HomeMy WebLinkAbout0142 SUNNY-WOOD DRIVE - Health (2) S Un rl ZJ 'j .
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No. —a 2 7 ' Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ,
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS S
2pplitation for MispoSal 6pStem Construction Permit
Application for a Permit to Construct( ) Repairv(Upgrade( ) Abandon( ) ❑Complete System Eq1ondividual Components
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Location Address or Lot No. kt4,1 :svNr,. _i ;.La®o6 �(' Owner's Name,Address,and Tel.No.
iS '
Assessor's Map/Parcel �? �� a S ��` �
Installer's Name,Address,and Tel.No. I Designer's Name,Address,and Tel.No.
Type of Building: XiL4 oo�,�
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
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) 00�� �X—i
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 Date < < ( 2
Application Approved byV?w Date X .i
Application Disapproved by Date
for the following reasons
Permit No. Date Issued 4 11 1.)2
�Y t
No.
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS �.•
Zipplication for Misposal *pstrm Construction Permit
Application for a Permit to Construct( ) Repair Upgrade( Abandon( ) ❑Complete System °Individual Components Xy
Location Address or Lot No. k`1 l Sv(.jr,y/_w Opd Owner's Name,Address,and Tel.No.
25 z,s c Assessor's Map/Parcel �? �� � Cam` C)n
Installer's Name,Address,and Tel.No. rrwtA �� Designer's Name,Address,and Tel.No.
Type of Building:�- _ S-� ail Ld Oo k" C1
Dwelling No:of Bedrooms A) f} Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( )•Cafetena(.. )
Other Fixtures
Design Flow(min.required) �j gpd Design flow provided Al f(3, 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)
Date last inspected: .; f`
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, A' Date
Application Approved by „� „_,e5- Date
Application Disapproved by Date
for the following reasons f
e
r "
Permit No. C3 `U / 6 Date Issued .?:2
THE COMMONWEALTH OF MASSACHUSETTS
rUY BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( �� Upgraded( )
Abandoned( )by S44 r-*V ;)
at 1( � 5l(nn. , ,,g r�S _(,.�� has been constructed in accordance
with the provisions of Title and the for Disposal System Construction Permit No..2 7,`d 76 dated
Y r
Installer 3 C_X1 �f`t_,.� 4 Designer
#bedrooms J , Approved design flow /)/'� end
The issuance of this permit shall not be construed as a guarantee that the system will functio has/designed.
Date 2 Inspector /V lA
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No. -2 O))" - o 7 Fee -
THE COMMONWEALTH OF MASSACHUSETTS
+
PUBLIC HEALTH DIVISION-BA� RNSTABLE MASSACHUSETTS
;3isp6sat *pstem Construction Permit
Permission is.hereby granted to Construct( ) Repair
rf( �j)� Upgrade( ) Abandon( )
System located at. &\J N n-,[ t,.I bo ell C_ ,
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. n
Date �I,; / Approved by