HomeMy WebLinkAbout0088 LEWIS BAY ROAD - Health 88 Lewis Bay Road
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Hyannis
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2s. 01)
No. 0— . Fee
THE OMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
ZlppYicatton for Mgaal bpgtem Construction Permit
Application for a Permit to Construct( )Repair( )Upgrade(. Abandon ) -❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
,:76-S Rs_,� Q-0
Assessor's Map/Parcel
Lk O v OR
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
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 gallons per day. Calculated daily flow gallons.
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)
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 Health.
Signed r P Date
Application Approved by a C - Date v�
Application Disapproved for the following reasons
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( )
Abandoned( by /O 2 (�_A►JCL_1
at 2C,-tea "�-__r),1 has been constructed in acc rdance
with the provisions of Title 5 and the for Disposal System Construction Permit No. 2C 6 dated .
Installer Designer
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Date Inspector
06
- No. - 4,:..,-: Fee
2s.
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
_ Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS
i
Z[pprfcation for�Mfgpogal bpgtem Coitgtruction Permit
Application for a Permit to Construct( . )Repair( )Upgrade( Abandon ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
Assessor's Map/Parcel.
n CD
Installer'Aame,Address,and Tel.No. Designers Name,Address and Tel.No.
Type of Building: rt
Dwelling No.of Bedrooms J Lot Size sq.ft. Garbage Grinder( )
Other Type of Building.1 No.of Persons Showers( ) Cafeteria( )
Other Fixtures - t
r
Design Flow gallons per day. Calculated daily flow gallons.
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)
i
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 Health.
SignedA Date
Application Approved by S C�,^ L�� Date o (S2
Application Disapproved for the following reasons
t _
Permit No. � � - Date Issued 1 k ��
i
THE COMMONWEALTH OF MASSACHUSETTS
i
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS II XO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( )
Abandoned(+' )by A
at" a �t S (2c� a- -m has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. ated Co [I S N2..
Installer Designer
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Date Inspector
---------------------------------------
No. .J�. �r^� Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
1wfgpogal *pgtem Congtructfon Permit
Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon(✓�
System located at sh Q S. P.C-t—,) Eli) . ��4 C;. C-
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.
Provided:Construction must be completed within three years of the date of this ermi . !
Date: ��� A roved b
rr y