HomeMy WebLinkAbout0088 MOCO ROAD - Health 88 Moco Road
West Barnstable
A — 1.95 — 015
i
No. FeeZI v
THE COMMONWEALTH OF MASSACHUSETTS Entered in compu er:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
4plitation for -Misposal *pstem Cons"ttion Verrnit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.fl R Owner's Name,Address,and Tel.No.
Assessor'sMap/Parcel �(�I�IVg^ ek% st�'�� !)S` V.
Installer's Name,Address,and Tel.No. I{ �.z,.1 o Svc 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
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs orAlterations(Answer when applicable) i p L� � ��r r'✓
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 aannd not-to place the system in operation until a Certificate of
�-
Compliance has been issued by t is Board of Health. �,
gne Q — Date
Application Approved by fiADate
Application Disapproved by Date
for the following reasons
Permit No. �� Date Issued
No. Fee
THE COMMONWEALTH OF'MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION,- TOWN.OF BARNSTABLE, MASSACHUSETTS Yes
01pplication for M11sposal *pstrm Construction permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No f W2d Owner's Name,Address,and Tel.No.
Assessor s,Map/Parcel P irr. S // vo'', r'J/-E'
Installer's Name,Address,and Tel.No. I`�K a"r a "cni✓—'Designer's Name,Address,and Tel.No.
�.� o E
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
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs orAltera 'ons(Answer when applicable) /�/ r ��^� /�'�-� �e��4 r-e^ D
r
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 of to place the in operation until a Certificate of
Compliance has been issued by this Board of Health.
Xgned Q. Date
Application Approved by ���/ , 'f Date Q +/ /
Application Disapproved by / Date /
for the following reasons
v
Permit No. "'~ Date Issued 17
-- - - -, --- - v --- -� - - -- - - -- - -- -- ----- - - - - ------------------------------------ -
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIF/YY that the On-site Sewage Disposal system Constructed( ) Repaired( v Upgraded( )
Abandoned.( )by CA,0 yl f)
at 6 C Q /� has been cons cted in accord,�ance
with the provisions of Title 5 and the for Disposal System Construction Permit N . / ted
Installer
t� A 1.,% Designer
#bedrooms, /� r Approved design flow gpd
The issuance of this permit shall not be cons�tted as a guarantee that the system ill function as d'esi ned.
Date `'/ /�f' �/ / Inspectors --. ,. . •-•^^,�
No. 's Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
disposal Opstem,Construction permit
Permission is hereby granted to Construct( ) Repair(!.�,< Upgrade( ) Abandon )
System located at Af
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 s ction ust be completed within three years of the date of this permit. G "�
� 1
Date / Approved by