HomeMy WebLinkAbout0028 GOOSE POINT ROAD - Health 28 Goose Point Road
Centerville
A= 252-049
No. 4210 1/3 ORA
ESSELTE
10%
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No. - `' ^Fiv
•~ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
01pplication for �Digozar *p5tem Congtruction Permit
Application for a Permit to Construct(►')Repair( )Upgrade( )Abandon( ) LJ Complete System ❑Individual Components
Location Address or Lot No. �� GOOSE np / �j, Owner's Name,Address and Tel. o.
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Assessor's Map/Parcel 0-5 y �,j a �k�n����7�a w-�—ATf4,dCe ,2 �/�
Installer's Name,Address,and Tel.No. 7 Designer's Name,Address and Tel. o.
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Type of Building:
Dwelling No.of Bedrooms Lot Size J�o sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 330 gallons per day. Calculated daily flow �3o gallons.
Plan Date I:Mq4 Number of sheets 21 Revision Date
Title
Size of Septic Tank 1!�Q® 6A• Type of S.A.S. ?eA/Gf
Description of Soil, U N0 t l f' e,f 45-
>t g yt
e
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 b this Board of Heal A,,,e
p Signe e#dG iWw, -17u '�/ r r e Date
Application Approved by Date
Application Disapproved for the following reas n - on
l o
Permit No. Date Issued
goo
0
fi THE COMMONWEALTH OF MASSACHUSETTS Entered Entered in computer:
� - Yes j
' PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
01pprication for Migoar *pgtem Construction Permit
Application f0r a Permit to Construct
Repair Upgrade Abandon 121C//om lete System
m El Individual Components
Location Address or Lot No. C� GOO$' �a� Owner's Name,Address and Tel.No.
�eGTii✓G�{vuJ�' T,e�sT T�Pvs�r.� �
Assessors Map/Parcel
02 S 2 a23JV Ti%✓GHovsF dvp r3 i31100, 4e-
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
y/"key C6a/sT/! o� "SAkr�2
0 �y
Os v/c-LC -
Type of Building: }
Dwelling No.of Bedrooms Lot Size / 90 sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures i
r !
Design Flow 30 _gallons per day. Calculated daily flow 330 --gallons.
Plan Date Number of sheets �� Revision Date
Title '
i
Size of Septic Tank /!5j2O 6,4. - Type of S.A./S. e - � s
Description of Soil s� ItUd SAND W 1 �o 6 ei �� I
III
Nature of Repairs or Alterations(Answer when applicable) 1
Date last inspected: j
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 Heal / ? .
Sipe a �12 // 6 /u� e e Date
Application Approved bytiX�Z4Date
Application Disapproved for the following reas /
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CE IFY, that the Sewage Disposal System Constructed'O Repaired ( )Upgraded( )
Abandoned )by
at - be constructed in accordance
with the provisions of Title 5 and the for Disposal System Cons ction Permit No. dated
Installer Designer
The issuance of this permit shall notbe construed as a guarantee that the syste. ill function as de xted.
Date_`�� z 7 -� Inspect
-------------------------------- -----�
No. �' Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Migpogat pgtem (Construction Permit
Permission is hereby granted to Co truct( Rep ' ( )U grade( )Abapdon
System located at (,✓
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:Constructtmpleted within three years of the date of this pet�Li..
Date: /77/<�Z Approvedby
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