HomeMy WebLinkAbout0023 WHIDDEN AVENUE - Health 23 Whidden Ave
Hyannis
A= 324-075
No. �0� Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in compu er:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
I
01pplitation for Misposal *pstrm Construction permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon V ❑Complete System ❑Individual Components
Location Address or Lot No.,P-3 CL1 j ep? {�_ jj�" Owner's Name,Address,and Tel.No. 00j,Mtr
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Assessor's Map/Parcel 3 3 S/ A 0 S� SG /'
Installer's Name,Address,and Tel.No. ( pr ® ¢. Designer's Name,Address,and Tel.No.
tits,41A 0
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)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and mai ance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environme Co and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Healt
g e Date
Application Approved byA-ijSDate
Application Disapproved by Date
for the following reasons
Permit No. Date Issued
No. ��/� Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in compu er:,,
Y
PUBLIC HEALTH DIVISION - TOWN-•OF BARNSTABLE, MASSACHUSETTS
01pplicatlon for Misposar 6pstrin Construction Vermit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon V ❑Complete System ❑Individual Components
Location Address or Lot No.,,2 3(Jp l•C4C%ca _ 14�,nn Owner's Name,Address,and Tel.No.
y s firenr +san�- rdrr,,,� vim
Assessor's Map/Parcel 3 at(/
Installer's Name,Address,and Tel.No. P-vr(614' Carte+, Designer's Name,Address,and Tel.No.
ys� '44 1&,'HA o;v-,,vS
50 U
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
1
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: f =�
The undersigned agrees to ensure the construction and mai�te{�ance of the afore described on site sewage•d'sposal system in
accordance with the provisions of Title 5 of the Environmmeental''Code7an/d not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.,
e / -
' _cV Date L/ l
401
Application Approved by / 4 Date
Application Disapproved by Date
for the following reasons
Permit No. Qf_ Date Issued q 9
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______-------------________
4
�• THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS J
Certifirate of Compliance
C�sn� ��� s,
THIS O CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
Abandoned by A&c ���j�i �n 4 ��'l nc
at o7 5 r ,, has been const cted'n acc 15 ce
with the provisions of Title 5 and the for rDis osal System Construction Permit No. ed
Installer Ir r �;;�r �;`r���l,rC Designer
#bedrooms Approved design flow j\ gpd
1
The issuance o this f ermit shall not be construed as a guarantee that the system will function as designed.
Date ! � ( � �� , Inspector ` �Jnv L <.
i -
--------------- -- -- ---------------------- ---- - - _ = - ----- � e -
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No. �� Fe THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS
Misposal 4�pstem Construction permit
Permission is hereby granted to Construct( ) Repair( ) / Upgrade( ) Abandon
System located at `
^a` L
and as described in the above Application for Disposal System Cori`struction Permit. The applicant recognized his/her duty to comply with
w:
Title 5 and the following local provisions or special conditions.
..�'
Provided:Construction a ust a completed within W:ee years ofithe date of this permit.
`/'7Ii t
Date �IL`� •` ` 1+��� Approved by '
f,.�.-• �4_ � � 1, i
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