HomeMy WebLinkAbout0017 EBEN SMITH ROAD - Health 1/7J �a Sm : rtG, Root d
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THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01pplitatlon for MispoBal ,*pstrm Colt8trUttlott permit
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ndividual Components
Location Address or Lot No.%- !V1 STAAV. Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel%-11 CA14.1p Zq-6 GT1 ot
Installer's Name,Address,andd Tel.No. Sc �r (-7ran< Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms ,v/�Y 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 or Alterations(Answer when applicable) asy\e4 G..P_ A
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 �A .\`j•Z'2--
ApplicationApproved by 4.
Date` .�
Application Disapproved by Date
for the following reasons
Permit No. Date Issued
S^.Y"
1 I
D n w
\\A
50
No. � �' L /A Fee A a C�
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
TippliLatiott for Bis.poBal 6pstent Construction Vermit
Application for a Permit to Construct( ) Repair(111upgrade( ) Abandon( ) El Complete System ptInd vi idual Components
Location Address or Lot No. '� ;h SrA4%'�?, Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel 111�1 ► � F (114-tD 2L1i'G G 1
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Y
{�,, lLiol
LC4�
Type of Building: /
Dwelling, No:of Bedrooms' / Lot Size sq.fl. Garbage Grinder(' )
r,
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 or Alterations(Answer when applicable) c--,�' A
s.
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 Environwentai-code and not to place the system in operation until a Certificate of
Compliance has been issued liy'this Board of Health. ,r
Signed QDate �{ ,t`C1 r�• '
Application Approved by N-1/.4 A ,., Date '
Application Disapproved by Date
for the following reasons
Permit No. `�'�`� 1� ` Date Issued".
THE COMMONWEALTH OF MASSACHUSETTS"-,
V1 tl'` BARNSTABLE,MASSACHUSETTS
Certificate of Compliance 4
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(k-1 Upgraded( )
Abandoned( )by <.r!'t;.� g.� ..• _ -_A
at 1 "7 1 r_1 _5 M,•+C4r1 AN C`1 has been�consttructed.in accordance �* ,
with the provisions of Title the for Disposal System Construction Permit No. a ? Id
Installer Designer ,�.w •'3
#bedrooms `Sr Approved design flow gpd
The issuance of this permit shall °ot be construed as a guarantee that the system will+furiction.ass designed.
Date / Inspector
No. ; �.�_~ r -� \,.Fee
THE COMMONWEALTH OF MASSACHUSETTS '
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Disposal *pstem Construction j3.ermit
Permission is hereby'granted to Construct( ) Repair( Upgrade( ) Abandon,(
System located at �� �, r+ ,, n ��
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 provisionstor special conditions.
Provided:Construction/must be completed within three years of the date of this permit.[
Date L/ /��1 r� Approved by 17•!���fii.