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