HomeMy WebLinkAbout0681 BAY LANE - Health PF 681 Bay Lane
Centerville
A= 188-069
/// FsM EA6
Na 245K OR
UPC 12534
smead com • Made In USA
.
No. D U J' C. q Fee /00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Application for Migoal *pztem Cow5tructfon Permit
Application for a Permit to Construct( ) Repair K Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. (Al GA Lon e Owner's Name,Address,and Tel.No. C4r4 4�0-L 1
Assessor's Map/Parcel 1
Installer's Name,Address,and Tel.No. �� � '' Designer's Name,Address and Tel.No.
7O aax ?r.,
Type of Building:
Dwelling No.of Bedrooms �j 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 �� ,n L Type of S.A.S. 6V0. rC-
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) Pe C,o ems,
Date last inspected: r
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 l' ZO b(;
Application Approved by _S Date 1 r 200
Application Disapproved by: Date
for the following reasons
Permit No 2006P 0 q- Date Issued 9 1 — Q 1
No. Fee �0V
J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: /.
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
application for �Ditpoal *p5tem Congtructiou Permit
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System p❑Individual Components i
i
Location Address or Lot No. (p$, QA,( L4 n e Owner's Name,Address,and Tel.No. C 44w
Assessor's Map/Parcel
c
Installer's Name,Address,and Tel.No. C.4 °u�/� �����f 5 r� Designer's Name,Address and Tel.No.
�0 3Ox -7
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
i
Title
Size of Septic Tank �e a pn,L Type of S.A.S. OV."r-1,�Lj pit LeAX'
Description of Soil 1A
Al /114
Nature of Repairs or Alterations(Answer when applicable) 1 C e p ;V',I A t IC ca"O ems,
Date last inspected:
Agreement: 1
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,w Certificate of
Compliance has been issued by this Board of Health. Q
Signed Date
Application Approved by .s Date
i
Application Disapproved by: Date
for the following reasons
Permit No. ZQ Q' 2 Date Issued
--------- -- - - -
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sew a a Disposal System Constructed ( ) Repaired (7G) Upgraded ( )
Abandoned( )by
at (p{� A.�, ( tq.,gyp, ��,�,�-si \L•. has been constructed in accordance
with the provisions of Title 5 and the fo Disposal System Construction Permit No 00 q- % R dated
Installer t(),� Designer
#bedrooms Approved design flow gpd
The issuance of this permit hall not be construed as a guarantee that the systme >wil'l`funetion�as-designed.
Date / J 9 InspecC_-A �1.�-
No. 4— - Z {'( 0 IN 1 �� 1 � ; !k. � �� t..% y Fee
THE COMMONWEALTH OF MASSACHUSETTS
- PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Migoal *pfstem Coufstructiou Permit
Permission is hereby granted to Construct ( ) Repair (x ) Upgrade ( ) Abandon ( )
System located at 6P)( �Bo,_., &-,,.(,.. \e—
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title S and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this pertnit. �J
Date — 00 04 Approved by / ,