HomeMy WebLinkAbout0208 OST.-W.BARN. RD - Health (2) _ _
i
i
i
__
w
i
I
j
y
i
I
II
i
i
No. / �1/�"' c Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01ppliLation for Misposal *pstrm Construction Permit
Application for a Permit to Construct( ) Repair(-J/Upgrade( ) Abandon( ) ❑Complete System E141 Idividual Components
Location Address or Lot No. 0�c C�`� Owner's Name,Address,and Tel.No.
l ;) l — ^
Assessor's MaOparcel V�t��`
Installer's Name,Address,and Tel o. Designer's Name,Address,and Tel.No.
11�Type of B ilding:
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 orAlterations(Answer when applicable)�1 c; ��A � (� ��S� «(6V ,�A
Y V '.",Fb-y-,\�
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 Healt
Signed Date
Application Approved by Date
Application Disapproved by Date
`` for the following reasons
II
Permit No. < -� c3077 Date Issued
---------------------------------------------------------------------------------------------------------------------------------------
No. J y�' Fee
THE COMMONWEALTH OF MASSACHUSETTS 'Entered in computer: L°""'-'
LO
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,'MASSACHUSETTS Yes
application for Misposal *pstrm Construction Vermit
CID
Application for a Permit to Construct( ) Repair(ei�Upgrade( ) Abandon( ) Complete System []I�Iri vidual Components
Location Address or Lot No. 1`��, Owner's Name,Address,and Tel.No.
p
tit-- a'�.. �6k ,
' Assessor's Map/Parcel t�,�r„�N�3yc1� (l ,\� VCV-N '�� ��-
Installer's Name,Address,and Tel,, 0 Designer's Name,Address,and Tel.No. +
S Cv \N;M 1C:rQ__0V C X S O ko YrI c
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 t
Size of Septic Tank Type of S.A.S. - y
Description of Soil
i
Nature of Repairs or Alterations(Answer when applicable) Re e\ r A.
;r
` Date last inspected: r y'�
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 Healt .
Signed Date / G
Application Approved by ---Date 4, ,
Application Disapproved by "D Date
for the,following reasons IN n A
Permit No. c.- - _" - Da
te z .,..� "'llI,
�.�' � t
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( J00K Upgraded( )
Abandoned
( )by
at O IS\ \1 i�\lC_ � U �G.(n 5��t� fZV has been construicted iri ccordan b A ce
• - "� with the provisions of Title 5 and the for Disposal System Construction Permit No dated
I�l
Installer S C.p psn "c-r-r,,,,N,K Designer
#bedrooms Approved design flow gpd
The issuance of this permit shall not be/coonnstru�ed as a guarantee that the system will ll function signed.
Date / ? Inspector,,
---- --------------- ------------- -------------- -- ---------------- --------- -----------------------------
N _G e � / Fee /C ;
THE COMMONWEALTH OF MASSACHUSETTS s
PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS
Nsposal *pstrm Construction permit �
Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( )
System located at (�u 0 S rti\,\X_ c=J t T c�r x` -k-A o ,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�comp edged within three years of the date of this permit.
Date Approved by