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Home My WebLink About0180 LEWIS POND ROAD - Health 18 LEWIS POND' ( r5ab COTu _ b A= 020-006 —_ — ---- --- --- — — - TOWN OF BARNSTABLE4"*-r- Jr LOCATION SEWAGE # S /6 VILLAGE ASSESSOR'S MAP & LOT` INSTALLER'S NAME & PHONE NO. S• SJ��Oi' fT-�J79 SEPTIC TANK CAPACITY %,�"OD LEACHING FACILITY:(tyype). _ Qtip (sue) 30O NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER : @R OR OWNER DATE PERMIT ISSUED: f-02 q- DATE COMPLIANCE ISSUED:__ ^` °! � VARIANCE GRANTED: Yes No , 0 a• A v oo TOWN OF BARNSTABLE4* r 114 LOCATION sd c� �i�-� �� SEWAGE.# VILLAGE ASSESSOR'S MAP & LOT d;? 0 INSTALLER'S NAME & PHONE NO. S �S '/ 'Z'?I � SEPTIC TANK CAPACITY l "OQ LEACHING FACILITY:(type) size) 300 � NO. OF BEDROOMS ':5, PRIVATE WELL OR PUBLIC WATER pw�- = R OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �r �� . a- c-�v o 0 ,, _ ate• ''r / ASSESSORS MAP N& cr No. c x P/RGM P g Fee J— ` . THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pphratton for Mioaal *pgtem Cougtruction Vermtt Application is hereby made for a Permit to Construct( )or Repair an On-site Sewage Disposal System at: Location Address or Lot No. wner's Name,Address and Tel.No. D � Wt s �o�:� 5 g 7V 0/ +M yam=L.l� Installer's Name,Address,and Tel.No. 4 -7-7 Designer's Name,Address and Tel.No. ;x clef el Type of Building: Dwelling No.of Bedrooms Garbage Grinder(Afp Other Type of Building W®®J No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil t"25-QS/v mac' 70 Cl`O y ee 5 Z 4 -^/0 Nature of Repairs or Alterations Answer wh n applicable) 11fr PA T� E5 f�TrC y Date last inspected: Agreement: The undersigned agrees to ensure the construction and nce of the afore described on-site sewage disposal system in accordance with the provisions of Tit1 5 of the Envir ental C,de and not to place the system in operation until a Certifi- cate of Compliance has been issued t t is Board of eal . Signed Date Application Approved b Application Disapproved for the following reasons Permit No. /� �1 Date Issued ——————————————————————————————————————— r.'''--"^ ` "'-"•.�.f"'d'�Ft"ems W.t 4Yh, r:N c,,,. t. "-`. ri•,Ji.t;.. � �"�w . ,-..,. _.. ...... . . , - ~^�� No. Fee ' �f THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 2pplicatiottf for Mio -gal bpotem Con!5truction Permit Application is hereby made for a Permit to Construct( )or Repair&01 an.On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. Installer's Name,Address„_and Tel.No. '1 7 7, Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder(^0 Other Type of Building w ao.D No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date ? Title Description of Soil 7 O O O y�e S'C _6 ,- X/A - ' y Nature of Repairs or Alteratio (Answer wh n ap licable) y� p/+ T (�ze7'f G Date last inspected: i Agreement: The undersigned agrees to ensure the construction and nce of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Envir ental C de and not to place the system in operation until a Certifi- cate of Compliance has been issue is Board o eal Signed N"ui1 Date Application Approved b s ' Application Disapproved for the following reasons Permit No: /�-✓ / �� Date Issued =_-___—_______-=— _------ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed(k or repaired/replaced( )on Q by :J� 6I A /,44 for as has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No� r dated Use of this system is conditioned on compliance with the provisions set forth below: No. 1 " V Fee G/a THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS x3fi5p g-al *p!gtem COu!5truction Permit Permission is hereby granted to to construct( )re ( an On-site Sewage System locate / (.s 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. All construction must be completed within two years of the date below. Date: A&✓" !- Approved 0 I cA I ►2r� jo ° J lxz CL CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed y me dated ��- �S , concerning the property located at meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility G g g g • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. 1� SIGNE f DATE: el> �l LICENSED SEPTIC SYSTEM INSTALLER 114TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submittedj. fe f ^4 1 r \ \ i