HomeMy WebLinkAbout0017 INDIAN TRAIL - Health p �� ch,
No. d Fee �-
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
1plitatlon for Disposal 6pstrin Construction 3dPrmit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon(� ❑Complete System ❑Individual Components
Location Address or Lot No. 1 ZN D 1 rt N T►P,?,i L �/
11---_ Owner's Name,Address,and Tel.No. ;4
Assessor's Map/Parcel 3 3 S O i 9 rjn(1`Tl" S�tf �T" n�f-7-4 T GV �'L3
I staller's Name,Address,and Tel.No. J`�� `i 1"I ' a B Designer's Name,Address,and Tel.No.
10 cte-1` 13 out co.
3�3 �h,ks P�+-►t o ITN y t�V+ 6 Z G e H
Type of Building: I
Dwelling No.of Bedrooms 0�✓►/�
Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) (J `/� gpd Design flow provided J✓/ 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)
/�bcN 0�a ��T �i c.JF}�s U/1Dc2 �C1 by Irce /741 dell buxjm�
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 Enviroial Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of It .or
e
Signe Date // -Z J 2
Application Approved by Date j/_
Application Disapproved by Date
for the following reasons
Permit No. 1 3 Date Issued 2 2 l
i
No. GU i. �. .i �3 Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer -
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01ppf cation for Disposal .pstem Construction VPrmit
Application for a Permit to Construct{ ) Repair( ) Upgrade( ) Abandon O ❑Complete System [I Individual Components
r. . x
r
Location Address or Lot No. �1 .TP:1�I�N 'C�;h i S. ! Owner's Name,Address,and Tel.No.
Assessor's'Map/Parcel s/o(9f✓'� J f�'�rk 1� /7ycJ s 1 �j/1 r !'T 1�1J6'P ,,.r
-y�'1 - ear
I;nstaller's Name;Address,and Tel.No. 5Q
RDesigner's Name,Address,and Tel.No.
u')Ci_r 0 vup C0 .
f'A- -H c Q1)4 Y4aLiAtQT14 C z c 4
Type of Building: 4!�1lll r �G -
7,.
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) N 14 gpd Design flow provided �I� 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)
i�CiRrJ d�I &L*0 P0- Tth4 tJq.s Unaeg, �.x►� hhy Tree 1714T F,-ll Dokirig kM
Date last inspected: '
Agreement: fix;`•. .
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 VofH t. �.
Signed----., Date j"z _L.r
Application Approved by;. G{ �- r !L/ Date
Application.Disapproved by Date-
- for the following reasons ,
Permit No. Cl , e ) Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS I TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( . ) ` Upgraded( )
/ !`
' Abandoned( )by .. ► '`7 T,r),w T n., % ��,cry, N'•t h i� •
at has been constructed in accordance ( 1
with the provisions of Title 5 and the for Disposal System Construction Permit No.`� ri ` er 3 dated
Installer Designer
#bedrooms N Approved design flo4\ Al I l� gpd
The issuance of this permit shall not be construed as a guarantee that the system dill function'as designd,,d.
Date 1 d Inspector
- ------•--- --------------------
No., 2 d.7- ( r ✓ Fee
THE COMMONWEALTH OF MASSACHUSETTS
0 PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS
Disposal 6pstetn Construction Vermit
...Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon
System located at ' —7. -_.?1„J,
t 7 ,
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. r
Date -� /d�i /d Approved by i, '6`' l 1! J
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