HomeMy WebLinkAbout0224 GREENWOOD AVENUE - Health jf
j 224.Greenwood
Hyannis
`A = 288 - 175
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No. D Fee
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THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
ZippYication for Misposal 6pstem Construction permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) AbandonX ❑Complete System El Individual Components
Location Address or Lot No. 2 Z�' [rt�,, G Owner's Name,Address,and Tel.No. ���
Assessor's Map/Parcel 2 Y9 17
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(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) Q:3 r4ni7I-, _5�J4'�
Date last inspected: U �,N
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 nne
' oard of Health.
S .P Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. Date Issued
7e?
No. D �!/\ Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
2pplitation for Misposai 6pstrut Construction 30-ermit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address,and Tel.No.
` Assessor's Map/Parcel 17 j r lY� L�t"T�dV?
Installer's Name,Address,and T61`.No:- x. Designer's Name,Address,and Tel.No.
f!Lip2r,J,�R lsh�'a�•� o� LLB ? -��67'1 /'7
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(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) k'c 'Ca
i
Date last inspected: U h V_,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. w
Date /
Application Approved by �,�y l f v /� Date
Application Disapproved by v V \ V Date
for the following reasons
v
Permit No. .ram Date Issued—! I
---------------------------------------------------------o----------------------- - -
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
Abandoned Y4 by (�4 S
at A'vc ( v,;5 has been constructed in accordant
with the provisions of Title 5 and the for Disposal System Construction Permit No. d at d
Installer � � �9.e �-t r,/l v LLc- Designer "l t�F
#bedrooms Approved des! flow 7 ', and
The issuance of this e it shall no be construed as a guarantee that the system 1Nfunon degil ed.
Date Inspector �'/l'
- - V-- ='� r V V----------:
---------------------------
101�
No. / 0ay
Fee
C/ ' THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS
Misposal .6pstetn Construction i3ermit
Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon(�)
System located at Z. o b J tkn v► ,S
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 / Approved by {