HomeMy WebLinkAbout0021 LAZARUS LOVELL ROAD - Health (2) ai��� �-� ��P
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No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Zipplitation for Misposal 6pstPin Construction 3pPrmit
Application for a Permit to Construct( ) Repair OO Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.2-( LA 2j5Kd.5 (,owe \ 12J1 . Owner's Name,Address,and Tel.No.
Assessor'sMap/Parcel 1I ISM} �f fIB /t N�4 MPfA!e CAPEC.Edf'
Wstaller's Name,Address,and Tel No. S° '`F�l'$i 7 7 Designer's Name,Address,and Tel.No.
Type of Building: /tl1
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) _ J�. gpd Design flow provided f 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)
Z1..5'lA-l/ Ano L83 1Tlb bz,x to. / /?l ,- 4nb (o t - o to it+De
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 Environmen ode and not to place the system in operation until a Certificate of
Compliance has been issued by this Board o t c�
Si ed Date
Application Approved by Date �-
Application Disapproved by Date
for the following reasons
Permit No. �-lJ��� -" J Is a Date Issued
No. `'�l Fee y
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH'DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
- 'Zlppliratlon for bisposal .pstem Construrtion Permit �
Applicationffor a Permit to Construct.( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.
21 (,A 2j+t4 d,S (L%r1 kh. Owner's Name,Address,and Tel.No.
i�i f/v r� M R rsr CA PCLC,S1"
/f
Assessor's Map/Parcel 1 I5�` }!
Installer's Name,Address,and Tef.No.�66 -+'1 ~ 7 7 Designer's Name,Address,and Tel.No.
t Type of Building:
Dwelling No.of Bedrooms A Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ). Cafeteria( )
Other Fixtures C
Design Flow(min.required) gpd Design flow provided (/� gpd
o , �
Plan Date Number of sheets Revision Date '
Title ,
Size of Septic Tank Type of S.A.S.
w�
Description of Soil. t`
Nature of Repairs or Alterations(Answer when applicable)'
244,411 nc,J �8.3 Ahr, �;...x tj. / )21A Anb (ro yi P. Ir t 4-pe
Date last inspected: "y
Agreement:
k '
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposals 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 I ealt q
Signed ` '` Date
r C t
Application Approved by c� Date
Application Disapproved by Date
for the following reasons
Permit No ' /� / ^" Date Issued d y
x
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CER�TIIFpY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
Abandoned( )by
at 1._ IQ f Yhas been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit N9 /-55Pdated J 6' r
Installer Designer
#bedrooms t,,/ A~ Approved design flow 014 gpd
The issuance of this permits all not be construed as a guarantee that the system will function as designed.
Date 1 ( Inspector / A
... .. j. _
No "� 3�C,t`` Fee 7
THE COMMONWEALTH OF MASSACHUSETTS
✓'"" PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal 6pstem Construction Permit
Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( )
System located at i �_a'�<st r— + 1--o / /
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
be�-completed within three years of the date of this permi 1
Date 1 ,f `i Approved by +.