HomeMy WebLinkAbout0087 QUEEN ANNE LANE - Health oqn f7 e �'-
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KEEPING YOU ORGANIZED
No. 10334
24 53L
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No. ..
i(i�l I Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
2pplitation for MispoBal *pstem Construction Permit
Application for a Permit to Construct( ) Repair(�/� Upgrade( ) Abandon O ❑Complete System ndividual Components
Location Address or Lot No.87 Ouan A1N+eLn, wner's ame Address and T 1.No. 50
cdrv�r � M��� B-981- 8689
Assessor's Map/Parcel Q nL jr 021, 5
I taller's Name,Address,and Tel.No.50-8-y77-$B 77 Designer's Name,Address,and Tel.No.
0244
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) geolaEe- D$3 A—/o -�(7pC, g►1s-�I I iQt Se(
G-Y� Covec TD �l�i�,in 6,�o��f �I, �9C. P� DTcen� Gzrtl /sT�,
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of fore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental e d not p e the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed 4 Date //7177
Application Approved by Date IS Z Z
Application Disapproved by Date
for the following reasons
Permit No. 2 Date Issued Z
No. ; Fee 0 0i
THE COMMONWEALTH OF-MASSACHUSETTS Entered in computer: V
PUBLIC,HEALTH DIVISION -.TOWN.OF BARNSTABLE, MASSACHUSETTS Yes
01pphcation for MispoBal Opstrin Construction 3permit >
Application for a Permit to Construct( ) Repair(Vf Upgrade( ) Abandon( ) ❑Complete System U,/ndiidual Components
Location Address or Lot No.87 Qveen Arin e ul,, 6,1Tv j'r Owner's Name,Address,and Tel.No. 5V 9-
Assessor's Map/Parcel
n
�
Installer's Name,Address,and Tel.No. 77-Q)S 77 Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms +!V i• Lot Size sq.ft. Garbage Grinder( )
Other Type of Building . F No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided` k/!' gpd
Plan Date " " ' Number of sheets Revision Date
Title
Size of Septic Tank ,, ;n: Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) Ke-p f ace b 3 14"/t?
Gn�- Cl)vpx 7U w 0b'i n Vna k r i S k g netA, PyA-d i-?Ln 1, anA !5,r*,,`7; -Ti 1 e..5 7 r,5p
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of t
m he afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environental @ode and not to pla the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed /r� t �'` - Date t //Z 1 Z 7-
Application Approved by "` `" Date 4 /lnh Z.--
Application Disapproved by V Date 1
foi•the following reasons
r.
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(Y•) Upgraded(, )
Abandoned( )by 1`O C 1' j,oyr (0-Tr14,
at 97 a ueeA A/1 t4 LA. has been constructed in accordance r '
with the provisions of Title 5 and thee�for Disposal System Construction Permit No. 24•j. .dated '7 i}�2_--
Installer /jo "i' , ,OU C cO , . '!C. Designer /J {
#bedrooms �1 .. Approved design flow ,1 !V�/Ff� gpd
The issuance of this permit shall not be construed as a guarantee that the system will f nc it b/n as designed.
Date Inspector
- --- - -----------------•---• -- -- - -- I --- -- - - - '-------------------
No. `"`' Fee 7�_
THE COMMONWEALTH OF MASSACHUSETTS
V PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposat *pstm Construction 7"llermit
Permission is hereby granted to Construct( ) Repair(V") Upgrade( ) Abandon( )
System located at 07 0u ee_n. A n re.. L n ,
: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. ;
i
Date ! ���� Approved by