HomeMy WebLinkAbout0016 IYANNOUGH ROAD/RTE 28 - Health (2) 9 .
7-1 16 Iyannough Road
Hvannis
A= 343-015-016
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THE COMMONWEAVni=GF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es
application for Mi pogar pgtem ��Complcete
ution Permit
SZL"" 30 -r ofiq,Vw- f✓ is _
Application for a Permit to C trust a air r p ( ) Upgrade( ) Abandon System.❑Individual Components
Location Address or Lot NN . (� _�_1,2��t'11G�LE Owner's Name,Address,and Tel.No.
Assesso ' Map/Parcel jW 3
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No. of Bedrooms N d9 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) 1 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 e ro ental Code and not to place the system in operation until a Certificate,of
Compliance has been issued by this Boar of He
Signed Date
Application Approved by Date
Application Disapproved by: Date _
for the following reasons
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
a og BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS ISS TIFY,that the On-site Sewage Disposal System Constructed^� ( ) Repaired (. ) Upgraded ( )
Abandoned( by
at Vd
has been constructed in accordance
with the provisions of Title 5 la"A the for Disposal System Construction Permit No.
Installer dated
/ Designer
#bedrooms Approved design fl w
The issuance of thi permit shall not be construed as a guarantee that the system will f n on as signed. gpd
Date �T t 3 IQ Inspector (�
---,------------- -------
No.
Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION- BARNSTABLE, MASSACHUSETTS
XD i5pofsal 6pgtem Construction Permit
Permission is hereby granted to^,Construct
( ) Repair ( ) Upgrade ( ) Abandon
System located at
and as described in the above Ap
plication pp tcatton 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: Constructio must he completed within three years of the date of this permit.
Date '; k �
s F . r Approved K; .��..�