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HomeMy WebLinkAbout0577 LUMBERT MILL ROAD - Health (3) umhe � 1 No. �Q i Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for Vsposal *pstem Coustrurtiou hermit Application for aTermit.to Construct( ) Repair( ) Upgrade( ) Abandon O� ❑Complete System Vdividual Components Location Address or Lot No. ,;a 7 1 ,M'"I I Rd.•; Owner's Vame,Address,and Tel.No. Ce.,,ieo-v1Ve 'MA OL63.Z t►�q„iCt 104*1 0c/41-14s Assessor's Map/Parcel f Installer's Name Addressennd e1:No. 77 y 4/e7 7-s'F7 Designer's Name,Address,and Tel.No. -W. ZiveIA4 z 7s 4o 6n,d Oas. Y �A ;�,r z 6 y Type of Bui ding: AX t 0IV"C4Aletom^c G ,yKalG.c�.^" Dwelling No.of Bedrooms Lot Size f . 7 9 Asq.ft. Garbage Grinder( ) Other Type of Building _��, ,,,,/y No.of Persons Showers(2 ) 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 30l M d Nature of Repairs or Alterations(Answer when applicable) A b ando-0 AV" 1RZ,4n iIC441A �e� �.,fiV8 lMs62G�!¢7�n , 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. Signed *, . ' Date 122 02-2 ZZ Application Approved by tAf 4=e 2j Date a g 202 2 Application Disapproved by Date for the following reasons Permit No. Date Issued `� " '22 ,...� ---------------------;.. -w- -----------------------------------—____— --- - - -- -- - - -- da vmf No. � l� f �" z Fee . THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes y PUBLIC_ HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS apphcatlon for MispoBal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon O ❑Complete System P'Individual Components ° Location Address or Lot No v lk� try! Owner's Name,Address,and Tel.No: Assessors Map/Parcel L r Q t Installer's Name,Address,and Tel.No. 7,7q 1-1?7 7s ?7 Designer's Name,Address,and Tel:No. Type of Building: "IC4,n pi,;Ac �'' �, M^s/t.c.�.r^ Dwelling No.of Bedrooms Lot Size 1110 a c sq.ft. Garbage Grinder( ) Other Type of Building S j%ole TA-",/r No.of Persons Showers(2 ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date r, Title l� r i Size of Septic Tank ! Type of S.A.S. Description of Soil S(A,m t) Nature of•Repairs or Alterations(Answer when applicable) r �^ k��ir�. .�, �'�$`�c''�,�:�a:.r.�,«, � � �a��e�?..��,��•�rd�€°,'��c�� �'�.yt'2"° f r � � I 1 � ,� Date last inspected: Agreement: S 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. Signed } � Date �'-©2-2c2 Z Z Application Approved by A t ,�(T,� A,41 Q � Date' .2 --- cj --,?U;� 2 Application Disapproved by Date for the following reasons Permit No. ',Z-4'Z 2 L, (� Date Issued 2 ' yr Sy - 4 � ` THE COMMONWEALTH OF MASSACHUSETTS , ° ^ BARNSTABLE,MASSACHUSETTS K n Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned(j)by 41 .ma c at ", )1 RJ , has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. - 22- dated .9- ' 2.2 Installer �y�,�./Y'Y�t!C /✓. C��iy�44 Designer #bedrooms /�/,Y Approved design flok�i 9 i/J gpd The issuance of this permit shall not be construed as a guarantee that the system w4ill function as designed. ! �� Date �..I.� � � � � Inspector ,,.I��" C1 �A 1 �. No. Fee I THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Mispoe-al bpstem Construction Vermit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon(61) System located at 5.-.-7 � (-,w„��2e t r !1^ }� A� r I, _/E Q 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 permit ��� Date ? a1��1� Approved by ,l / b�