HomeMy WebLinkAbout0126 SHEAFFER ROAD - Health (2) ��� s��e��..�. ��
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No. I Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Applitatlon for Disposal 6pstem ConstrUttion Permit
Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System Individual Components
Location Address or Lot No.1 J� G �Q O Nine,Address,and Tel.No. /a 1—3•Z Z-0 I31
Assessor's Map/ParcelF f ze
�Ol21> 1l l
Installer's Name,Address,and Tel.No. '4 7 7 Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Aj 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 Irr 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:
F
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 %z-1 7—Z J
Application Approved by Date _�A-d
Application Disapproved by Date.
for the following reasons
Permit No. / ' Date Issued r d
No.-r)" f ` �/ }4 r tv ` Fee
__/ CD
THE COMMONWEALTH OF,MASSACHUSETTS Entered in computer: Yes
M
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
' application for Misposal .0pstem Construction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ stem Complete Sy
stem y ®individual Components ;
Location Address or Lot No.l J5 e? J 1 �'JJ Owner's Name,Address,and Tel.No:
l U��� •�;,; ,
Assessor's Map/Parcel tv V l jr e �-^l fill 5 G f' f'r 2P trA-rp.av i 1-e
Installer's Name,Address,and Tel.No. 5(3 - ,1.i 7 7 Designer's-Name,Address,and Tel.No.
al 53
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
t
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures & / d
Design Flow(min.required) gpd Design flow provided A' Ir- gpd
Plan Date Number of sheets Revision Date
Title w
Size of Septic Tank" Type of.S.A.S. q
Description of Soil
Nature of Repairs or Alterations':(Answer when applicable) H 2 O 08 D- Box
x
t a
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.
r i Signed Date /2-)7 2-
/
Application Approved by L Date /
Application Disapproved by t Date
for the following reasons
n
Permit No. 2 / � 5 Date Issued
__ -._._
THE COMMONWEALTH OF MASSACHUSETTS d` box .0 4 L Y
BARNSTABLE,MASSACHUSETTS
(Certificate of Compliance
T S IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( �)' Upgraded( )
Abandoned( )by~ 8 ( ✓/ It 1 &o
at r) (, ..eJ,f}-lr P fr-4zr eo (p4 T- has been constructed in accordance �
with the provisions of Title 5 and the,for Disposal System Construction Permit No./d � dated ��
Installer (r` hPP-7- Lr0 y t A Designer
#bedrooms Approved design flow / / gp&
The issuance of this permit shall not be construed as a guarantee that the system will f m.ctibn�as,ddesi}gn~edd.
Date 12 21 ! Z02.1 Inspector4 ='' ,•_� .
No.. � �1 /' Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
.r. `
Misposal &- p�tetn Construction Permit
Permissio�ereb anted to Construct( Repair( Upgrade Abandon
Y P� - j r) p ) pgr ( ) ( )
Systemlocated at 1247 ..� (�Qt�',!� ,I >P 2l,i- (Pn I f''e ydt r
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 permit.
Date t r Approved by
r