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HomeMy WebLinkAbout0195 LINCOLN ROAD - Health 195 Lincoln Road _ Hyannis A=270.—035 i i i I No. (/ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0(ppiication for �Digool *pwm Comaructiou Vermtt Application for a Permit to Construct( ) Repair(Q Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. S Li rt C o 1 rt (l,o Owner's Name,Address,and Tel.No. VVA i j-oS Assessor's Map/Parcel 'Z?t] C 31 S AA Installer's Name,Address,and Tel.No. GA Pia L� �5 Designer's Name,Address and Tel.No.� P o)c -2 to 3 Type of Building: Dwelling No.of Bedrooms Lot Size Do t 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 `Qd5 p V, Type of S.A.S. ®U-c.d f_. 0,..., Description of Soil Nature of Repairs or Alterations(Answer when applicable) (4—Q too<e Q 1 ® M 4-;),N Csa-5S ll C,oL pa)� © U�2 F�a t j 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 Date tO Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Issued No. Fee ,x 1 1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Migponl 6- 0tem Construction i3ermit Application for a Permit to Construct( ) Repair(Q Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. I (l 5- L-i n G O 1 i1 R , Owner's Name,Address,and Tel.No. VVI i kp..._ vj}*,}-oS Assessor's Map/Parcel 2 7 01 A 3 Installer's Name,Address,and Tel:No. !2,A Designer's Name,Address and Tel.No. (�p 3 aif 7 4-'3 Type of Building: + Dwelling No.of Bedrooms 3 Lot Size ;Uq — sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons 'w- 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 C`e55 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �/.lc Q_ D 1 VQJL ® M A-•t C--55 Date last inspected: d F 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 i r/ } fl Date Zo Application Approved by L�, A `� Date Application Disapproved by: Y V Date for the following reasons Permit No. Date Issued Q�L THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERT�tIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (�). Upgraded ( ) F, Abandoned( )by C� •.�.( l� �P� S Le IL_<_ at tR5 hasbeen construct7/0 or4tice , with the prjo�stons Title 5. , d the for Disposal System Construction Permit No. "` dated Installer Designer l/1 A r r . V �,� � � #bedrooms' Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system wl1i ctiort0as delsigned. Date /o/ 0� Inspector �9' flr THE COMMONWEALTH OF MASSACHUSETTS Pee r PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS w Migpo.5al �bp!tem Construction Verntit Permission is hereby granted to Construct ( ) Repair ( ( Upgrade ( ) Abandon ( ) System located at (. y ,1 t �S7 4A I �Qrr v�i S and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. _ Provided: Construction must e completed within three years of the date of this pe, it. / r Date � Approved by 4Yi V