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Home My WebLink About0173 LUMBERT MILL ROAD - Health 173 LUMBERT MILL ROAD Centerville A = 168 - 001 s �® KEEPING YOU ORGANIZED No. 12534 2-153LOR SUSTAINABLE FORESTRY RECYCLED eww er�fi dNITLATIVE CONTENTIO% wsfipropram orp POST-CONSUMER s�wtsvo MADE IN USA GET ORGANIZED AT SMEAD.COM No. Fee �5 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftpYication for -Misposal *pstrm Construction 3pPrmit Application for a Permit to Construct( ) Repair(L1_*1Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /7.7 Z 4,,A bet )/p Owner's Name,Address,and Tel.No. Assessor's Map/ParceI e eG?4',,r L,,1 ff jr t6? 00 f I-ofS el o V. `�( �� / t i Installer's Name,A dress,and Tel. (No. D Designer's Name,Address,and Tel.No. C6-2 Type of Building: t V " t�-OA6 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 47 Nature of Repa* or Alterations(Answer when applicable) e l&c � ZV � LO 1V-ei 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�Healt Date Application Approved by Date — •2 r fi{� Application Disapproved by Date for the following reasons 14 Permit No. e� d Date Issued f No. Fee i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN.OF BARNSTABLE, MASSACHUSETTS Application for Mis stern�� os al� p Construction permit Application for a Permit to Construct( ) Repair(V-`Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 172 L 4,/fi/ Owner's Name,Address,and Tel.No. Assessor's Map/Parcel d rbt �v' !r� t�?_OC) Installer's Name,Address,and Tel.No. S, A 0 Designer's Name,Address,and Tel.No. Type of Building: l �6 t Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) s Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided Al 11 Oe gpd ' Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil i Nature of p Repa'rs or Alt erations(Answer when applicable) U, &C. 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 Healt ,.�-,�."/'y,,,.� Date Application Approved by Date /l- `�( Application Disapproved by Date t for the following reasons r ent Permit No. v2 L( t Date Issued 1 F THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( H Upgraded( ) Abandoned( )/by D 1/11,0 are o s use-,o/ . e,- / )e1PC /vL at (.. 4. 2-,1-4- Al ell df has been constructed in accordance J r with the provisions of Title 5 and the for Disposal S,j stem Construction Permit No!po/'6' q/C dated !! r''� 2 _`,6 Installer 4�Jj 6y�,o••� t/ "✓'° I�r G, Designer , #bedrooms f 1� Approved desigiow�as ( gpd The issuance of this permit shall not be construed as a guarantee that the system wil functio designed. Date t( �7 Inspector 'j,-- s --------------------------------- ----- U - - No. dI (,,,� ! --Fee------ ------------ V I THE COMMONWEALTH OF MASSACHUSETTS ' PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal *pstem Construction 3permit Permission is hereby granted to Construct( ,)Q Repair�(/� Upgrade( ) Abandon( ) System located at ��J 3 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:Construction must rrbe completed within three years of the date of this permit . Date 11 2 '- i Approved by /��r AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION �L> 219filr7 .f% t/ SEWAGE# '` l VILLAGE !>/ 4;4'1 J, r ASSESSOR'S MAPr& LOT INSTALLER'S NAME& PHONE NO.G�/11, K SEPTIC TANK CAPACITY 1,5 G D C' I LEACHING FACILITY.(type), 1041 (size) NO.OF BEDROOMS ) PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER 061? L� r" � DATE PERMIT ISSUED: DATE .COMPLIANCE ISS D• VARIANCE GRANTED: Yes __No---- Car b & S wl c G,Oc, a ' r http:Hissgl2/intranet/propdata/prebui It.aspx?mappar=168001&seq=1 11/22/2016 TOWN OF BARNSTABBLE \, LOCATION ,�L> ��f J1 r/ SEWAGE # 6 "T< 42. r VILLAGE �PI ✓¢fit/ _ ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. !�'6�d� 1 C�,-'l S SEPTIC TANK CAPACITY GS 0 l LEACHING FACILITY:(type) 0 �� (size)�-9 f�- 5re. ` - NO. OF BEDROOMS _ PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER 06 a DATE PERMIT ISSUED: DATE .CO?,iPLIANCE ISSU Dc VARIANCE GRANTED: Yeses '_ --------- -- - r s Ir ,dok 000 T' No.... FxigO.0�........... THE COMMONWEALTH OF MASSACHUSETTS BOAR F• HEALTH Y_� .0_4 n..............OF....... ...t77. 1.. . tq..U..r.. .................. Appliration for U44pusal Works Tomitrurtiun ramit ! Application is hereby made for a Permit to..Construct ( ) or Repair ( Individual Sewage Disposal System at: 10.............6--f E'.*C'a"tjort Addr s p or Lot No. ............ Aw r /• - dress � � Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms....:........... .......................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures . W Design Flow............................................gallons per person per day. Total daily flow.............................................gallons. WSeptic Tank—Liquid'-capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) �.' Percolation Test Results Performed by............................................................................ Date........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ } -----•---- ---- ...........................................................................---- ---------. ............ 0 Description of Soil... ?i.�i-c........ . .......... __ j f r� / W .. _ _M. ---- -- - -------- - --- Nature o Re airs or Alterations—Answer hen a liAle._ ..1 Z. �e'f� J�- {'/ L7pp �C/ -- - A-}d/�-� ------------------------- -----------�------- U .p........... i��... ,----.�I-.l?.5�-.,v-'. ----------------------------------- Agreement: /v,G. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL ITL 1�. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' the ar f health. Signed N �1?Lr •--------------•--- . .. D Application Approved By............... r.�v, -.a. --------------------------------- ...................... ate v Date Application Disapproved for the following reasons:............................................................... ................................................ --------------------•-----•--••-------•-----•---••-•--------...-•---------...----•----•----•---.....-------•--•-------------------••--------••-----•--•---•-••----------•--•••------•-••----•-•--------- Date Permit No.......Fl. 3.1.1 ....................... Issued_....................................................... Date r N22 .d I�z Fxa. O.s.. ..o THE COMMONWEALTH OF MASSACHUSETTS �- BOAR OF HEALTH ................OF........-.. Appliraation for UWpaaiiaal Works Towitrnrtiun thrutit Application is hereby made for a Permit to Construct ( ) or Repair (4an Individual Sewage Disposal System at: ...............el// ufd............... Loca' Addr s or Lot No. po _._/_ ..... -.... &. `� '� ... ------------------ ------------------------.----------------- j�wner � a r P Q� PvUe 1 ........A ...V Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures ------------------------------------------------•----- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ 4 H Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.-_.-..-----_.__.-.--.-. G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P1' .--••-----••-----------•--••---------•----•---••---•-•..............•-------- 0 Description of Soil---------------------------- -- ------------..............-•------ x ----------------•--------•-------•---•--- -----�-- : .____: _ _r :::____. r ��: . ___P�: s.---.-.-•---.-.--.--------_-.-_.- W _U Nature of Repairs or Alt ati s—Answe w�Ien applic ble..�'a.4Q-____--__ _.� �___ -_- -_ n/_A __.---.............. Agreement-: C The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T?T L is 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until.a Certificate of Compliance has been issueddb the board of ealth. Signed---' "% r - •- - - - ER% Jir�------.- ��!l�'��--•/.�:--.. Date Application Approved By............... ,...................� " `"' Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- --------------------------------------------•---•----------...-------•--...------•-----------•------•-•-------•---...------------------------------------------------------------....------------..-•--- Date Permit No.----� •---�.f.1-•----•---------•----.--- Issued--•-----------------------------•--- --•--- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH D... .............OF..... 61-9- 40"7_S.A(..Qr............................ �rr�if iraa#r laf f�rrnt�liaanrr £� THIS IS T�Q CERTI Y,_1hat he dividual Sewage Disposal System constructed ( ) or Repaired (4, r by.......,�e.�!/T�l..�`... .......�..-__ '..�......--•--...-- Install has been installed in accordance with the provisions of TI T 1_E, of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..-- .................'_.�............. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. S, DATE.....................5:...`..1 .` = ......................... Inspector--•---. ---------------------------- ,i THE COMMONWEALTH OF MASSACHUSETTS BOARU OF HEALTH IP7- 31�, , d. -CJ .............OF.. ol. ..5 ....................................... NO......................... FEE........A...0--- Disposal orks(pTonstr ion amit Permission is hereby granted.......... .... ` c!clli•--•----•---•------•-•................................................................... to Construct ( ) or Repair (xf an Individual Sewage Disposal System atNo.---------1 ' ..... -k,...Q.. ..AM :L/--•---•.....................-----------------------------••--------------------•--••-------------------------......-•---•-- Street 8-I _a y )}. as shown on the application for Disposal Works Construction Permit No....!... ........ Dated.......................................... ------------------------•------------••------•---------------------•-------------....----•-•--••-•-----•- Board of Health DATE......................................................................---.----- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS asffi