HomeMy WebLinkAbout0216 ANNABLE POINT ROAD - Health 21.6 Annabelle Point .Road
Centervi Ile
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20 CONNERP CENTERVILLE
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UPC 12534 a
No. 2-153LO(
HASTINGS, MN
No. —2 Fee l 4 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS YeS
2ppl.Cation for ]Disposal *pstem Construction VPrmit
Application for a Permit to Construct( ) Repair(,)c� Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. ;t i(o A. n Owner's Name Address and Tel.No.
P , TE^hdC1r
Assessor's Map/Parcel V,V i t) O c,-Z
Installer's Name,Address,and Tel.No.(�qP ��� Cat ��.� Designer's Name,Address,and Tel.No.
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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(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
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 Certificate of
Compliance has been issued by this Board of Health.
Signed SignedA sz= Date
Application Approved by Date :.
Application Disapproved b Date
for the following reasons
Permit No. 2 Ut1 C1 " 2 7 Date Issued ��� -
• -�' :,, _..-.. ,max _-... r r„ ...r,- .y n f, .3.-.3-.-....-`n..>*t;,�+,in.:-Ff.+w. .a+"'4 -•.. - .. _ t.., � -
No. / - 1 Fee ( y U '
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
2pplication for Nsposal 6pstem Construction permit
Application for a Permit to Construct( ) Repair" Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. aZ t (o A#n a ge i/c po,;,f R t) Owner's Name,Address,and Tel.No. h L 4=Tow i
VIV 2tbAnn,03¢tIQ �. .
Assessor's Map/Parcel I I p o-Z �, u P
Installer's Name,Address,and Tel.No.C Apt,cog IEv�ri s-> Designer's Name,Address,and Tel.No.
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C .t-f-
Type of Building: Cc
N � C� u� ry
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) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date f
Title
Size of Septic Tank Type of S.A.S.
--Description of Soil
Nature of Repairs or Alterations(Answer when applicable) 04'-P I A-U-- / 111� W 2 J 5.+�
T �,2SG Ono
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. G
Signed SignedA A Date
Application Approved by C�:0 PC Date )C'
Application Disapproved b Date
for the following reasons
Permit No. 2 Urt ci ^ 2 2 Date Issued
u. rip THE COMMONWEALTH OF MASSACHUSETTS �
iC�P Y BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(&L Upgraded( )
Abandoned( )by C AA j i U oa Ay,-5 eu
at 2/t:., Q,%n r4161 t ec,,,IT (2,oP4 has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.�?W5-?79 dated —U
Installer �,��dLA L-tl)-V gyp,, (,,.l,L. Designer
#bedrooms �AIIA- Approved desi flow A/ ,/� gpd
The issuance of this permit sliall not be construed as a guarantee that the system will fwncti n`,�s designed. (f
Date 1 () Inspector
No. yU GI 2-7 Z Fee I0�
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposat *pstem Construction Permit `
Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( )
System located at aZ 16 Ann q bl,C- Po -T
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 completed within three years of the date of this perm. n�
>p
Date /? b/U Approved by J /
t / ci-