HomeMy WebLinkAbout3600 FALMOUTH ROAD/RTE 28 - Health 3620 ]Falmouth Road (Rte 28) �
A= 077 - 005
i
No `� Fee a5
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
OfppYicatiou for Misposai 6pstem Construction permit
Application for a Permit to Construct( ) Repair( ) Upgr de( ) Abandon Complete System El Individual Components
Location Address or Lot No. �7�o-ate Owner's Name,Address,and Tel No.
Assessor's Map/Parcel d7XJ-C �Vt
C o v ZKC,3'S�'
Installer's Name,Address,and Tel.No.Sv'S L/AS— 99c Designer's Name,Address, d Tel.No.
s� 104-o to-tt Qc�vu tgAAA-l4c..-�, T-ne Po./3cx i�'i AJI1
o>4
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 maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental C and of to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Date �(
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. Date Issued
No. t t�Lam'"" Fee 9
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01ppfiLation.for Disposal 6pstem Construction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandons ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address,and Tel No.
Assessor's Map/Pazcel r)J- `j 'f.a•c.c r l� . vvt v'4-. t?c`?<,75 '7,7/. S x r0/
Installer's Name,Address,and Tel.No.60S V,)!F'- 89o'a Designer's Name,Address,and Tel.No.
9�4r�o(UtttC: 'r1, #'li c.��i +. Z-)c jDo. "t,s
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 -`1-1 , -
Size of Septic Tank Type of S.A.S.
Description of Soil
/ r
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected: .f�l
r
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 to place the syste n operation until a Certificate of
Compliance has been issued by this Board of Health.
S��tgxtdd — Date
Application Approved by ( Date
......... ;
Application Disapproved by Date
for the following reasons
Permit No. 4 Date Issued r a
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
f/ Certificate of Comptiante
THI�)b
dTO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
2 f
Abandoned(b� y Jam�Q/G'�fL-[. (/`rf;;�
at i,4(.ryaVW.x-4 sd .A@� �` t:t t r has been constructed in accordance /
with the provisions of Title 5 and the for Disposal System Construction .a -Permit No -t-),N5dated
Installer �_"i'}'2: j ��w ra~an : 9 ca.P J f/}�7 ,k,Designer f '
#bedrooms Approved design-flow gpd
/ � ,
The issuance of this permit shallinot,be construed as a guarantee that the systemNh1 function ass des'igrted.
Date ( - t/ �S"" Inspector ,`"
_-_-----__--_y__.________________________________.__________.-----------------------------------------._______________________________.____-__
No. - 3_5 Fee
-
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Bisposal 6pstem ConstrUCtion Permit
Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon(
System located at :n ,. cla
.-
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 c Approved by _