HomeMy WebLinkAbout0121 BEECH LEAF ISLAND ROAD - Health (3) 1s L
17 - 06/3-- 00/
S M EAD
KEEPING YOU ORGANIZED
No. 12534
2-153LOR
SUSTAINABLE
E FORESTRY MIN.RECYCLED
INITIATIVE CONTENT 10%
CerdfiedFiberSouraing POST-CONSUMER
www.sflprogram.org
SR01290
MADE IN USA
GET ARGANI7.EAAT SMEm.Gom
C4 ,(to /
No.�T hD�+ 3 l t' Fee f ,o n
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: .
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
RppliLation for MISp08al *pstrm Construction Vermit
Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System Xindividual Components
Location Address or Lot No.I a I oa:aAq X544b Ab Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel TAGGn A` — ��(r
Installer's Name,Address,and Tel.No.5D16 77 2F87 7 Designer's Name,Address,and Tel.No.
zrl
Type of Building: A-/L
Dwelling No.of Bedrooms ` Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
r
Other Fixtures
Design Flow.(min.required) 10+� gpd Design flow provided iv 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) R6*Z�O(
l-t r l Rdk �tJ M It 492IM4 l 9a)GW, "rie,7 eJ
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 Environme de and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of H th.
Signed 4&Zz ; Date —X3 X6.-X
Application Approved by 44: Date (�2 6
Application Disapproved by Date
for the following reasons
Permit No. '9_0 3 0 Date Issued 6
No. C3� ! a r Fee ! �0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLENMASSACH,USETTS
Af4prication forlDisposal*'*stem- tt rnitiSZ
y . Application for a Permit to Construct( ) Repair( Upgrade-( ) Abandon(/ ) ElComplete System , Individual Components ro
Location Address or Lot Nol;t I QE'N 444 XY44b, P�> Owner's Name„Address,and Tel.No.
M "t fdl ej "•
Assessor's Map/Parcel'
Installer's Name,Address,and Tel.No. �{'77 $$?7 Designer's Name,Address,and Tel.No.
{L�C9�.i Pi Utz CO .
Type of Building:
f
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( ) w r
Other Fixtures /► t
Design,Flow(min.required) gpd Design flow provided dN/f gpd
Plan Date Number of sheets Revision Date
Title_ "
Size o''f Septic'Ta&, Type of S.A.S.
Description of.soil
ry
Nature of Repairs or Alterations(Answer when applicable) R6WO(,,6 -/A 16c 6V4L5' (
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction an,d^^mamtenance of the afore described on-site sewage disp4osal tsystern in
accordance with the provisions of Title 5 of the Environmental'Cpde and not to place the system in operation until a Certificate of
i
Compliance has been issued by this Board of Health. -
S — b�
Signed Date ' �,Application Approved by 1 r_ ,^, 1 , Date
Application Disapproved by V Date
for the following reasons d -
Permit No. ?0 r , Date Issued
--- --•---• -----
U P TFIE COMMONWEALTH OF MASSACHUSETTS '
F_6J r °� �'-BARNSTABLE,MASSACHUSETTS
`CErtificatfof Compliance
- THIS IS TO `ERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(x) Upgraded( )
Abandoned( )byXt.`I
at LpZ( �Elt{ 15CA66-h 'Ut 4t it has been constructed in accordance
with the provisions 5 and the for Disposal System Construction Permit No.-tad 1, 31� dated
Installer oar A 0.3 P-C n Designer WA //� �
#bedrooms k�! �� Approved design flow �
!'7 gpd
The issuance of this permit shall not.be construed as a guarantee that the system wifi functi nr�igned.
Date Inspector ,.--�.
_.. x
No. ��� (_ 3 i� -•--•--- --•-•--•Fee
., " THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
]Dispo5al *pstem Construction Permit
Permission is hereby granted to Construct( ) Repair(X) Upgrade( ) Abandon( )
System located at (/Z( ZR34 C-•�i 1 $L)LLL�=�
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 yearspf the date of this permit.
Date :pPproved byVW
' f a