HomeMy WebLinkAbout0010 OAK STREET (CENT./W.BARN) - Health 7T9=
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10 Oak Street
Centerville
A= 173-006
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No. 4210 1I3 ORA
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No. 01 C.�—O F-0 Fee
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THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
21pplitatlon for 3DispoSal 6pstem Construction 3permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon ❑Complete System ❑Individual Components
Location Address or Lot No. DO l7 Owner's Name,Address,and Tel.No.- 1
Assessor's Map/Parcel U CP�J�C/Zul1/,/> /L'f P D C—rO Z D11VjJ
I staller's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
el I '6105 j Ps O A pV. 9,ew) 4,a7
V,
Type of Building: "a/AS
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 Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
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 Board of Health.
Signed Date
Application Approved by _ Date %l!Z�ZG i2
Application Disapproved Date
for the following reasons
Permit No. Date Issued �,
` No. . O'Z—O Z 0 Fee 1G�.�' u�
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
01ppIication for Vsposal 6pstem Coustruction Permit
I' Application for a Permit to Construct( •) Repair( ) Upgrade( ) Abandon X
ElComplete System ❑Individual Components
j
Location Address or Lot No. 1 7 3, D U Owner's (Name,Address,and Tel.No.
Assessor's Map/ParcelA /�X�� �pn1�CyZ���: /L V. el fJ�f J� G Z-.D/Lv/t)
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
r Type of Building: (�2L45
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
r
-° Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures }
Design Flow(min.required) gpd Design flow provided gpd j
i Plan Date Number of sheets Revision Date j
Title
i Size of Septic Tank Type of S.A.S.
i Description of Soil
Nature of Repairs or Alterations(Answer when applicable) `
Date last inspected: j
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 Board of Health.
'r
Si ed Date
Application Approved by Date /�/Z�Zoiz
Application Disapproved - Date
for the following reasons
Permit No. Date Issued
i
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
Abandoned( ✓Sby
at has been constructed in accordance
'With the provisions of Title 5 and the for Disposal System Construction Permit No.00 I j DZO dated j 'I Z 'Zo►Z
P �
Installer Designer
#bedrooms Approved design flow gpd i
` n The issuance of this permit shall not be construed as a guarantee that the system'will function as designed.
Date f�A CKf 1 C%"� Inspector _ --
----------------------------------------------------=----------------------------------------------------------------------------------
J
No. Z D I Z — O Z O Fee Z7 _
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal ,6pstem Construction 'ermit
Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon(v�
System located at 119 OAK 15T C EVuT
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.
l +
Provided: onstruction must be completed within three years of the date of this permit.
Date 1 I Z J Z a 1 Z Approved by
t.
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