HomeMy WebLinkAbout0346 GREAT MARSH ROAD - Health 346 Great harsh Road
Centerville
A= 190,170
INISMEA C.aJ
No. H163OR
UPC 10259
smead.com • Made in USA
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No. � Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
application for 3Di5pogA1 �&pgtem Cott.5truction VCrmtt
Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. ly� Owner's Name,Address,and Tel.No. j/
Assessor's Map/Parcel � O
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.fr. Garbage Grinder ( )
Other Type of Building `P 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) GZ ��� c3'��f c /i✓ �.lZ cry
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 Boar f Pealth. -7
Si e C� Date -
Application Approved by Date Orl
Application Disapproved by: Date
for the following reasons
Permit No. ! ued
------ -- ---— - ----- ————-- — - -
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ZipplicatioH for ]h5pont 6pztem CoH$truction 3permit
Application for a Permit to Construct( ) Repair(�ade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. �� 4r/yJ�(�L�1�� Owner's Name,Address,and Tel.No. `
Assessor's Map/Parcel 17 4 AZ
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
)✓welling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( )
Other Type of Building �� `P 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 r Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)/C
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 Boar f ealth. -07
Si ed lJU 119, Date , d
Application Approved by �/f / Dated rl
f�
Application Disapproved by: / �' Date
for the following reasons
Permit No. Date Issued -
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance.
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired Upgraded ( )
Abandoned( )by k7T� 4Y L 4164'&'044'G*40C-
at 3 � C� -��`�✓� <20/I as been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer Designer
#bedrooms Approved design flow gpd
The issuance of this permit shall not be construed as a guarantee that the system will fu function 8 designed.
Date tS,r Inspector
--------------------------------------------
No. r� D� Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS
Migoal 6p!5tem Cow6tructioH 'Permit
Permission is hereby granted to Construct ( ) Repair (.Upgrade ( ) Abandon ( )
System located at d eetc`e /fii�Ot'-r� �'d' �`�✓
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: Construction must °e competed w' hin three years of the date of this permit.
Date / Approved by a