HomeMy WebLinkAbout0120 MARSTON AVENUE - Health 120 M'arston-Avenue- .
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A= 288 — 101
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No. (oi Fee— ( J-00
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THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
appliLAtion for Disposal 6pstem Construrtion VPrmit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon(01/❑Complete System ❑Individual Components
Location Address or Lot No. ).2 C, /y t-r„a A v Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel ,. f 0 f „ e-
Installe ' Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
� _/V
Type of Building: IV
Dwelling No.of Bedrooms ("A— Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 0�' gpd Design flow provided NA gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
4
Nature of Repairs or Alterations(Answer when applicable) A ��'C2� S� c jA
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.
Si Date
Application Approved by Date
Application Disapproved b Date
for the following reasons
Permit No.6,y /�. Date Issued f N� 70 1 y
No- Z)i 1 Fee
Entered in computer:
THE COMMONWEALTH OF MASSACHUSETTS 4
PUBLIC HEALTH DIVISION -TOWN OFJ,,BARNSTABLE, MASSACHUSETTS ,
0[pplitation for Disposat,*pstem Construction VErmit;,
Application for a Permit to Construct Repair Upgrade Abandon Complete System Individual Com onents
PP ( ) P ( ') Pg ( ) (�❑ P Y ❑ P
Location Address or Lot No. t G �(/tf/g f r,,.� J Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel 2 0 1
Installe�' Name, dress,and Tel.No. Designer's Name,Address,and Tel.No.
w 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) #A� gpd Design flow provided N gpd
Plant Date Number of sheets Revision Date
. ( I
Title
Size of Septic Tank Type,,of S.A.S.
Ij. Description of Soil
Nature of Repairs or Alterations(Answer when applicable) /�. j«�)e,,N 1 r an
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in''
accordance-withthe provisions,of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
41
Compliance has been issued by this Board of Health.
Si a Date
Application Approved by Date
Application Disapproved b Date
i t
for the following reasons
Permit No. � Date Issued AD lq
THE COMMONWEALTH OF MASSACHUSETTS
w?r BARNSTABLE,MASSACHUSETTS
Certificate of Compliance x
i THIS,ISS TO CERTIFY,that the On-site Sewage Disposal�C1 system Constructed( ) Repaired( ) Upgraded( )
Abandoned(vT oY yc 1 G S �i A ✓c;,�)001 1 sy jVC
at / 2 6 A4 s jr,..i /4 Dr has been constructed in accordance
with the provisions of Title 5 and the for Disposal System'Construction Permit No. 61 dated/q�Wiq
Installer Designer
I� #bedrooms N Approved design flow , gpd
' The issuance oft is permit shall not be construed as a guarantee that the system will nc'o as desi d.
r �rDate Inspector ,.
------ -- - — - - - -_ -- . . - -_
No. t Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
MispoSal 6pstem Construction i3efmit
Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon
System located at /262 m IY41 u—, c
•
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.
i Dates Z01� Approved by
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