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HomeMy WebLinkAbout0166 GREENWOOD AVENUE - Health (2) %llP ����� moo d ,41��ic., �� 1 ,. .�. No. �'yi�r Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Bisposal 6pst>em Construction 'Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon ❑Complete System ❑Individual Components Location Address 1otANo. �(� UX�OO AV R_ Owner's Name,Address,and Tel.No. OL Assessor's Map/Parcel " - M " Installer's Name,Address,and Tel.No. a� Designer's Name,Address,and Tel.No. Sc©We-, Type of Building: LYY ^"-L% 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) 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 alth. Signed A Date Application Approved by ` Date Application Disapproved by Date for the following reasons Permit No. daa Date Issued 1 f �' t . No. �)1� 'Fee el S o v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:,s, . ,PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplication for Misposal 6pstern Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon ❑Complete System ❑Individual Components . Location Address or Lot No. f/ j Owner's Name,Address,and Tel.No. �a 14 b lTc-G�Wd vJ f�V V_ tl'1 Assessor'sMap/Parcel Installer's Name,Address,and Tel.No.' a Designer's Name,Address,and Tel.No. A tier raw Aot" 9- � Type of Building: LF „nt Dwelling No.of Bedrooms / „ r; Lot Size , r;�_ . 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 Soill r} r`, 4 Nature of Repairs or Alterations(Answer when applicable) Lt_n ri F1/'t OF4 t tc AGt^� #; r Date last inspected: o .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_ p f Date Application Approved by ,r Date Application Disapproved by Date for the following reasons e �, Permit No. �� i Date Issued �> --------------- _----- - -- - -- -- - -- - - - ` - ( ----- --- --------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS `5 Certificate of Compliagu e, THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandonedl,(/')by AA atChas been constructed in accordance - with the provisions of Title 5 and the for Disposal System Construction Permit.No. .� a�r�."ox` dated << .? la � r Installer / Designer �r #bedrooms Approved design flow P J "' gpd The issuance of this permit shall not be construed as a guarantee that the system will function,as.designedr Date , / / ,.- .�j,� Inspector --------------- ------------------ ---------------------------------------------------------------------------------------- - k• No. y r Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS CF Misposal stern Construction 3dermit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon System located at t-X,3 0 c, Ac i m- r 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. r.___ � Provided:Construction must be completed within three years of the date of this permit. Y, r� Date 1! d t - . Approved by