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HomeMy WebLinkAbout0141 LOMBARD AVENUE - Health 141 LOMBARD AVM, >. BARNS74BLE A. 155-BAR7 Of 005 0 is D TOWN OF BA.RNSTABLE LOCATION r�S�a14�/ � 1� /Cf �UL SEWAGE VILLAGE ► Imo/ ASSESSOR'S MA/fLOT INSTALLER'S NAME&PHONE NO. 1.1'e',k.,As—J SEPTIC TANK CAPACITY I � _ LEACHING FACILITY: (type) /, o (size) �✓ NO.OF BEDROOMS BUILDER OR OWNER G c, lCs+.e I r PERMITDATE: ' I ' F5--"COMPLIANCE DATE: '13 r y Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet . Private Water Supply Well and Leaching Facility (If any wells exist 10 on site or within 200 feet of leaching facility) ��� Fee: Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i � � ��� �\ e _ �. �d11 ._._ - - -4 �� I— — — _ � / � � ��° �� r ���b �� \ � `�'e ' � �\ � r I__._.-- i N cry �, � 1 � � � �- � r ' � i t ASSESSORS MAP NO: 1_�5�� No. I � Fey, f✓lJ PARCEL N0: C7, THE MMONWEALTH OF MASS TT5'— PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS `- .. 0[pprtcatton for Migozal *pmem Conetruction Vermtt Application is hereby m de r .Permit tp Const t(A')or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. rrJ Owner's Name,Address and Tel.No. �!J cab�O 0`4 L 6 T � d, l 6d"M6191" � /Yic�:vl� z= Installer's N e,Address,and Te1LNo. 4a'�r n fit, Designer's Name,Addr ss and Tel.No. Type of Building: Dwelling No.of Bedrooms_ Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow oela,6�mom gallons per day. Calculated daily flow 330 gallons. Plan Date "Pi— N her of sheets Revision Date Title S/%� ,50.., IV14ICf�'44 G e-d' Description of Soil s� '602,9,m 12 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 Environment 1 Code and not to place the system in operation until a Certifi- cate of Compliance has been is ed b t ' oard Signed 1k Date Z / Application Approved by en Application Disapproved for the following reaso Permit No. y ' �� Date Issued------------------------------- � f ^ -- _ . _. e'"Sel.'y.G^ 'Y4.w�v:.t71�-r'1.-rH-r^....4r.r r.r�.�.,,`... 0 ,.-��.. . ,. '.... •.•. _y.. ^ ... ; ;, Al...- • -- _. fro�' -,:�✓ ' Y" 41a,,5 r THE MMONWEALTH OF MASSAC4ETTS �t - - "' PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS 01pprtcattou for Mtgpool *pgtem Cou!5tructton Vermtt Application is hereby a e f r a�Permit,t Constru ( x)or Repair( )an On-site Sewage Disposal System at: - G, Location Address or Lot No. Owner's Name,Address and Tel.No. F 36 2, Z ! LG7—AM, 1 Lor�t3�92� t/L /YiG.ev BJ4D/ivG Co f �6,4n*srwe�,45 A/t 1F wlr yays A Installer's N4rne,Address;and Tel.No.—.;,- wvoy 1) �� Designer's Name,Add r ss and Tel.No.. ..�� � d �TType of Building: Dwelling No.of Bedrocros 3 Garbage-Grinder( f ` Other Type of Building No.ofs r ons .� Show r ( ) Cafeteria( ) ' Other Fixtures t Design Flow //40 ��o oern gallons per day. Calculated daily flow f 43 O gallons. w Plan Date f -/P -9J N mber of sheets / I/ . I_1Re�Ai`ssidn ��td r Title ,.Sl%G S4tt11?V:e /7 r0/1- /014XU49'4 g54o[?r = 01 Description of Soil -/Z LO. ' 1? 41'=/ e-- Via %.' Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: Th undersigned agrees to ensure the construction and maintenance of the afore des -ribed on-site sewage disposal system in accordance with the provisions of Title 5 oft Environment Code and not to place the�system in operation until a Certifi- cate of Compliance has been ' s ed b t ' oard o ' e th. Signed Date Z Z Application Approved by Application Disapproved for the following reason Permit No. f / �� Date Issued THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certtftcate of Comphance - THIS IS TO CE .FY that the On-site e Disposal System installed�__)or repaired/replaced( )on� ,�-oi"' A('- by � .'� ,t'.J ��.r,Gl�'c. /.a for as C- t•ter -c has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No dated Use of this system is conditioned on compliance with the provisions set forth below: ,rAr 0 ----- No. / Wf !———— ��._...•.�. �.._._ Fee �t�2 ��C—,----- � ) THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARN"STABLE., MASSACHUSETTS Mtgpogaf �&pgtem Cougtructton Vermtt Y ' Permission is hereby granted to i -"to construci(,Pl'r'epair( )an-On-site Sewage System located at ,.0 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 m st be compl within two years of the date below. l Dater Approved by i c i ✓� i z No.---------- --------- Fee--------- ----------- BOARD OF HEALTH TOWN Off' BARNSTABLE ZIpp[ication-for Vell Con5truttionpermit Applicatio is hereby made for a ermit to C truct ( ), Alter ( ), r Repair ( )an individual Well at: 00 Location — Address Assessors Map and Parcel Owner / Address / ��� -------------------- =� — � / - - i cr. h_ 1 ® - -- = Installer — Driller Address Type of Building Dwelling----- Other - Type of Building----------------------------------- No. of Persons------------------------------- — --------- ri Type of Well— - G -_-------------------— -- - O Capacity----------- 'cfG�'n Purpose of Well------------------------------------------------ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certifi of C plia ce b issued by the Board of Health. Sign -— ----------- ---- --- - --- - — ------- G date Application Approved By, -- -- _ _- -- -- -- ___----------- date II' Application Disapproved for the following reasons:-- -----------------—-------------------------- ----------------------------------------------------------------- date PermitNo.-- -- —--— — -- Issued---------------------------------------------- -------------- date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate ®f Compliance THIS IS T ERTI T Ife Indiv'd al�W 11 Con cted ( ), Alt r ( ), or Repaired ( ) by_---_---- ____ ___ Z Ins at-------------�— — --- -- � �� - -- - - - -A 14 has been installed in ac rdance li the rovisions of the Town of Barnstabl p e Boar f Healt Private Well Protection Regulation as described in the application for Well Construction Permit Nc Dated-----------------_----- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- --- ---—-- ---- ------ Inspector------------------------------------—--- - --— -x?r"'p;sw•,,,,.,r""d.'-�i..��,. ,,,,�� =,�'' '"'�'N�,,,,`,,,,,�.,v'�..�'Asa`1'�:ij'4e+�:c�i`�6�{'v'°'+"1"`�-�"=""'9r+�.ls-�...-..-.�+�`�'"""'�'("'".1r,��"�f V't -�Mr,-F4'�°"'`�t�' No.---------- --,------- Fee--------------------- '� BOARD OF HEALTH TOWN OF BARNSTABLE 0(ppCicat ion-*rVell Contruct ion Permit Application is hereby in de fora ermit to C truct ( ), Alter ( ), r Repair ( )an individual Well at: „^ Location - Add.-ess - Assessors Map and Parcel Owner Address -__�-__�- . �-------- -''c�`' — ------ � -�... c�:c- = Installer - Dnl.er Address Type of Building Dwelling------- - ---------- Other - Type of Building --- No. of Persons-------------------------------______-______ /y Ca acit "e! ,re'' Type of Well----------- ------------------------------------------ P Y------------- -------------------------- Purpose -- of Well------------------------------------------— --- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until. a Certific .of C : plia ce h b issued by the Board of Health. Signe --- - - -- ---- ---- -- ----- �----------- O date Application Approved By -- - - --- - --------------- date Application Disapproved for the following reasons:----------------------------- -------------------------------- date PermitNo. -" ---- —-- Issued----------------------------------------------------------------- -- date a.e..eu.w.�.,...�,e���s�.=.n..a..,.....ww.,-�...w+.a.�o..�..,n.a.....«+.a.........nme.�,m.,.osre.r��..va.�e..me d....�oo.�a..�r+.�-a•m,�:�v m..a�..sar -r BAYiD OF-WEALTH - TOWN OF BARNSTABLE Certificate (Of Compliance THIS IS;TTERT T t e Indiv'd ,all Well Con cted ( ), Alter ( ), or Repaired ( ) by--- �l � ��t �r -- - -- -- -- sa U� at- - -- - L -----------------------------------'-- has been installed in ac ordance with the provisions of the Town of B stable Boar f Health Private Well Protection Regulation as described in the.application for Well Construction Permit No."5----q_Dated------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--------- — — ---- - - --- -- Inspector-------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE VeCC �Congtrutt ion Permit No. - --- --- ----- r.. Fee-- - -------1-ag Permission is hereby granted '----__ --to Construct ( Alter ), or/ R/e�jair ( ) I d'vidu 1 We at/ as shown on th pli ation4fr as Well Construction Permit 9 No. ------ - � ---- -- - - Dated - z--- e --- ----------- ----------- -✓ ........_ Board of Health DATE-------_-- _-- __ _____-------____-- zr 0 �7 _'- Aiv - ._,1 —z�,2 4,0 —.. 3 ' -r- x33•" X �wet r z Zo, S x X ge-Of r 3Z, VAC,41 29 9 99, Z07 No. 1 y43� 871 s,F o 3° X29.8 x V.gc�NT �:R9f'/�//C SCALE /N SET O So /oo OA'A4se N/GCu 4. 4//✓IT ?f- Q lly.4itIW f; s G 9 Z .SD/GS Lt G,S d , 1 o TLFST /VD. 2 c MtN, 34 M/9ri:�YE/P o 37.s . . 9 ,/�� Mom►' LD c ,. ,. P,VG LDA�1 y suMP z p flMy ., 8 !3 7 - 4 ?VC M/N. /2 /NEE' �IMssiYv''�e�✓ Z �O�i�� 3 �9'� r�/� V. 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