HomeMy WebLinkAbout1541 HYANNIS ROAD UNIT UNIT 1541 - Health Bdms,tabltF" 01f
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No. _ ' Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVIS ON 4TOWN OF BARNSTABLE,, MASSACHUSETTS
ZIppYication for 30igpogat *pgtem Cottgtruction 3permit
Application for a Permit to Construct( )Repair( )Upgrade( Abando�( Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel No. 1 QG D�
159.1� N��iS 0O �7
As ssor's p/P el
Installer's 4ame,Address,and Tel.No. Designer's Name,Address and Tel.No.
.13ev 1-,C)-
P-v•i��x ��,� _ ForcS-r�-du..(e, ��,� v1�49 N q
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
DesignFlow gallons per day. Calculated dais flow gallons.
g P Y Y
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
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Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the cons ction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of T 5 o e Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issue th• bard of Health.
Sign Date
Application Approved by all Date
Application Disapproved for the following re o
Permit No. MJ Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( )
Abandoned( )by
at has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer Designer
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Date Inspector
Cam..-, y. i
No. f� r � „r--j X �� ..
_- Fee
—•� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
�. PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE, MASSACHUSETTS
, fication for i� o�aY ipotem Construction Permit
Application'for a Permit to Construct( . )Repair( )Upgrade( Aband�( Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.5411 N o ')is �)- i r)6b A._6te-: Pa. f lc r. Mu-I CCIh Y �O0U ��..5 - 9 7
Assessors ap/P cel 1��I � ��'� �� nS� � •d ' }
Installer's Pfame,Address,and Tel.No. Designer's Name,Address and Tel.No.
. I3evr lacqu•0.. co,Stru ti by\
R 0 13aX (IZ-V- Fort Sfd a(e 11A.- 024,E � NIA
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Gyinder(. )
Other Type of Building No.of Persons Showers'( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
V 'Size of Septic Tank Type of S.A.S.
F
R
Description of Soil "
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
;Agreement:
The undersigned agrees to ensure the cons ction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions off 5 o e Environmental Code and not to plac tithe system in operation until a Certifi-
cate of Compliance has been issue& th' oard of Health.
Of
Sign r- Date ?�>Application1 Approved by Date
Application Disapproved for the following re
Permit No. r Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS'TO CtRTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( )
4'
Abandoned( )by -
at has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer Designer °
The issuance of this permit shall not be construed as a guarantee thatthe system will function as designed.
Date Inspector
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS } v
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
lwigogai *p!5tem Congtruction P, rmit
Permission is hereby-g� to t ons ct( ) e n) rade �andon
System located at (�
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construct ;diust be c mple d within three years of the date of tet
Date: / 7 Approved by //.1 /
TOWN OF BARNSTABLE
UNDERGROUND FUEL AND CHEMICAL.:STORAGE.SYSTEMS. V
n -
ASSESSORS MAP NO. Z�� ' PARCEL NO.
ADDRESS; ��� �I 14YA&a15 VILLAGE: d/l&y5
y '
NAME;.__
CONTACT PERSON PHONE NUMBER 3607-' 34 W
LOCATION OF TANKS:. CAPACITY: TYPE OF FUEL.;. AGE: TYPE.:. LEAK
OR CHEMICAL: DETECTION
SYSTEM
L SL 5149E /000 ®/,L
DATE' OF PURCHASE OF. EACH: 1. 2. 3 4. 5. .
DATE. OF FIRE DEPARTMENT PERMIT:_/_C�`7
TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS
PLEASE PROVIDE A SKETCH SHOWING THE LOCATION OF. TANKS ON THE BACK OF THIS CARD.
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