HomeMy WebLinkAbout0152 HORSESHOE LANE - Health (2) ■■■■■■■■■■■■■■■■■■■■�■■■■■�■■�■■■■■■■■■■■O■■■�
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No.�(b_2] i��b Fee . s
s THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Rpplitation for Misposal 6pstem ConstrUttion permit
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) [:]Complete System R1 Individual Components
Location Address or Lot No
ls'a ® s-6 Owner's Name,A ress,and Tel.No.
Assessor's Map/Parcel-J&7 09 Cen-ttwik_ AfA
C�bnd�d1tress,�hd el.Neo1.�j;>r5�-lye�s�-ry�� ' Der's e,Address,and Tel.NInstaller's esgnN/ o.
c��3vx .c, reP�
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
Title
Size of Septic Tank e_1A 1[!j Type of S.A.S. CA s�jt q
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) / !"r d -
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 Zdand t to place the systemin operation until a Certificate of
Compliance has been issued by this Board of Health.
Sign / Date
Application Approved byZj24� elDate :>--
Application Disapproved by Date
for the following reasons
Permit No. 2� �� Date Issued
L_�=�- ----------- ------- - - -- ---- _ ------
----------
i
No. 1S 2 /, Fee ✓
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes �•
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
Rppfication for Misposal *pstem Construction 3permit `
Application for a Permit to Construct( ) .Repair('Upgrade( ) Abandon( ) ❑Complete System ®IIndividual Components
� + 0
Location Address or Lot No. 1S/ Hot �f_ &t Owner's rN�a"me,Address,and Tel.No. �_ o� . l�/f
Assessor's Map/Parcel.45?7 A lm�� /��lY��r���'��/ �,J �/� l�►5'Q f�
Installer's Name,:Address,and Tel.No., e,>5• � j�� Designer's Name,Address,and Tel.W.
LAA0"P; CA4,YA Ay c�slrfA Y)W• A11
Type of Building- r
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
Title ii
Size of Septic Tank e Xr s Type of S.A.S. C"_
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) A0.014,0 P drS t`A ty-4 lra Ir". v e ,l L'. X,a
lk r
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 Envirorunental Code'and of to place the^system,inf Aeration until a Certificate of
Compliance has been issued by this Board of Health. ,
Signed,..-.,,A t w 1 Date
Application Approved by w<,,. �;1, fi �t Date -4/ /A.-/
Application Disapproved by'�'`(V_ y�`•�L . ;. ,1 A-) t s' 11 t Date
for the following reasons
Permit No. •Date ilssu88ed? � �(
-----
r THE COMMONWEALTH OF MASSACHUSETTS
Vile 61" °I( BARNSTABLE,MASSACHUSETTS
Certifirate of Compriancr.
THIS IS TO CERTIFY,that the On-site SewageDisposal system Constructed( ) Repaired(�) Upgraded( )
Abandoned( )by 1/ira,r -/: t �i,v,<
at 1�_ Hrarr.ova " 7 ,f � ( ,a,„ ���f�p has been constructed in accordance I /
with the provisions of Title 5 and the for Disposal System Construction Permit No.�o�l a'7 J dated -7//aZ.)
• Installer 9111
rs ��.� It, LAr,.� /129 �".-,/• Designer w1A
bedrooms K/ Approved design flow t✓J/Z gpd
r The issuance of this permit shall not be construed as a guarantee that the system wil�lfunction as designed.
Date - ` Inspector ,,n.: ✓` {• a
No. 2'0- f- :2-70 Fee - )
THE COMMONWEALTH OF MASSACHUSETTS `
PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS
Misposar *pstrm ConstrUrtion J)ermit
Permission is hereby granted to Construct( ) ]]Repair( s1 � Upgrade( ) /Abandon( )
System located at ok-Anf o X-2a d//�P
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 years of the date of this permit. .^� 1�Y• J
Date -7I//V Z-A ( Approved by �d
a-
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t