HomeMy WebLinkAbout0071 PEACH TREE ROAD - Health 1-7� ' e� boa d
No. .2 — Fee 76 GD
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer.
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es
01pplitation for -MisposaY 6pstem Construction Permit
Application for a Permit to Construct( ) Repair(t� Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Lo action Addrgs��r,Lot No.7/ P.tAz+\ 79 9_ Owner's Name,Address,and Tel.No.RS N-yq y-2 y b j
Assessor's it Map/Parcel � (� �'' Tohn Kelleher
n `1 026
Installer's Name,Address,and Tel.No. 508—Y)7-SB 77 Designer's Name,Address,and Tel.No.
(4llrr�3. 6t Ca.rn M .� 626Gy
Type of Building:
Dwelling No.of Bedrooms A � Lot Size sq.R. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures A
Design Flow(min.required) 10V 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) Afto? 1/T� PA fWA4 TXy►k BVJ ItT 7b D—&7JC
n/&w D-UX kh 11A Rib& Ar%d Cower
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenan f the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Enviromn 1 de an o place the system in operation until a Certificate of
Compliance has been issued by this Board oflJealth. CC
Signed Date .5-572
Application Approved by Adl Date S� 2
Application Disapproved by Date
for the following reasons
Permit No. 9_tY.; P y 3 Date Issued 9
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�ry �J Yrt
No. 1.h a.?� - `i Fee 16 :33
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
es
PUBLIC HEALTH.,DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS -
2ppYication for Misposar *pstem Construction permit
Application for a Permit to Construct( ) Repair(Vf Upgrade(' ) Abandon.( ) ❑Complete System ❑Individual Components M.
X
Location Address r Lot No. ' P tO.0 h r Owner's Name,Address,and Tel.No.qs q-qq y-2 9 5 x,
11�1 . AA ! ohr� K �Ih�r
Assessor's Map/Parcel o �-^ 0`� A�"rflaw°84. /tb-(510, s /o,'/o vu V9
Installer's Name,Address,and Tel.No. 300—Y77-06 71 Designer's Name,Address,and Tel.No.
&r r OVf Co. rAG.
Type of Building:
Lot Size s ft. Garbage Grinder Dwelling No.of Bedroomsd�„���t'"� q, g ( )
i
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) IV 1� gpd Design flow provided / �E 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) Alets! )4,+ fife,fro/C `—Xpi K. oul Jer 'rb D—&7A
Date last inspected:
Agreement:
The undersigned agrees to ensure the constructiop,and maimenance,of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the EhvironmentA Code andhot to place the system in operation until a Certificate of
,
Compliance has been issued by this Board of Health.
Signed,,`,', i i r+ ��� � � Date
Application Approved by —L—Aell i"Ll-, ,� . % Date
:Application Disapproved by Date
for the following reasons
Permit No. Date Issued1.�
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THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO C �`'Y,
CERTIFY, Y ),,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( )
Abandoned( )by go� 1 /I 4,yr t0,-T/14
at -7N ,
1 ACIN Tf,, R46. has been constructed in accordance
wifh the provisions of Title 5 and the for Disposal System Construction Permit No- 2- dated
Installer �c r ,wIJ�Lt?, ,; t'l rr, Designer
#bedrooms ' Approved design flow ,fV[ gpd
The issuance of this/permit shall not be construed as a guarantee that the system rill^function as designed.
Date ( , 0/ f' Inspector
-------------- ------
No U.) ? ( . Fee
THE COMMONWEALTH OF MASSACHUSETTS
J PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposar 6pstem Construction Permit
Permission is hereby granted to Construct( ) Repair(vr Upgrade( ) Abandon( )
System located at 71 w k rree 9A,
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 � Approved by