HomeMy WebLinkAbout0143 MAIN STREET (CENT.) - Health (2) t�r.ri
C
No. 1 — ND Fee /vor
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ZippliLation for Misposal 6pstPin Construction J)ermit
Application for a Permit to Construct( Repair( ) Upgrade( ) Abandon( ) ❑Complete System �Zdual Components
Location Address or Lot No. 14$ A 'mQ,n SkcWr Owner's Name,Address,and Tel.No. mock. Pw k%qp
Assessor's Map/Parcel C4"W%S"QW C g- 0
It13 A ('Hain cA. Ce4ero�\ka. CSog)332•A't$q
Installer's Name,Address,and Tel.No.246 6 G.xccWahoy` knt- Designer's Name,Address,and Tel.No.
S44 Roo•c k3b So^aw'c1, Ma• SOa•Wn'ObSl NA - Ike-►r kc •¢xis+koa Qcw% OWN�.
Type of Building:
Dwelling No.of Bedrooms -/Vft Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)_CIO me Ck j 0 n o� QV C. stw o r of co. £co(, nc,')
CA46 p� 10 2).-Et n x Se(;A C. -4 0, L o nlv A
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Si ed Date 1111k
Application Approved by Date
v
Application Disapproved by Date
for the following reasons
Permit No. (ram i ��� Date Issued 20
No. t' �✓ Fee /' V
° Entered in coni uter: A
P
THE COMMONWEALTH OFfMASSACHUSETTS ".Yes
PUBLIC HEALTH DIVISION.-.TOWN OF'B'ARNSTABLE, MASSACHUSETTS
2pplication for 33isposaf 6pstrin Construction Permit �q
Application for a Permit to Construct( Repair( ) Upgrade Abandon( ) ❑Complete System 0/ndividual Components
Location Address or Lot No. 14$ q O)o n `k t t0- Owner's Name,Address,and Tel.No. Me,r
Assessor'sMap/Parcel cxrrVecu•tty q5 A tNv, ;A. (Sool,32•A1sc�
Installer's Name,Address,and Tel.No. b�y 6 x c,V o}o� 1n�- Designer's Name,Address,and Tel.No. co
311-1 RoAe l30 .5ol Qil-bu53 NA - ��e ;�0 8u� tiob at skem.0Qly
Type of Building:
Dwelling No.of Bedrooms / r .Lot Size, sq.ft. ,Garbage Grinder( )
/1 Other Type of Building No.of Persons Showers( ) Cafeteria( )
( r
Other Fixtures nn
Design Flow(min.required) /�} f'P gpd Design flow provided A) gpd a
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
t,
Nature of Repairs or Alterations(Answer when applicable)(,,,nnor jr.'A nt Q\�=
4
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. °
Slim Date t
Application Approved by ( Date C, 1
Application Disapproved by Date "
for the following reasons
Permit No. /�7_� ,<—�,�(� Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance `
++ THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded
Abandoned( )by P) {'a Y I jr-k�r n lA f
at \�% A llrw',r, cst•c F..+ C a n4�c9�,t1 , has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. l� r Av dated ' r
Installer (�A kne . Designer -&I
#bedrooms Nlq- Approved design flow gpd
The issuance of this permit shall not be construed as a guarantee that the system will (function as designed.
Date f �..t t Inspector AA 1.1,0k d.��4 .n'�Il!� � � ��b/f.l�,, ��.s !iI .
r
No. / 2 I Fee
`� THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH-DIVISION-BARNSTABLE,MASSACHUSETTS
Bisposaf 6pstrm Construction Permit
Permission is hereby granted to Construct O Repair( ) Upgrade( ) Abandon( )
System located at
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:C nstructon must be completed within three years of the date of this permit.
Date ��1 9 D 7 1 Approved by 2��
l va.ry `
,No
` y TOTE carrvE n+�MAS ►GTJSETT5 Fee— -
' [TB AI TH'llY't�is N B. -x, "MU SA ii75ETFS
ss
S
Pe i r ' the ;ranted}to Construct-;(: } Repatt(✓�. On
Upgrade
;,
artdr de e�Si d e dbaveApp itatton far Disposal System Cohn - Ptton emit;: The applicant recognised luslttar duty to co npiy with
Tttlts� tt� ld�g lr5eal provtstons.or special_condttidns
Prvvtded otiai d ust ccS 10eted v�thin three yea"rs of the;data of this pe it
Date AFProvad by
•
' TOWN OF BARNSTABLE
FLtGATIQt�T jN3:A tcaar` 5A SEWAGE#
ASSESSOR°S Mrs'&P�IRCBL i
I1�FSTAxER'S &NAME PHONE NO r 7�Cayb��� a/ t4nn 04�.
LI j
SEPTIC TANS{CAPACITY
I�� GhiC'FACIIITY (type) (size)
NO,fl °I3�DROQMS
R -
`- E TATE "� 2: 9 CQMPLIANCE DACE . 1�}
� ea;aFtcin Distance Between the:
1Ma�c44utn Adjusted Groundwater Table to the Bottom of Leaching Facility Fact
Pti9p Water;Supply Well and:Leaching Facility(If Any. exist-ori
`sta or wttlun 2Q0 feet 6f Ieaching facility Feat
Fdge of Wetland arid'La�ching;Faciiity(If any.wetlands:exist wittun
30Q feet`of leachtt�g facil,ity) ;Feat ,
FUTt"MED BY
�zcr A1. 2 5
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3 Ga ��•
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