HomeMy WebLinkAbout0044 CHASE STREET - Health j'21F Cross,'Street; Sewer Acct # 4280
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21 Cross Street Sewer Acct# 7740
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No. �(Q3 �' Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in compute: 1/
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PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
ZippYication for Dfi5poml *p5tem Construction Permit
Application for a Permit to Construct( )Repair( )Upgrad )Abando ) ❑Complete System ❑Individual Components
Location Address or Lot No.�_` Cross �1. �VIA%S wner s Name,Address and Tel.No.Z
Assessor's Map/Parcel 30� Zyy �A-�� ,�
("Oil t� 's
I taper's Name,Address,and Tel. o. 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
Nature of Repairs or Alterations(Answer when applicable) V /A C 7e-,
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 of t e En nmental Code and not to place the system in operation unti a Certifi-
cate of Compliance has been issued by thi Bo d of e th. /
Signed Date ` U
Application Approved by Date
Application Disapproved for the following reasons
�—�a / 3 J Permit No. l � 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
LOCATION SEWAGE PERMIT NO.
VILLAGE"
•
T
INSTA LLER'S NAME & ADDRESS
OR OWNER
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED
Aj
t pro �
Z
C
F ANo. '-2_0Ol';7 163
' �`',� � a �°, Fee
- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer•/
Lis
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
f ricati"on for ;Digpozal 6p.5tem Construction permit
Application for a Permit to Construct( )Repair( )Upgrad Abandon ) ❑Complete System El Individual Components
Location Address or Lot No. f Cr�SS E caner s Na
y� me,Address and Tel.No. r
_ �c�nn1S �c ..L �
Assessor's Map/Parcel 'Z .� `• t �, kviQ,T,Rf�s
Installer's Name,Address,and Tel. o. Designer's Name,Address and Tel.No. J
(`�pCxVln to., 1 Cur.�J
(A G c ,n1 , �l l i p , !'1'1 u ,
Type of Building: r,
Dwelling �eNo.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
� -7�' a�r)�c - on ,�..uc �s.+.c,�2r` 1--�--/- n P✓'`� �';�",� IC b' M4 r o
Nature of Repairs or Alterations(Answer when applicable) ! V /?� ;Frca t Sap�c
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 t e Env rotmental Code and not to place the system in operation unti a Certifi-
cate of Compliance has been issued by this oar of /
Signed Date ( G DJ
Application Approved by " Date
Application Disapproved for the following reasons
Permit No. <—a a ( Date Issued ,) I
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certiftcate of Compi ance
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 - BARNSTABLE, MASSACHUSETTS
If 6poal 6pgtem Con!5tructiQn ermit
Permission is hereby granted to Construct( )Repair( )Upgrade( Abandon
System located at 1 C r
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: /�t Approved