HomeMy WebLinkAbout1404 MARY DUNN ROAD - Health 1404 Mary Dunn Road, Cummaqul
A=334-011
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TOWN OF BARNSTABLE
LOCATION Lj � SEWAGE # "
r
VILLAGE vo ASSESSOR'S MAP &LOT
INSTALLER'S NAME&PHONE NO. "1p;L Gone,
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) '( C<,+(-of mlys(size)
NO.OF BEDROOMS ,
BUILDER OR VAR 7?-AfCJ 14lor o ,
PERMITDATE: COMPLIANCE DATE: ;L
Separation Distance Between the:
Maximum Adjusted Groundwater Table and 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
91 - ��
g3- qq
No —7 •/ Fee d
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: I
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
01pprication for aigaar *p6tem Construction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No. 77/02G3
CUIVLA-C! &VI� kPy �JofC'� kE ,%r c wti
Assessor's Map/Parcel 3 .. 4, '
Installer's Name,Address,and Tel.No.:;;I
' t Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size Zxsq. ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 336 gallons per day. Calculated daily flow 3 G % gallons.
Plan Date //—.16 — 9 :7 Number of sheets % Revision Date
Title Z�E ndw j" Rik�v. .I L v t6ft w.g. M.A
Size of Septic Tank �kao A19L Type of S.A.S.
Description of Soil A (GIL TLAO
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 Certifi-
cate of Compliance has been iss by Board of H • . '
Si Date i 7_/G-17
Application Approved by Date/Z
Application Disapproved for the following reasons
Permit No. 7— 7 f Date Issued / 'Z —/y/— 7
L -------------------——-------------- ———— — --
TOWN OF BARNSTABLE
LW-ATION 10 4 SEWAGE # rI '
VII LAGS ASSESSOR'S MAP& LOT
INSTALLER'S NAME.&PHONE N0. 'JC&C) ! GyNS►1-.
SEPTIG:TANK CAPACITY I Sa o1
LEACHING FAClLrrY: (type) Cruel GI Mn <(size)
NQ OF BEDROOMS
$U#IaDER OR�OWNER� 1�iR4fl� KQ
` PERM-TUDATE: l�.-IL- ;7 ^COMPLIANCE DATE: �L -��o- ?Ff
S'0%0 aA ton Distance Between the
'• � %>:x:.:., . . - Feet
Maximum Adjusted Groundwater7able and Bottom of Leaching Facility
Piiwate:Water Supply Well and Leaching Facility (If any wells exist
- ows to or within 200.feet,of leaching facility) Feet
Edg0f Wetland and Leaching Facility(If any wetlands exist
:;`within 300 feet of leaching facility.) Feet -
FUr fished by
. .. C. -
,T xNo. 7 �/ Fee `�a P3
• THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
01ppficati"On for loigooal *pztem Con!5truction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. �yJ�l�7 7�l fv/v�' Owner's Name,Address and Tel.No. -771 OZ 3
,Y,A �,,D �y j'�1 yeE SCE vmQ,�1N
Assessor's Map/Parcel
33y- Pr /
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
gig
Type of Building:
Dwelling No.of Bedrooms Lot Size�C'sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 236 gallons per day. Calculated daily flow 3 G 9 / gallons.
Plan Date //- Ito - `/ 7 Number of sheets Revision Date
Title 5 /T /�ifr4�/ ��+r Q/4 Riy STi Lr .��v u�k d /V 1 A
Size of Septic Tank lS,do Aq L Type of S.A.S.
Description of Soil Aa Kit PLArJ
r r
Nature of Repairs or Alterations(Answer when appliddble) s I !
,Lj , ..
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 Sef.ihe Environmental Code and not to place the system in operation until a Certifi-
cafe of Compliance has been iss by Board of H
s
Signed 42641 11 _r Date
l t'' y �'
Application Approved by" � � Date !2-
Application Disapproved for the following reasons
Permit No. 9'7- 7 0 Date Issued / Z -/`- 9'7
————— —— — ——— — ———————————
f 6 '' 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{r
at ///O<! ,41&,Y ���H R C, Cv P.,vn ot at has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. 9 7-7// dated Z-/(- `�-7Installer Designer C d A--e(IV, _S A,/.1 C,,-, /A !/
The issuance of this permit shall 7ot be construed as a guarantee that the syst will function as designed.
Date Inspector
---------------------------------------
No. - //� Fee QU
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
migool = ztem Con!5tructton Permit
Permission is hereby granted to Construct( Repair( . Upgrade( )Abandon( )
System located at ZL/o �//1/lA�, ��hr GP , 1/76 (AA J-1 q v r
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes 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 ermit.
Date: l '��" 7 Approved
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BOX
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SOIL LOG SEl1'AGE, DISPOSAL SYSTEM --lrx tees seentr`.`.
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PROFILEI 0=
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SEIYAGE DISPOSAL SYSTEM -CPi?L CROSS+�t �5 SOIL LOG
( t / / ac/.;!Ti;.nA.E NO SCALE LEACH I G• TRE1\'CH
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