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HomeMy WebLinkAbout0070 STUB TOE ROAD - Health (2) rcd No. 'Z i Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Misposal 6pstem Construction permit Application for a Permit to Construct( ) Repair(__<1U'pgrade( ) Abandon( ) ❑Complete System L;415dividual Components Location Address or Lot No.9,4 c;A„A,+o �j Owner's Name,Address,and Tel.No. Assessor's Map/Parcel cu* L T o, qo, d -k Q v e�i,ti I;;nsstaller's Name,Address,and Tel.No. 3�y �3" rj Designer's Name,Address,and Tel.No. Type o'ffBuilding: Dwelling No.ofBedrooms 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 ©�l Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) C r C C ' !4 ✓n 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 ystem in operation until a Certificate of Compliance has been issued by this Board of He Signed Date Application Approved by (Q Date Application Disapproved by Date for the following reasons Permit No. '� _ y Date Issued c No. 'I G ! 2 l 1p Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISIONa- TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplicatlon for Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(- Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot Nott 0 S4--Gt A 4o-e' J Owner's Name,Address,and Tel.No. Assessor's Map/Parcel c&-' � o t-10,{ ( 6 VG-Z F^ 41 �In\staller's Name,Address,and Tel.No. 3;j / q f- 7 Designer's Name,Address,and Tel.No. Type o'.f?Building: Dwelling No.of Bedrooms 614, 21J 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 ,lU a Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) f� G.f0/e C G f�'i_ 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 (� ^2 `2 Application Approved by r/1 Date Application Disapproved by Date for the following reasons Permit No. )0 1 2 Date Issued ro — _ - -----------------•---- -- - - - - -- THE COMMONWEALTH OF MASSACHUSETTS k�(Ak 9-box BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTI,F�Y,that the On-site Sewage Disposal system Constructed( ) Repaired(I-) Upgraded( ) Abandoned( )1by D, _� p.w a ��^�✓ �i'e,,5-11, at S � -G°e4 has been constructed in accordance with the provisions of Title 5 and e,for Disposal System Construction Permit No.,)O.L '2 ° dated 6 / 3 o 4/ Installer 1Pe 4'L" °'t d 4j 1D/'k,%,Designer #bedrooms Approved design flow �� _. • gpd The issuance of this permit shall not be construed as a guarantee that the,system will function as designed. _ Date Inspector /A .��f� l.-, �'� � ,� ��• �- • ----------------- ------------- --- ----"-------- -------- No. e�'.1 f Z S� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS E . 0 Disposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon System located at (� � G+.U .� !/t•y� 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 / y/ �( Approved by � V