HomeMy WebLinkAbout0030 CROOKED CARTWAY NORTH - Health I
f 30 CROOKED CARTWAY PJOr-4+
WEST BARNSTABLE
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No. DLoj V—)-7 Fee '
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es
01pplitation for Disposal *p8tpm Construction permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon omplete System dividual Components
Location Address or Lot No. 3c) AcL�� Owner' A Viand Tel.No. i�1 a
W t (3 /�•"�ZC_ /. • ( w 9
Assessor's Map/Parcel % 3 c> 0 C W 41 t Z to l ��N
Installer's Name,Address,and Tel N� Designer's Name,Address,and Tel.No.
N A II�
Type of Building: }-�C1(j%— U R hJL5 C
Dwelling No.of Bedrooms d lkt4-1 t-1 Lot Size So CIA 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 / ) ® ,ram-� � /�q �� 1 e Q
CY
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected: V A 1 V-w 74
Agreement:
4/U 00 N1
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. q r J
Sig Date
Application Approved by Date co
Application Disapproved by Date
for the following reasons
Permit No. C1 Date Issued ,L( L
CX
No. GaZ C1 C Fee
' r Entered in computer`: /
' THE COMMONWEALTH OF MASSACHUSETTS .
PUBLIC HEALTH DIVISION - TOWN O'F"BARNSTABLE, MASSACHUSETTS
Application for MispoBal *pstem Construction Permit
Application for a Permit to Construct Repair(') U rade Abandon x C lete System bdividual Components
PP ( ) Upgrade( ) �'� P Y � P
Location Address or Lot No. 3o .G Owner' ,fAd rand Tel.No. -1 C) 0jt
Assessor's Map/Parcel f 3p V1 e'r t �5
Installer's Name,Address,and Tel.No. E,, Designer's Name,Address,and Tel.No.
Type of Building: ti Cd ( O f`-J6'p � _
Dwelling No.oe Bedrooms Ci &J W-LA u 1`I J�f� Lot Size s�/�' Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
r.
r Other Fixtures `a
' d M,
Design Flow(min.required) �I� �T gpd Design flow provided +U gP
I d
Plan Date Number of sheets Revision Date
Title '
Size of Septic Tank Type of S.A.S. r.
Description of Soil
c
Nature of Repairs or Alterations(Answer when applicable)
" Date last inspected: t.!1.1 V^_tj 14
4
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 a(d not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health. g 1
i Signe -`�---- Date i !
Application Approved by A p Date °►A 1 IA.
�{
l -
Application Disapproved by / Date J ,
for the following reasons
Permit No. tJ ,y a q t0 Date Issued
y t
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS T�,013. RTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( - .) Upgraded( )
Abandoned(i/)by
at uv has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. 2 0)w if T dated
Installer Designer
#bedrooms Approved design flow A �/� 1 gpd
The issuance of this pe it s all not be construed as a guarantee that the system w il�tion, designed..
Date �� �1 Inspectors
• ' v
Fee .—
,✓ THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Vv, � lr �M . . .
/�� Misposal 6pstem Construction 'Permit
t/ 'e6dission is hereby granted to Construct( ) Repair( ) `f Jpgrade( ) bandon
� System located at
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
5
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this p rmit.
Date Approved by �/� i