HomeMy WebLinkAbout0473 GRAND ISLAND DRIVE - Health (2) W7;7--T 67�and .TsLQjW Tr
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No. _ / � Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ftplitation for Disposal *pstpm Construttion Permit
Application for a Permit to Construct( ) Repair upgrade( ) Abandon( ) ❑Complete System ividual Components
Location Address or Lot No.5/73 &/,;1 t? er's Name,Address,and Tel.No.
Assessor's Map/Parcel 070-00 'od V J. C cj4P 5u.J4 ,
Innstaller's Name,Address,and Tel.NoSfjy- �/� `5 157,P7 Designer's Name,Address,and Te.No.
Type of Building:
Dwelling No.of Bedrooms M 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. 7_
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) Ile- C'v_-
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 Date
Application Disapproved by Date
for the following reasons
Permit No. ?�a �" Date Issued
r�
�-No. / � Fee e75
THE COMMONWEALTH OF MASSACHUSETTS, ! Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ftpYication for ]Disposal 6pstem Construction permit
Application for a Permit to Construct( ) Repair,(/KUpgrade( ) Abandon( ) ❑Complete System dividual Components
Location Address or Lot No. /7-7 &/w+ ;S>a h wner's Name,Address, Land Tel..No.
Assessor's Map/Parcel `�-�cJ��//e (/7(�—(�Q$" l�l� ( (V t/n
Installer's Name,Address,and Tel.No5'OF ?4 C 5'�?7 Designer's Name,,Address,and Tel.No. s.
'✓l. (/plc o �L''�it"� ��►✓ "�/'4' ►'\ ,
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. �l•�o �S
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
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. . �r
Signed Date �'� e-;2
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. Date Issued
------------------------------ ----------------------------------------------- --------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
\ BARNSTABLE,MASSACHUSETTS
1 Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(Upgraded( )
Abandoned( )by �JGt �''� ��`^'``� G�-✓ /-//
at ��� !f�'�✓r l�j��� � has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No:X--'D—)'p dated `7 f�j f 2 :1
Installers--�.� �i •-� r ". Designer I '
#bedrooms �_ ) ��l/�- Approved design flow gpd
The issuance of this permit shall not be construed as a guarantee that the system wi fimc' as designed
Date ��' Inspector l� ,
v
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No. , Fee 76
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
a Misposal 6pstem Construction permit
Permission is hereby granted to Construct( ) Repair U grade( ) Abandon( )
System located at
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 ompleted within three years of the date of this pe
Date ��r� Approved by �- —�