILLAGE. �Q�� (_ -C� ESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO. r
SEPTIC TANK CAPACITY L\n�( �.(,t�� �(�J''�V�}' } c1•� �c 0�(
LEACHING FACILITY:(type)` (size)
NO.OF BEDROOMS '` - J
r
� OWNER.' ,
'PERMIT DATE: (�U J U I K COMPLIANCE DATE: z ISI 19
:Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility F:,_L Feet
Private Wate'i 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 t
FURNISHEDBY
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TOWN OF BARNSTABLE
LOCATION�. dJ �t� W p SEWAGE #_ g o_ ) 7
VILLAGE WEST )3Ak-A)l7-AA1Q- ASSESSOR'S MAP & LOT
-.4"
INSTALLER'S NAME & PHONE NO. R,A�
SEPTIC TANK CAPACITY Jinn GS"1
LEACHING FACILITY:(type) I&RCcjS7" (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER WELL
BUILDER OR OWNER R o �LAT C. 6 A,,JCAoF7-
DATE PERMIT ISSUED: Z a.
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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No i Fee_% Ir
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Wieation for Misposar 6pstem Construction Permit
Application for a Permit to Construct( ) RepairA Upgrade( ) Abandon( ) El Complete System gKndividual Components
Location Address or Lot No.aCA SQ r\ C/��'�+ a� Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel 2 (a I b to K \I 11c"^c rU Ft
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Type of Building: b� any amt,y
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) �_,p L`L[ L(NC,, `(1
�AM)5 e % 4 D\,G[1, L� �� M �,r r`.�,(,� `��?1[I.>
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
Si ed Date
Application Approved by Date :
Application Disapproved by Date
for the following reasons
Permit No. ��� q Date Issued
No. .-- Fee
-�/1' r
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:_1101,
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
4plicatlon for Misposal 6pstrm Construction Permit
Application for a Permit to Construct(")—°RepairZ) Upgrade( ) Abandon( ) ❑Complete'System Q4ndividual Components
Location Address or Lot No.'a v^(��,\ ' .,W&,j Owner's Name,Address,and Tel.No.
Assessor's MaplP'azcel \(o b(m
Sk c�i A 1-> c-,,c—,-V 1p�k
Installer;Name,Address,and Tel.No. Designer's Name,.Address,and Tel.No.
T I J
Type of Building: S O a cl y O G
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 �' t %.f., Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) Of 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.
Signed`-) Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. /e— Date Issued
------------------------------------------------------------
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 A �C k
at D q c,, k J o }�„ �has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No..� dated ~
Installer y1PoN Designer
#bedrooms Approved design flow A�1�- gpd
The issuance of this permitt shall not b const�rue~d as a guarantee that the system i11 fiinctian as f si ed.
Date 1 -mot 8 / Inspector
---------------------------------------------------------------------------------------------------------------- -------------------
No.
730 Fee _
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
MispoBal *pstent Construction Permit
Permission is hereby granted to Construct( ) Repair(� Upgrade( ) Abandon( )
System located at t P n t i c L u
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:C nstruction must be completed within three years of the date of this permit
Date Approved by