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Home My WebLink About0132 KEVENEY LANE - Health 132 Kwe fey Lane r Barnstable A.. 3,51 — 023• 7 \ /TOWN OF BARNSTABLE LOCATION Q"GREWAGE# 0 1 �— VILLAGE L,JASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY L' G �(y �02 �-� loo LEACHING FACILITY.(type) (size) NO.OF BEDROOMSe- OWNER to �t-n Se, PERMIT DATE: 1 \ '"1 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 An No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplitation for Mispo8al *pstrm Construction permit Application for a Permit to Construct( ) Repair(L4'-Upgrade( ) Abandon( ) ❑Complete System ®fh—dividual Components Location Address or Lot No. 1.31. Vz cv-e—A Lov—— Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Gv M Mrs e�'V a z Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 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) a�� C�l�a.�Z CUSS rum � 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 f Heallh, Q l Si Date / // / /1 7 Application Approved by- Dat Application Disapproved by Date for the following reasons Permit No. 2p� G Date Issued -- ----------------------------I_ . _ Fee No THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: v 'PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 9pplitation for -Misp6sa1,0pBtrm Construction Permit Application for a Permit to Construct( ) Repair(I/lkUpgrade"( ) Abandon( ) ❑Complete System Lr'Individual Components Location Address or Lot No. Oer's Name,Address,and Tel.No. Assessor's Map/Parcel GV ^Ae`cvu% J23, Installer's Name Address,and Tel.No. Designer's Name,Address'and Tel.No. S c-o A 1\-% 4` LCii%A QC�b Type of Building: Dwelling No.of Bedrooms A Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures / 1 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 bf Repairs or Alterations(Answer when applicable) 4. l M a\ ^,A_ �PI"C> mf1 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 Heal ` /i �/►`7 Sued Date ` Application Approved by Dat —//— Application Disapproved by Date for the following reasons Permit No. CG G 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 `�'C d�1 M k'• -cM Lk at t ` � �1-t �-G LC,,&t (-v.,m s-,UY%h1s been constructed in acc re�fj ce I . with the provisions of Title 5 and the for Disposal System Construction Permit No. 1 dated ( — . Installer C G C\ t"\ Designer #bedrooms Approved design flow gpd The issuance of this permit shall not be Oonstrue4 as a guarantee that the system<ll-funetio as ig�ned.,_____ � Date , / ' �� Inspector —F _ -- -- ---- - -- - .- - - F - - -- -- -- - - - •- --------------- ---- - ---- ------------------------- v f " No. ` � ---- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS ;Sisposal 6pst n Construction J)ermit Permission is hereby granted to Construct( ) Repair Upgrade( )+ Abandon( ) System located at_/'�Z� V,e Q-C A�� L(M�. C v , U X 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. 1 i Provided:Construction mustbe o pleted within three years of the date of this permit.' r Date Approved by if 7 4 :J L f � ` TO,WN OF BARNSTABLE LOCATION Qt,"10EWAGE# 7—Z Oy VILLAGE 1kJ4 ,J\J_ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY L_' G j u L_ (;k J� 5�-� /oo ',!V LEACHING FACILITY:(type) (size) NO.OF BEDROOMS ^ - OWNER PERMIT DATE: 9 COMPLIANCE DATE: C7 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 •; :.;.,, ,.. , ,�. ..'ti. -.. .,,,._...,.... �,�...:,,'-- .=.v�� .r+,..r...,i.:_...,...-ti._�.,,�n..-.r�..r..�-•�,.i�%n..,-•Ri,rr••- �a�..�;.N-asy�,, �f'�•rF•,N,". .... . ..�-•.:t'.. TOWN OF BARNSTABLE —UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION OWNER AND INSTALLER INFORMATION .:a ADDRESS: �. K3�/1= MAP NO. PARCEL NO. Q 1 OWNER NAME: T_4� VILLAGE. (�1 f �,Y) INSTALLATION DATE: . � Y: ;. ADDRESS: '` CERT. NO Y,' C�A`NK INFORMATION' LOCATION OF TANK: TYPE CAPACITY � " AGE d) FUEL/CHEMICAL TESTING CERTIFICATION C ] PASS C ] FAIL DATE LEAK DETECTION CJ ] CHECK IF N/A TYPE/BRAND .. ASAIPZONE OF CONTRIBUTION C ] YES C!" NO , DATEx TO BE REMOVEDy FIRE DEPT. PERMIT ISSUED C ] `YES C ] NO DATE CUNSER.VAiION EX CHECK IF N/A DATEAs r t1 BOARD OF HEALTH TAG NO. C .. ]C ]C ]C ] DATE �l PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD f� pp ` � A. � 'r y � � � � � � , y ` _ � �j �>