HomeMy WebLinkAbout0071 BERNARD CIRCLE - Healthr ,7 / Bcr ,? aAcl C,' re -C -e—
No.oU ✓� ,/'D Fee / /Z�_
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
RpPhLation for Misposal *pstrm Construction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 6`1'c l-4- Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel CBS'!fci'd, /l Qbq Lin
Installer's Name,Address,and Tel.No S f( F 36 `/ �F_Fr Designer's Name,Address,and Tel.No.
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
I °
Size of Septic Tank O d� Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) t' /�G C le- fi P� apC
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 Hea
Signed Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. Date Issued
No.eCQc�-�� �� �/l Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:_L-eff
Ye
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
x
01pplication for MispoSal *pstem Construction 3dermit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) [:]Complete System ❑Individual Components N
Location Address or Lot No. /r i c/-t- 'Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel C,. tv✓- f
Installer's Name,Address,and Tel.Nos`'Q 36 `/ Jr4FtV Designer's•Name,fiAddress,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft-i Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
i
Other Fixtures
f
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title *,
Size of Septic Tank �O a p Type of S.A.S. r n m,2 l e—
Description of Soil
� r
Nature of Repairs or Alterations(Answer when applicable) c 9 Q�4/ �� l u t ' `'"` o➢�
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 Hea ��—
Signed Date
Application Approved by 00,6AA Date
Application Disapproved by Date
for the following reasons
. Permit No. Date Issued
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THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliante
THIS IS I CERTI-YY,,that the On-site Se age Disposal system Constructed( ) Repaired(,/� Upgraded( )
Abandoned
O /
at has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer All �` t o/• �-� 'a�" Designer
#bedrooms Approv eafuncti
gpd
The issuance of this permit 1 knot be cort§trued as a guarantee that the syst m wi esigned. '
Date /( Inspecto
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No. ao a- , f a Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
-Disposal �6pstem Construction Permit
Permission is hereby granted to ConnJtruct( ) Repair(� Upgrade( ) Abandon( )
System located at / vo
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 l' 14 Approved by /�r'y,
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