HomeMy WebLinkAbout0191 OLD POST ROAD (CENT.) - Health C',e 17 r e v V-- / 4- 4, .� I
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No. �(! Fee :2 r
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
01ppliLatlon for Misposal 6pstem Construction permit
Application for a Permit to Construct( ) Repair(/ Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location�Ad�s�or 1�Lot No.\CA\ �j��- P��C � �1��11��jt Address,a�Tel.No.
Assessor's}Map/Farce Z 1
I,nstaller's Name,Address,and Tel.No. ,71')k- g-fit --CX)C-Z Designer's Name,Address,and Tel.No.
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Type of Building: 'n,
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) TJ I,� 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) eV, V O
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 Hea 1
Signe I Date 16 ZC-A 12
Application Approved by !C Date 1
Application Disapproved by Date
for the following reasons
Permit No. a� — �� Date Issued
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No. — �-i(P Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: A,
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
Application for -Misposal 6pstem Construction Permit
Application for a Permit to Construct Repair 4 Upgrade Abandon pp ( ) p ( ) pgr ( ) ( ) Complete System Individual Components
Location Address or Lot No.\G\\ Qa.A Owner's Name,Address,and Tel.No.ra ,� ,
Assessor's Map/Parcel?pC,\k C -L�QCa2»
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Type of Building: v
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) V)A gpd Design flow provided /l/�✓1 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 0 C r�4. V,
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—, A e d'f ,..�'`� Date
Application Approved by 14- Date
Application Disapproved by \ 7 Date
for the following reasons
i Permit No. -9.a. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BA ASTABLE MASSACHUSETTS l
Certtificate,of Compliance .. Y�`
3 Fty ,' L 1,.
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired;`(` )t ;.Upgraded( )
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Abandoned( )by lit a%CV\<. f'� ,yr �e�r.r� -'� P � + z ,w++'00, �
........
� has been constructed inyaccordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.D.e2/ 9t-p dated-"1
Installer;'�,, r r �'_�f , ,r,e +C✓(1 Designer J
#bedrooms` AlP A Approved design4low /1 k1 dir;( ;\`�""\ U gpd
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The issuance of this permit shall not b"construed as a guarantee that the system function as de igned'
Date ( / Inspector ''
No. I F! Fee -7
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
,;;,.w Mispo$al *pstem Construction Permit
Permission is'hereby granted to Construct( {)� Repair O Upgrade( ) Abandon( )
System located at ��\ ,.Qfj.° C 1�` /,.� ( C� �{U A'r
y
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.
Date ( ! ; L f Approved by t OA