HomeMy WebLinkAbout0327 LAKE ELIZABETH DRIVE - Health 3 17 Lake Elizabeth
Centerville
A = 227/011
1
No. - / D � Fee_
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
2pphLation for Vsposaf *pstem Construttion 3pErmit
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System Individual Components
Location Address or Lot No.3GC LCA. El `z Owner's N e,Address apd Tel.No. S�8`�7
`sir , W \iQw_ I1_hQ
Assessor's Map/Parcel a X7 O t/ 3 9-7 \eV-e— i�c+.b E C.0 17IFry 1 Pr
Installer's Name,Address,anj Tel.No. .563-q-77—�977 Designer's Name,Address,and Tel.No.
W ► r.,,r,$0-S
Type of Building:
Dwelling No.of Bedrooms Lot Size °X A sq-3. 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
Nature of Repairs or Alterations(Answer when applicable) �-- 1 V`�
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 Health.
Datea-
Application Approve Date
Application Disapproved by Date
for the following reasons
Permit No. r-y kY 1 y��1 Date Issued
____________________________ _�"j
No.�-7`t_..�� � ��� Fee�—
THE-COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC'HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
4pftcation for Disposal 6ps trin Cons trurtio n' Permit .
Application for a Permit to Construct Repair Upgrade Abandon Complete System Windividual Components
pp O � p (�) pg O O ❑ p y p
Location Address or Lot No.3a7 Owner's Name,Address apd Tel.No. S lql E'
Assessor's Map/Parcel a A7 p 1/ 3 a7 �e�� E i ZO.� C e-q V J
Installer's Name,Address,an4 Tel.No. SIB-y77—g$77 Designer's Name,Address,and Tel.No.
EVrip-
1)rpe of Building:
Dwelling No.of Bedrooms Lot Size ° A sue. 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
Nature of Repairs or Alterations(Answer when applicable) �-- V_1L
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 Health. Q
ed Datea-
Application Approve b Date
Application Disapproved by Date
for the following reasons
Permit No. ry4o) Date Issued
---------------------------------------------------------------------------------------------------------------------------------------
„ TH E COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( )
1' Abandoned( )by Cc�y.��• Cti1���,Arig—S L�L
at 3 a? LaK_ E I`/Z�621L. D Y, C6. 1 has been constructed in accordance
with the provisions of Title 5 and the,for Disposal System Construction Permit N410 I'c�-3 dated
Installer C-o`�Q w`��- ``�'��'�S Designer
#bedrooms Approved design flow gpd
The issuance of this permit shall not.!be construed as a guarantee that the system will funct/ion as designed.
Date h Inspector
--------------------------- -------------------------------------------------------------------------------------------------------
� � 6
No. ,� v -- Fee
THE COMMONWEALTH OF MASSACHUSETTS
r, PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Disposal bpotem Construction 3permit
Permission is hereby granted to Construct( ) Repair(/ Upgrade( ) Abandon( )
System located at 3 o)-7 LA" E)(ZcA5Zt� DO,
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.
Date Approved ,_
Provided:Construction must be completed within three years of the date of t is permit. ( � -
1 'by �—
v
TOWN OF BARNSTABLE
LOCATION 3,247 LAIC r LI Z.E6C_1_4OSEWAGE#
VILLAGE /Ia,E ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY CC->S,GboL
LEACHING FACILITY.(type) P]j (size)
NO.OF BEDROOMS
OWNER
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Betweeri 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 CAPe .r.(, 3 S
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