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Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided r 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) V !7a-L 5e pTl G 7Arj le__. Tb Zisen s —its 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 H alth. Signed Date 45 1 Application Approved by p Date Application Disapproved by Date for the following reasons Permit No. ePal r—.017 J Date Issued I 00 No. Fee ._ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplitation for Disposal 6pstrm Construction Permit - Application for a Permit to Construct( ) Repair() Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. t 9096A' E A- '' Ow,jter's Name,Addre s,and Tel.No. G�ni t1 ttUi 1�NN Assessor's Map/Parcel u.�"' ,� I�(� fi I N In ller's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. I��i tee+OLA-S A. _TAro4" ..- 508 3`-+-�757 Type of Building: �1 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 �— d gP 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) M G( EVr4 £' C_ -T-iA%/VL 6e*tA SSA 1, PTI(- -f lr►Imo- `9 1 M ?D�S( t.E� l-t Ar lL =K1,5Tpr t ,. 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 of H alth. Signed &4 DateA 'Application Approved by Date O ' t l 2 P Application Disapproved by Date for the following reasons Permit No. golf i;L7 5 Date Issued THE COMMONWEALTH OF MASSACHUSETTS t -.r— BARNSTABLE,MASSACHUSETTS '✓� (Certificate of (Compliance THIS IS TO CERTIFY,tit the On-site Sewage Disposal system Constructed( ) Repaired(V)- Upgraded( ) Abandoned( at �p ( has been constructed in accordance Q / with the provisions of Title 5 and the for Disposal System Construction Permit No d at-97 dated Installer Designer #bedrooms �— Approved design flow gpd The issuance of this permit-shall not be construed as a guarantee that the system will function as d signed. Date ` ` Inspector ------ -�--/------ =_Fee THE COMMONWEALTH OF MASSACHUSETTS U PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal &pstem Construction lermit Permission is hereby granted to Const ct( ) Repair( ) U -ade( Abandon( ) System located at (Of ( _ and as described in the above Application for Disposal System Construction Permit. The applicant recognized hi.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 Date D Approved by r�