HomeMy WebLinkAbout1860 SANTUIT-NEWTOWN ROAD - Health (2) ,�l� �v Scent o.
cot ,
No. l ' 1 Fee 7 f
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ZippliLation for ]Disposal �pst Construction VPrtnit
Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ) ❑Complete System Vlndivival Components
Locatio-a Address or Lot No. _` t ^ Owner's Name,
1Address,aq Tel.No.
Assessor's Map/Parcel
Installe;;s_YTamg`Zd_dies nd Tel. Designer s Name,Address,and Tel.No.
��'i1Z,IJ lr� ,xA
Type of Buil
Dwelling No.of Bedrooms q 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 Repairs or Alterations(Answer when applicable ��
lo u7�J3r�x . -i �
Z4_1 Uy_1p I q�
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 thLvironmentall C e and not to place the syst m i operation until a Certificate of
Compliance has been issued by thi
Signed Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. O f U Date Issued —�.
2
Vr-
1.
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t
.> Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
2pplication for MispoBat *pstgm Construction j3Prtttit
Application for a Permit to'-Construct( ) Repair( ) Upgrade(++)'Abandon( ) ❑Complete System 2'Individual Components
Locationss or Lot Noo r^�� Owner's Name,Addre's`s,,and Tel.No.._ j _, 1
Assessor's Map/Parcel � OK r1L�W .�' � ' " `s»d `"�
Installe 's ame,Add ess and Tel o Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
i
Design,Flow(min.required) A Av gpd Design flow provided U A gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.'.
Description of Soil �'� -, ' A�"-r'
Nature of Repairs or Alterations Answer when applicable) _ .
Date last inspected:
r
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 Titles 5 of the�Egvironmental Code and not to place the system i operation until a Certificate of
y Compliance has been issued by this Board of Health. t
Signed _Jt Date " 14(.
Application Approved by \A \� Date 1
Application Disapproved by Date
for the following reasons
rw
r _
Permit No., a a /tf Date Issued �/
THE'COMMONWEALTH OF MASSACHUSETTS
ow BARNSTABLE,MASSACHUSETTS
Certificate of Cotupliaucr
THIS IS TO CERTIFY,that the On-site Sewage Disposal ( ) Repaired( l ) Upgraded(3�•')�
Abandoned by 0IFG-� wwl—. .(K).___�eW ! \� (�`'' t
at Lory)_Noky as been constructed in accordance
with the provisions
off�itle 5}and the for Disposal System Construction Permit No.:2 0-?,7' /U j dated 7-' •�
Installer C JT'�' it's' 11.E ✓ Designer
#bedrooms / /}- Approved design flow vQ- gpd
The issuance of this permit shall not be construed as a guarantee that the system witrunc d;;designed.
Date / { Inspector .. �----�----
No. Fee S�
THE COMMONWEALTH OF MASSACHUSETTS
- PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Disposal 6pstent Construction V.Prmit
Permission is hereby granted to Construct( ) Repair( ) ' f Upgrade(lam') Abandon( )
System located at
and as described in the above Application for Disposal System Constructio Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions. _.
Provided:Construction must be f completed within three years of the date of this permit. f
Date h Approved by F:; l kl IV —P ec
l
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