HomeMy WebLinkAbout0080 VANDUZER ROAD - Health $0 Va-nduzer Road
Barnstable
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EDWARD E. K ELLEY
REG. LAND SURVEYOR
CUMMAQUID, MASS.,
02637
Tel. 1-508-362--5079
Fax 1-508-362-2266
Town of Barnstable
Board of Health
367 Main Street
Hyannis, MA. 02601
Re : R. Reed Gramse , Tr.
80 Van Duzer Rd. j
Cummagnid
Map 352 parcel 62
Lot ##17
Date October 20, 2003
The sewage system was installed a 's shown on the, approved plans,
with the exception being that 'the pump chamber was rectangular,
rather than round. The unsuitable material was removed and
replaced with . clean*'sand.
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St o R Wo N S. Edward I9e•1Z§WY, P . .S.
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Fos �Noe
TOWN OF BARNSTABLE
SEWAGE # Ud,j` l �
LOCATION 0 P� 3-5 0(��
ASSESSOR'S MAP & LOT
VILLAGE
2-6�
INSTALLER'S NAME&PHONE NO. 3
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
No,OF BEDROOMS 3
BUILDER OR OWNER I(P 63
PERMIT DATE: S`^ `0 3 COMPLIANCE DATE:
Separation Distance Between the: Feet
Maximum Adjusted Groundwater Table to the Bottom.of Leaching Facility.
Private Water Supply Well and Leaching Facility (If any wells exist Feet
on site or within200 feet of leaching facility)
exist
Edge of Wetland and Leaching Facility (If any Feet
within 300 feet of leaching facility)
Furnished.by
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No. ��3' "( � Fee `
t THE COMMONWEALTH OF MASSACHUSETTS Entered in computer.: I/
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Zipprication for nigpogar *pgtem Congtruction Permit
Application for a Permit to Construct( . )Repair V)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.17 Owner's Name,Address and Tel.No. 1
80 (1�i4VVZ.Crj C`v�.'¢„�'t -634�f ► ( VV94 i Re�ra a Z 1"+5 C j/ 3 &off
Assessor'sMap/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No �ph ay I
�3 /inter' 4d P.p.��'TJ �G37
Type of Building:
Dwelling No.of Bedrooms .3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date_ 1���3 Number of sheets Revision Date
Title
Size of Septic Tank er Type of S.A.S. ' i �► 77 1
Description of Soil S'e r 'r'—' V
Nature of Repairs or Alterations(Answer when applicable) ST C n-t
Date last inspected:
Agreement: DESIGNING ENGINEER MUST SUPERVISE
FRRTIFY WRITING
The undersigned agrees to ensure the construction and maintenance of the I�fSTj�t�i- I i�ogjem
in accordance with the provisi s of Title 5 of the vironmental Code and notTcMF1a0eY$J9W
�era�ion until a Certifi-
cate of Compliance has been' s ed by is o d of ea ACCOI�DAI`!
Signed Date
Application Approved by A6Y -Date.- ' --od:W 3_
Application Disapproved for the following reasons
Permit No. _rZo03- 191 Date Issued —��0�
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINALS)
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m / IL
DATA
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y
No. � 03'� f ' t , O
_ "' /, � � �"•' -Fee
'� �-sue: f
- — Entered in computer:
THE COMMONWEALTH OF MASSACHUSETTS
1- Yes
` PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETT&
ZIpprication for Mi!5pogal 4pgtem Construction Permit
Application for a Permit to Construct( . )Repair(/)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or-7Lot No.17 Owner's Name,Address and Tel.No. /7 3 Cad 3 GS
/. ( A }•
V�.1 L`)u .f` J ('".v�` s J y n)' >� ✓ � n �C P t /7 �j `�S (' `.
Assessor's Map/Parcel �
3-] l d l �I 1nYV' 1 n� ; r� tlt� l5�7`� �� �' �i 1� 7
Installer's Name,Address,and Tel.No. 3 G� /v 7 Designer's Name,Address and Tel.
( ( 5 OrrT-< J C� '7 St G (J +-
a fl��7r i�f-f /Z ul G• �n1 s)
�. od&3�
Type of Building: Yr --«--.-�-
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 3 gallons per day. Calculated daily flow gallons.
Plan Date Ian C 3 Number of sheets f Revision Date
Title
Size of Septic Tank /SGc Type ijf S.A.S.1 / 'r�' rfi n, S z', -7 �, 11i f y rP
« V
Description of Soil 1~ vl
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 Issued by is d of ea
Signed � 1�kl Date '{J
Application Approved by Date
Application Disapproved for the following reasons
Permit No. 2U0 3- 0.1 Date Issued S`.� 0?
----------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS t
(Certificate of (Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded(� )
Abandoned( )by 1= 11, 5 ��� T r.c, S C c��Sf '' `�
at 6 Q \l �` / E P 12 f t i l',,,.M AN 4 A�(� 1�. has been constructed in accordance
with the provisions of Title 5 and the for Disposal Syst Construction Permit No.o'2103``°1 f' dated J=.2- 0-?
Installer 1 t(, c i;-e t S CS IS t.Cc ( Designer Sic(f,c„ I)1 t I-
The issuance of this permit shall not be construed•as a guarantee that the sy m will function designe .
Date �;T 6 0 3 Inspector r O t
--------------------------------------
No. 0 UP 3 Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
1=igpo5ar *pgtem Construction Permit
Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( )
System located at U U 11 Q U Z-e r it` " "I (I« r, v',l /v , d) ' l3,9�n fJ709i
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 thiKermit
Date:_ - o Z Approved by y ., /^'J• 'es
"d TOWN OF�ARNSTABLE
L�UC,ATIC N St ycza n i-) 2PV' SEWAGE # 2 ,3 06 '/ 91
VILLAGE C u/ n4a,-e I d ASSESSOR'S MAP & LOT
INSTALLER'S NAME& PHONE NO. _III i1 6!'d J
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) ,14112&77 /CAR S (size) /0 ' X 35�
NO. OF BEDROOMS 3
BUILDER OR OWNER T& N et _
PERMITDATE: S^2-03 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
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EDWARD
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KELLEY
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