HomeMy WebLinkAbout0026 PIRATES WAY - Health 26 PIFZATES WAY, HYANNIS
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No. Fee EoVYe
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
2pprication for Miopooar *p5tem Congtruction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. I WAY Owner's Name,Address and Tel.No.
As Ma az / -,7A,#v es 4clWN5
It er's Name,A—ddriss,and Tel.No. Designer's Name,Address and el.No.
Type of Building:
w___ 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) C`i �!
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.
Signe Date.
Application Approved by Date
Application Disapproved for a following reasons
Permit No. Date Issued
Iv
it
Fee "
No. X-0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: \
Yes.
PUBLIC HEALTH DIVISION.=TOWN OF BARNSTABLE- MASSACHUSETTS
Rpprfcatfon for Df5pool *pgtem Comaructfon Veriuit - -�
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.Ma az AM / J/)� Owner's Name,Address and Tel.No.
ok A �. l V�v �/fa/►��S ���/ns
LI,
Installer's Name,Zddrlss,and Tel.No. Designer's Name,Address and el.No.
Type of Building:
welli } No.of Bedrooms Lot Size sq. ft. Garbage Grinder( )
er Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
t1j Plan Date Number of sheets Revision Date
i rr
d Title
;Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) Se�7�I C L'»e CA 5-e
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.
CO
Signe Date`�C S
i
Application Approved by If Date
Application Disapproved for the following reasons
Permit No. 6J9 Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CER ,that e n-s' age Disposal Systeet Constructed( )Repaired ( )Upgraded( )
Abandoned( )by c-�
at has been constructed in accordance
with the provisions of Title 5 and the for Disposal S stem Construction Permit No. 3U5lated
Installer Designers f1
The issuance of this permit shalli not be construed as a guarantee that the sem will function as designed j%
Date '3 ( }t /�� Inspector � 3 4a i }�iF.�")�A I
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———— ———————————————————————
No. Fee -
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Migogaf *pgtem w5tructfon 30ermft
Permission is hereby grante to C struct( e�e( p$r d ( )Aba
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 u�beted within three years of the date of eDate: Approved by