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HomeMy WebLinkAbout0128 STARBOARD LANE - Health (3) dS % ��' �• LLB New gP�+�L 1.�^� •� � A�a;,r„�irnP,r��-. 7 No. �y �'�—` � �! Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es 01ppritation for Disposal 6pstem Construction permit Application for a Permit to Construct( ) Repair(''51-U'*pgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Addres f ppr Lot No. I 1 gar �a (,,J Owner's Name,Address,and Tel.No. Assessor's Map/Parcel /(�G d O� 1"6 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 1�c S _y -7161 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) N gpd Design flow provided f}- gpd r 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) bc„i-3C)n rJ b G C k k E c ck 1.5 S �y S}� C"O ru r� h1Cc.J Lwe (GMoVdIP1- cry bGcIc5e +�c to�l� w-r -b Lowec V- f-ic tem i�ro pgj:- k 4 S 3 S yjtctA3 c,10 �ys� Date last inspected: LrSd' (�( (r bGvd' y t) 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 `' .2Gb;_ Application Approved by u Date ' Application Disapproved by Date for the following reasons Permit No. t' �' 3 j Date Issued a 1 2 NP sP p+ A � s No. �� a z E Fee ) THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �«. ' PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS rya 2pplicatlon for Mispo8al 6pstetn Construction Vertu t4i Application for a Permit to Construct( ) Repair(-`upgrade( ) Abandon( ) []Complete System ❑Individual Components z Location Address or Lot No. I�S � �SAGfICJ L Owner's Name,Address,and Tel.No. � Assessor's Map/Parcel /G O 5 7 }j0C'5)"6 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms A/ or Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) nj ,/l gpd Design flow provided ►>J+f) gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. .'':Description of Soil 1r Nature of Repairs orAlterations(Answer when applicable) r orn 6 NCW L­)r_ Lomr�>u t('t 0� 06CI( 5fn+ 11*0k0 Lnw of)fI V i t^rn �l6004,1 Z 3 SVS+!?^-S CCU C'NC'xxK A A lI(-,kA 16 br� f�iC + 1� SYx)�C�'c�(0,1 T�fY 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 ` daGb Application Approved by �,. �? /� Date y1/ , 'a/-)-I ' I r Application Disapproved by Date for the following reasons Permit No. C' 2 ` 3 Date Issued --- _ . -------- -- - - - - - _ -- - - - - -- ------------------------------- s THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO that the On-site Sewage Disposal system Constructed Repaired 1/ U aded g P Y ( ) P ( ) P!�' ( ) i Abandoned(V�by t1 �jipu. NC- at I 4a o.t \:)Ur(c) L p� n a4rf,)1`�� 'has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. D0,4A- dated l Installer �. A NC Designer #bedrooms e��f' Approved design flown A/14 n god I t The issuance of this permit hall not be construed as a guarantee that the system will'function as designed. Date 1 Inspector No. Fee 7-) THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS r } ) f Disposal 6pstem Construction 3permit Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( ) System located at a 1 1 f y l � CI w) LA o' Fr-r v r rr and as described in the above Applicatiowfor Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. ry Provided:Construction must be completed within three years of the date°of this permit. �J Date t?t''? 7 ?. �». Approved by