HomeMy WebLinkAbout0011 STUDLEY ROAD - Health 1 STIUDLE_ Y'ROAD
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THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Replication for Misposal 6pstrm Construction 3dermit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon K ❑Complete System ❑Individual Components
Location Address or Lot No. i( `Yr-q A 1.'t " Owner's Name,Address,and Tel.No. I�CN n 51'e2k
t'.1��tnri 1
Assessor's Map/Parcel -3 U r. ®2'L �1 5 Tu Ak
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms N14' Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) hoof gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
a
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 to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
gn Date
Application Approved by Date /o&e Zo,- _
Application Disapproved Date
for the following reasons
Permit No.Z-01-2 ' �j Date Issued 1 b 2 6 741 Z
No. Fee
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THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
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Yitation for Op
stem veer � stem Construction
truction ermit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon ❑Complete System ❑Individual Components
Location Address or Lot No. ( S Tti d /� Owner's Name,Address,and Tel.No. �n Sot k.
Assessor's Map/Parcel 3 n^i S s f L c}l�-5 t tq
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
C ;ae
Type of Building:
Dwelling No.of Bedrooms f IJW 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 /yH' 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)
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. ,
gne _ Date
Application Approved by �.--� Date /p/2��
Application Disapproved Date
for the following reasons
Permit No. Zo 1 Z d`5 Date Issued f1 21 �n 1-4 '
TH 1;COMMONWEALTH OF MASSACHUSETTS
— BARNST=ABLE,-MASSACHUS-ETT -:S ------
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
Abandoned l'v by
at k \ ST Q Ak�,t K-4 has been constructed in accordance
with the provisions of Title 5 and the for QSPr';10V,,)
sal System Construction Permit No.Z5tz 31('3 dated
Installer �c�-e- ��L Designer /1
#bedrooms i�� Approved design flow N It gpd
The issuance of this permit shall not beconstrued as a guarantee that the system`will n t-n\d signed.
Date z®!j/���/1 Inspector\
_____________ ___________________________________________________________________
No.ZO lZ—7�;LI 3 Fee Z�
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Bisposal *, psttm Construction Permit
Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon V)
System located at \•
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 perm'e14
Date 10�Z G �7 J l-) Approved b,
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