HomeMy WebLinkAbout0194 LAKE ELIZABETH DRIVE - Health 194 Lake Elizabeth Drive
Centerville
A = 226 097
. I
No. Fee $5
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
01ppfication for Xh5po l *pgtem Con!arurtion Permit
Ap '� ' n for a Permit to Construct( )RepairXX)ummde( )Abandon( ) O Complete System O Individual Components
Location Address or Loot No. C T a i g v i t� Owner's Name,Address and Tel.No.
7 SecSsor azc Ae Uvizaf e.fh L Cizaigv�..�.�e Con/ezence Centee
C2a.igv.iiie, t4azz.
Installer's Name,Address,and Tel.No. 5 0 8-7 7 5-3 3 3 8 Designer's Name,Address and Tel.No.5 0 8—7 7 5—3 3 3 8
a. %. NacomE e2 (t Son Inc, a. %. NacomPLe z & Son Inc.
Box 66 Centezv.ii e, 1la,3,3. 02632 Box 66 Cente2v.iege, Na.6.s. 02632
Type of Building: cc"PJQ
Dwelling No.of Bedrooms 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 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)I nZ t a i e.i n g a c c e,3,3 way ;to t h e
/zum/z chamic2. Fx.i.sLi_ng acrv.s.s way 1A 4aPD.ing nnnnf_
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 is ued by t s oar f Health.
Signe Date8/2 7/0 3
Application Approved b Date ? 2,? 3
Application Disapproved for the following reasons
Permit No. Zap 3— Date Issued 28—Oa
No. 2 W3- -1 (IR Fee $5 0. 0 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
01ppYication for Miopooar *potent Con!6truction Permit
App)}_�a��n for a Permit to Construct( )Repairl U rade( )Abandon( ) ❑Complete System El Individual Components \
Location Address or Lot No. C)t a-i g v.i-e.e a y Owner's Name,Address and Tel.No.
/he rjn a4e F_2.izageth Dn� Caa.igv.iiie Con�enence Cen.te2
o
or tea. Caa igv.iLee, Na s s.
Installer's Name,Address,and Tel.No. 5 0 8—7 7 5-3 3 3 8 Designer's Name,Address and Tel.No.5 0 8-7 7 5—3 3 3 8
a. 7). Nacomge z R Son Inc. a. 70. Macomgelt k Son Inc.
13ox 66 Cente1.v.ii-ee, Na.s s. 02632 [3ox 66 Centezv.iiie, Pla,3.s. 02632
Type of Building: GPCN rvQ V ,'L
Dwelling No.of Bedrooms Lot ize 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 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)I n z t a e-Ping a c r e.6.5 wag to t h e
12umR chamAg4. Ex.i sting acngAz way .i s Xall ina a2aat. '
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 Vs 'oard of Health.
Signed I Lte8/2 7/0 3
Application Approved by/ Date
Application Disapproved for the following reasons
Permit No. 2C.b 3' y� Date Issued 2 8-03
---------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
C, BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repairedy(xx)Upgraded( )
Abandoned( )by ;. 10• 1*0acom9e z 9 Son Inc.
at 208 Lake Uizageth !hive Caa.igv.it2e, Na-s.s. has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. 26G3- W? dated ?- 2 8"C3
Installer ,?. 10. Nacomtez 9 Son Inc. Designer 1. P• Placomke2 9 Son Inc.
The issuance of thiVpermij shall not be construed as a guarantee that the system w' ct s ig
Date Fd Z 3 Inspector .t
./
--------------------------- ------------
No. 0_(4)3-If( C Fee$'5 0. 00
ACC PSI _ P � THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
0711
1=i2;po5ar *p.Mem Construction Permit
Permission is hereby granted to Construct( )Repair X )Upgrade( )Abandon( )
System located at 208 Lake E.P.izageth Dizive Cza.igvi te_, (7a•sa.
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 pe
Date:_. �G 3 Approved by