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Home My WebLink About0527 LUMBERT MILL ROAD - Health 527 (Lot 55) J,umbert Mill Rd. CENTERVILLE MAP-146 PAR-095 . Sri IN UPC 17534 No.2153COR "VOWOSO k-ASTINOS.YN TOWN OF BARNSTABL LOCATION /0 #4Z VILLAGE / ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. .�irr� /J�Cf�✓`�J SEPTIC TANK CAPACITY V C LEACHING FACILITY: (type) C-00 T%lk�, (size) NO.OF BEDROOMS___ / BUILDER OR OWNER r C 4/ CJ //-f (/t or PERMTTDATE: COMPLIANCE DATE:?�S Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility &C ti4 Feet Private Water Supply Well and Leaching Facility (If any wells exist ``/� on site or within 200 feet of leaching facility) 44 '1'r Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) / G Feet Furnished by S7 � ti'�� 36' zs� No. / Z^ 3_5�b Fee P a 7 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Di5po5ar 6p5tem Construction Permit Application for a Permit to ConstrucKRepair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.jptor_ � �� f �1l wner's N e,A dresss and Tel No. oc!of Ivt SZ� h of n 6 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 1,00�,C: eo /-/C,(- ,-a ,-;- IJ, ?G ZG Type of Building: Dwelling No.of Bedrooms Lot Size �q.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ! / Design Flow gallons per day. Calculated daily flow S gallons. Plan Date f Number of sheets / Revision Date Title Size of Septic Tank T ) ij Type of S.A.S. Description of Soil r Stern 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 this Board of H th. Signed Date Application Approved by Date Application Disapproved for th ollow g reasons Permit No. Date Issued TOWN OF BARNSTABL LOCATION S v.•a SEWAGE # .VILLAGE /K ASSESSOR'S MMA/P & LOT INSTALLER'S NAME&PHONE NO. Zrdd / AICf�✓```J SEPTIC TANK CAPACITY fl C LEACHING FACILITY: (type) A'w (size) NO.OF BEDROOMS BUILDER OR OWNER r C PERMTTDATE: COMPLIANCE DATE:-Z��► Sepaiation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Q111-14 Feet_ Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) ';P Feet Edgc:of Wetland and Leaching Facility(If any wetlands exist Within 300 feet of leaching faty) / Feet cili Furnished by t 1. No. � � µ Fee 7 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: I PUBLICrHEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS VY Zl ` Ytcation for Mtg ogar Stem Congtructtott Permit Application for a Permit to Construct Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. / wner's Name,Address and Tel.Now. gv,df ` ,Pr(jt'/� Assessor's Map/Parcel C �" Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. fj `.� 7 f C r 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 cz 9, gallons;per day. Calculated daily flow ,` S� gallons. Plan Date .Q-ry /-/T� Number of sheets / Revision Date Title / Size of Septic Tank ,t""r (� r1 Type of S.A.S. �'� 5^0 tS f r_ / Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: " f. 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 this Board of He .l1th. rr Signed Date Application Approved by t ._°' . Date --/ Application Disapproved for th ollowt g reasons 1 Permit No. Date Issued ----- ---` — -----R ..t------- THE COMMONWEALTH OF MASSACHUSETTS ' - fBARNSTABLE, MASSACHUSETTS" certificate of `horn Y ance 'j r THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( "y) Repaired ( )Upgraded( ) Abandoned( )by at in Z-)' / o fa v. .� � ��/ ;!• � rPdy r7,.� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer o '. _ /,r'�Designer The issuance of this permit shall of,b'e c strued as a guarantee that the system�A on as designed. n . Date / 7 Inspector Cry t No. 917. y Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION..- BARNSTABLE., MASSACHUSETTS Mwtg;potal *p-5tem Congtructton Permit Permission is hereby granted to Construct(Repair( )Upgrade( )Abandon( ) ,,.. System located at Goa rJ c r f ` {{{ and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to l comply with Title 5 and the follow'ng local provisions or special conditions. Provided: Construction must be,&pleted within three years of the date of this permit. Date: �7 ^- P 9�' Approved by F.