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HomeMy WebLinkAbout0017 EBENEZER ROAD - Health (2) SUU ® ��J��CVC(fp�a s� PC 12534 No.21_63LOR HASTING8.YN a � No. `-1©�f Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Nsposal 6pstem Construction permit Application for a Permit to Construct( ) Repair X) Upgrade( ) Abandon( ) ❑Complete System XIndividual Components Location Address or Lot No. 1-1 E�tl�-ZC - U Owner's Name,Address,and Tel.No. Assessor's Map/Parcel _ 0 , • $ 3 Installer's Name,Address,and Tel.No. esigner's Name,Address,and Tel.No. s8h 114-M-00qe -- 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) _ K/ 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) arc l-t t ffiau_ t i {- = 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 e E ' onm Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board He t Signed Date Application Approved by J Date a Application Disapproved by Date for the following reasons Permit No. �� oZ l� Date Issued t No. ' 2�•� ( , Y + Fee THE COMMONWEALTH OF'MAS'SACHUSETTS Entered;n computer: i/'r-•+ PUBLIC HEALTH DIVISION TOWN:OrF BARNSTABLE, MASSACHUSETTS Yes 2pplication for Misposal Wpstrmi ConBtCUction.i3ertnit —rl� , r a Application for a Pertn't> to ConsflructA( Repair�( L�Ty�grad�,( Abandon( ) ��Complete Systems mi]Individual Component ku X TLocatibn Address or Lo No. YYt'i t ��� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel I V'7_ 0 ?" (� Z_ , ��; Yl �l l ' E�t0 ' "( G ► Installer's Name,Address,and Tel.No. (-tea 54?et-e[t Designer's Name,Address,and Tel.No. L% s "�-- Type of Building: s- Dwelling No.of Bedrooms 1� ��w Lot Size sq.ft. Garbage Grinder( ) Other Type of Building s, ' ` No.of Persons Showers( ) Cafeteria( ) ' Other Fixtures I. _ „'. Design,Flow(min.required) gpd Y Design flow provided f\ I't f gpd #Plan -Date Number of sheets Revision DateTitle + t Size of Septic Tank Type of S.A.S. Description of Soil a 'Nature of Repairs or Alterations(Answer when applicable) ♦ A i1 -�- Date last inspected: J �£ 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 Etivironmetffal Code and.not to place the system in operation until a Certificate of `` � A r Compliance has been issued by this Board o`f Health! Signed ,^-w 1`1 -W _ t Date Application Approved by r tt Date Application Disapproved by Date for the following reasons Permit No. `�' ' . t�r Date Issued 2,P6 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CE/RTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by at �� �- �{n Q 7�{ p(�� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ,2 /^.2 Updated 6 Installer �t�l jh !((�l� �h t 4.r C Designer #bedrooms iJ3" g Approved design flow )y gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed! Date ;Z Inspectorc� No. �g Fee 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Oukr- . v_ Disposal bpstem Construction 3permit. 40, Permission is hereby granted to Construct( ) Repair O-....; Upgrade( ) Abandon( ) System located at ! w 1-7 L-[9tnfIfy V_w0 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. ,r Provided:Co n�truction must be completed within three years of the date of this permit., �4 1r Date Approved by a ...r