HomeMy WebLinkAbout0106 TUPELO ROAD - Health --�
Marstons Mills
No. � I Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01pplitation for Misposal *pstem Construction i3ermit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ndividual Components
Lo tion Address o of No. /06, 7d�F�6 Zj Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel (D67 /6'f
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
00-A &0V3.N)'!�C� (SQ -yQQ -sir N
Type of Budding:
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) k! gpd Design flow provided f✓ 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) _ PC QI"e C) —'COi<
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.
Signe Date
Application Approved by Date 1 a
Application Disapproved by Date
for the following reasons
Permit No. Z f 3 Date Issued 7
1i
No. f Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ' +
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
rication for -is osal stem Construction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System 2i Individual Components
r.
L tion Addre s oc LLot No, 10e;. Td�r��b R Owner's Name,Address,and Tel.No.
T6(00sS ?V��`1g
Assessors Map/Parcel O S 7 104/! S
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
2�6v�^) mil c. cur -Z00-71�5 N {✓
Type of Building: n
Dwelling No.of Bedrooms �14 t Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 1t/(�' gpd Design flow provided f✓ 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) 'R,-!Pk rP C) _ X
Date last inspected:
Agreement: t
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.
^'
Sign' 7 Cam-: Date ��/. G/,2.�--
Application Approved by ,. Date 111-2 7h
Application Disapproved by Date
„! for the following reasons
r Permit No. G 7 3 t Date Issued V
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( )
Abandoned( )by ,► ). R C c 1 1�X
at I o C TO Cr 10 y{{t 4,ctryoS AJ,,V, has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.) ��Y j t✓ dated
Installer �4 Designer
#bedrooms �,l�J� Approved design flow A gpd
The issuance of this permit shall Jnot be construed as a guarantee that the system
(w 11 fanctio as designee �^
Date "t ,'/ Inspector
- -
No fiefs tf �.7.- - FeeTHE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
N s` Misposal 6pstem Construction 3dermit
Permission is hereby granted to Construct( ) Repair( ``Upgrade( ) Abandon( )
System located at �trJG 'I t)�x��C% 4�� /L+Uts tCNS
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 1 l 1 7�J J Approved by
+ C t•
II