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HomeMy WebLinkAbout2361 MAIN ST./RTE 6A(W.BARN.) - Health -361 Main Street West Barnstaple A= 237-030 i i I I 0 No. Z®0�6— Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppliCo.tion for ]h5poml *pgtem (Cold.5tructiott Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. L 3(a i A A,,h $7_ 2666.9- Owner's Name,Address,and Tel.No. 56-7f2leA 'TZ+/'R-ea l.WeS'r vnrnS I_ 23tor ma.�, sr &KIG Assessor's Map/Parcel Z 3 O 3® Ljesf- 3 R�TpQte Installer's Name,Address,and Tel.No. C- "�' t�s Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size JQd b} 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 qpp L Type of S.A.S. Ok1._9� Description of Soil Nature of Repairs or Alterations(Answer when applicable)01 A+_�Sf7tA©L 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. Signed Date Application Approved by s Date 7— '� /� Application Disapproved b Date for the following reasons Permit No. 0 C�� I. (� Date Issued 7— 3 I OL- Fee �DO THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for �Bigonl *pgtem Cougtrurttou Permit Application for a Permit to Construct( ) Repair°J4) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. 'Z 3(a) Ih A4i h S 7 /Z`C(,A, Owner's Name,Address,and Tel.No. S C--1m A 7.rr h-e a _ Wes—) ^4on sr A2 C(,oij Assessor's Map/Parcel 230 30 ,� Installer's Name,Address,and Tel.No. C"" 1 " `, ?�F���S Designer's Name,Address and Tel.No. r Type of Building: Dwelling No"!of Bedrooms � Lot Size O0�} sq.,ft. Garbage Grinder ( ) A Other Type of Building 5jn No.of Persons Showers( ) Cafeteria( ) Other Fixtures- . _•� . .Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title i Size of Septic Tank J (. Type of S.A.S. Description of Soil 33 Nature of Repairs or Alterations(Answer when applicable) i,, i.�,Q (tom? y( /uvv� f-4 (,,P_%goo L 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. Signed Date Application Approved by e Date - /" OS Application Disapproved b Date for the following reasons 4 Permit No. GO — Date Issued 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 C.4o&j U- (a,(„(„ at S3(g I (VWV1 5i. (4)C)f 1~I'("f P has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.—Z006" 31 dated 7- 3/—O 8. + Installer ,,t1114 ( ( tQ , tS Designer o #bedrooms Approved-design gpd The issuance of this permit shall no be1c�r�istrued as a guarantee that the sy�will fun to as •es ned. Date y Inspe 'o ------------------------------ No. �2:00 25— 9/ FeeTHE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS 1wigpogal *pgtem Construction Permit Permission is hereby granted to Construct ( ) Repair (L: ) Upgrade ( ) Abandon ( ) System located at .. t S r• 12 C�(A LA-'9— 1 61�J`T Cr 41 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this pe "it. late Approved by I