HomeMy WebLinkAbout360-362 BEARSE'S WAY - Health J1 t�OL h �� S
i
No. 20 2� ) Fee
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THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
0(ppfiration for Disposal 6psteut Construction 3permit
Application for a Permit t Con truct( ) Repair 6( Upgrade( ) Abandon( ) ❑Complete System Individual Components
Location Address or Lot .3(p2_16 Owner's Name Address,and Tel No.
"\(C,,r��S mA 01&Q Cc < 5 •�� 1e\'(, Pam: e
Assessor's Map/Parcel 2C\'L I \bC-\ LI+h (AVe—
Installer's Name,Address and Tel.No. 6c—m G\ Designer's Name,Address,and Tel.No.
C)u,\6(\5 Lncc-.v�X-�,o('\3,S�-E-,C. 7143ci2
�.0 ZOA 5
Type of Building:
-'-Dwelling No.of Bedrooms I Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) N �— gpd Design flow provided A) 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:
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 ned Date 2 I22I�UZZ
Application Approved by y^./ to Date 2 /_> 2
Application Disapproved by Date
for the following reasons
Permit No. a- ° z JU Date Issued 2 > Z 2
a '' ;
{ S
I
^� C?
No. L y 1 U� 4i Fee !
THE COMMONWEALTH OF MASSACHUSETTS Enteredincomputet
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01pplication for MIspoi sal 6pstetn (Construction j9Prinit
S
Application for a Permit to Construct( ) Repair V Upgrade( ) Abandon( ) ❑Complete System Individual Components T—
Location Address or Lot No. � ,�j G, �,<, f�G�.; Owner's Name,Address,and Tel.No.
c,�tGy� I Cc ,< �� �r �� t6,`{
Assessor'sMap/Parcel ' OG 'L { N4UC-\ Gii1, C,Ue A .�e_�If V L4
rInstaller's Name,Address,and Tel.No. (�U �h Designer's Name,Address,and Tel.No.-nLj f.
Type of Building: °
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
" � I
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures ( A
Design Flow(min.required) gpd Design flow provided AJ i VY gpd z'I
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
I
Nature of Repairs or Alterations(Answer when applicable)�,( i ' (1 P CP(x
.
ti
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. t
Signed - Date
Application Approved by v1,/ Date 2 b 2
Application Disapproved by Date
for the following reasons
Permit No. cf Q °I r Date Issued Z 1 21/Z 2
r i f
THE COMMONWEALTH OF MASSACHUSETTS
l i Q. '- BARNSTABLE,MASSACHUSETTS
Ho"r Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(k) Upgraded( )
Y`
Abandoned( )by0i ii n FXC/_ 1c A1Cx-\--) Ser-A►C
i�at�j(,:Z <L.CS S (i��-( 6�`�I L�ll C� ►``, has been constructed in accordance.� '� �dated 2? 2 fffff t ' /
with the provisions of Title 5 and the for Disposal System Construction Permit No. a d �/�
Installer (Y� C� Designer n 1 /
#bedrooms iA- J Approved design flow, A0 �11 gpd
The issuance of thus permit ha not not be construed as a guarantee that the system w ill\function a/s"designed.
Date I InspectorjJl
------.:--.- -- - _ ._.:__ F ------- ----- - -------- -- - - - - ------ - - --- --
No. �_rJ 12` � � Fee —,7
THECOMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH.DIVISION -BARNSTABLE,MASSACHUSETTS
p p
L misposal *pstem Construction Permit
Permission is herlel granted to Construct( ) Repair( Upgrade( ) Abandon( )
System located at�' / G.C C P_ 7 }Gti f . �`l C,t1 �
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 P ermi.
Date 1 3 312 Approved by O" � � ,