HomeMy WebLinkAbout0346 OLD STAGE ROAD - Health (3) C3
No. Fee 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS Yes
o� TippYicatiou for Disposal .6pstem Construction j3eruut
QApplication for a Permit to Construct Re ai Upgrade Abandon pp ( ) p �) pg ( ) ( ) El Complete System ndividual Components
Location Address or Lot No. (,I (o (� l S c�5 (Z Owner's Name,Address,and Tel.No s'a ;e 0 3 3 l) o
Assessor's Map/Parcel k 50 1 p` C e VOke Q ` 01—r cc,S S 1,5
Installer's.Name,Address,and Tel.No. Designer's Name,Address,and Tel.No..
S-tl 19L4 GOGw
Type of B ding:
Dwelling No.of Bedrooms 1
• g �/� Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures p
Design Flow(min.required) Iy 1 gpd Design flow provided */' gpd
to
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)_ Cam- Q \ CL�oU k`U�
4C C-0 M C. j)A D'k�� kC..n lam. 4-O Q G 6%
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 o ealt�h.
Si ed Date l/
Application Approved by T -4 Date
Application Disapproved by J Date
for the following reasons
Permit No. �� Date Issued _G
'F •F.. 1 r '" ....m.' v r.. .. ,..:-e!S -�.... �. ry �..o.. N7',1.•.^ �'JS_.. A .f..'e`%k.F..y,r'is., � ,.
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4
No. :;Z.992 _ 1-3 Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
p� 0[pplication for Misposal *pstem Construction Permit
Application for a Permit to Construct( ) Repair,/) Upgrade( ) Abandon( .) ❑Complete System 54Individual Components
Location Address or Lot No. (,) (o U $fi�5 C C? Owner's Name,Address,,and/Tel.No.V S' e 0 U
Asses L(sor's Map/Parcel I S 0 0 C.V ,� ��r1 r 1 ( 5
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
S c c; rr���/C: 3 G Xd y C_rn&tjQ\N.\,.n c/
Type of Building: Itl
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) iy gpd Design flow provided 01 A gpd
ra 1
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)
'row\ C1�. ka k- r��� �C. l� 4-r-\ d1�G
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 o ealth. o
Signed . Date (`
.Application Approved by 11(\ . / Date lax o a
Application Disapproved byY Date
for the following reasons
Permit No. I?j� Date Issued
r
THE COMMONWEALTH OF MASSACHUSETTS
!, PC BARNSTABLE MASSACHUSETTS
6
F4 Certificate of Compliance
THIS IS TO CERTIFY that the On-site Sewage Disposal system Constructed( ) Repaired(V"') Upgraded( )
Abandoned( )by fr C S t- ,.n k—
c^C 1 L
at c,c t R.j • V ih`Ween constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No dated
s
Installer C O A M C't'CMV4._ Designer
#bedrooms }, Approved design flow ✓) gpd
The issuance of this permit shall not be construed as a guarantee that the system wiillfWi pion as designed.
Date 2 Inspector t l�t
No. .�/(� �' Fee
THE COMMONWEALTH OF MASSACHUSETTS
j PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
isposal *- pstrm Construction 3pErmit
Permission is hereby granted
to Construct ) Repair t6l) (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:Construction must be completed within three years of the date of this permit.
Date �// 1 �p.� , ' _ Approved by