HomeMy WebLinkAbout0032 SEAN'S CIRCLE - Health (2) 3a Weans C 'ic Fe Ce.�- .
f'7o /05---7 1069
'p No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS
rjoI 1 � Application for Mig ozar item Conelruction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.y
(_._®� Owner's Name,Address and Tel.No.
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
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 gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type,of S.A.S.
Description of Soil 4 AAO
1
Nature of Repairs or Alterations(An wer 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 Certifi-
cate of Compliance has been issued by this Board of Health.
Signed Date
Application Approved by Date
Application Disapproved for the following reasons
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( ) Upgraded( )
Abandoned( )by
at has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer Designer
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Date Inspector
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
lwigpogar *p5tem Construction Permit
Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( )
System located at
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes 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: Approved by
23 5
,t,No. Fee
/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
} Yes
qio .' PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS
ID b�� � fication for i5 ool stem o t
0 � �� � � �p � ngtructton �errrtt
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
r
Location Address or Lot No., Q ^ Owner's Name,Address and Tel.No.
Assessor's Map/Parcel..
�
f
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
i
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 gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
i
Title
Size of Septic Tank Tvnee of S.A.S.
Description of Soil 4 00 `
ti
Nature of Repairs or Alterations(An wer when applicable
i
Date last inspected: `. 1
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 Certifi-
cate of Compliance has been issued by this Board of Health.
Signed Date
Application Approved by Date
Application Disapproved for the following reasons
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS '
BARNSTABLE, MASSACHUSETTS
G —^ Certificate of (Compliance
THISIS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( )
Abandoned( )by
at has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
' Installer Designer
The issuance of this permit shall not be construed as a guarantee.that the system will function as designed.
Date Inspector
�II
—————————-——————— —————————————---—————
E,
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS -
PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS .
Mj5po5a[ *pkem ConfStruction Vermit
Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( )
System located at
- i
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to.
comply with Title 5 sand the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date;of this permit.
Date: Approved by
19q 75 TEST HOLE
I - .,....�--•-'�"' MARCH a 3,/9 7-7
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PROP /
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'
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PROP "
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100' WIDTH \Q� TOWN I.JATER AVAILABLE
--........ 35.00
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