HomeMy WebLinkAbout0081 HIGH SCHOOL ROAD - Health i 81 High`Sc
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No. �� . 1 •Gi Fee .v
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
2pplication for Mgogar *pgtem Construction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon(Y ) ❑Complete System ❑Individual Components
Location Address or Lot No. ,.��7� Owner's Name,Address and Tel No
Assessor's Map or
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
'��t-7 IAJ%k4b CA!4.
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) �
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 t to place the system in operation until a Certifi-
cate of Compliance has been issued this Board of Heal //
Signed Date /V
Application Approved by _ a Date
Application Disapproved for the following reasons
Permit No. Date Issued Z --�
61
No. --/ l Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Ot.p'.plication'for ]Digaal *potem Construction Permit
A lication for a Permit to Construct Repair Upgrade Abandon( ) ❑Complete System ❑Individual Components
PP O PO UPg (. ) P Y P
Location Address or Lot 'o. L� d ) !I Owner's Name,Address anA Tel.No
a^,4 fY it y�4 rG ' f,S�Z
Assessor' Map/Parcel �
r.
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.t ,
L_QLA 4ZJ Qr,t
- Type 611 Building: J
Dwelling No.of Bedrooms 1 Lot Size sq.ft. �GdrbagerGrinder( )
',§holders r
Other Type of Building No. of Persons (j.� )•,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 0 .-
Nature of Repairs or Alterations(Answer when applicable) u4 co
Date last inspected:
Agreement:
i 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 issuedt, this Board of Healt�i'�'—
' Signed Date
Application Approved'by Date '
Application Disapproved for the following reasons
Permit No. r Date Issued
i( ————————————————————————————————{——————
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
I` THIS I}�TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( ) Upgraded(, )
`s Abandoned(V )byAo 1 PK
at 45 0 '1 L, sC kA,o-Z " � has been constructed in accordance
with the provisions of Title 5 and the for Disposal S stem Construction Permit No. ". d dated
Installer C C� l�, Designer
The issuance of this permit sha 1 not b4construed as a guarantee that the sys 'll function as�esigne
Date r^� Inspector C� ��
j
h� E
Y r ----�—�j----- ---
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9Zr No. s Feel✓
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THE COMMONWEALTH OF MASSACHUSETTS -
PUBLIC HEALTH DIVISION- BARNSTABLE., MASSACHUSETTS
Migpogal,*p!6tem Con.5truction Permit
4 Permission is hereby granted to Construct(� )Repair( )Upgrade( )Abandon )
System located at (� 1 �( I&MI,
i
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 it. ;j
Date: a Approved bY4. �3f. -a�+ ""�/ / li�,r
f 5
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