HomeMy WebLinkAbout0005 AURORA AVENUE - Health 5 AURORA AVENUE
Centerville
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S M E A D
No.2-153LOR
UPC 12534
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TOWN OF BARNSTABLE
SEWAGE#
LOCr"ilON _ �'
--Q-T0k-,--- ASSESSOR'S MAP &LO
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACTTY
C44��1 (size) �Q K
LEACHING FACILITY: (type) f)`c L
NO.OF BEDROOMS 3—
BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the: Feet
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility
Private Water Supply Well and Leaching Facility (If any wells exist Feet
on site or within 200 feet of leaching facility)
exist
Edge of Wetland and Leaching Facility(If any Feet
within 300 feet of leaching facility)
Furnished by
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LOC&.TIOK.I : SE\AJOC;E PERMIT U0.
VILLAGE
It�1STQLLER�S W&ME ADDRESS
BUILDER 5 Q &VAF- �- QDDRESS
DATE PERMIT ISSUED 2L/ 26- — —
D ATE coKAPLI &KICE ISSUED
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TOWN OF BARNSTABLE
SEWAGE#
E "C� ��� `\—�_ ASSESSOR'S MAP & LOT-15 ' JI
INSTALLER'S NAMEME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) 1� D`�CWSJ- (size) h,P1'67 j&-41(
NO.OF BEDROOMS
BUILDER OR OWNER
PERMTTDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maxus num Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
TDI)OVO OFFICE
_? ocblTION ' 5EW&(:,E PERMIT MO.
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V/ILLAGE ������� L�F — — —
IWSTQLLER 5 1J&ME ADDRESS
BUILDER5 IJ &"F- ADDRESS
DNTE PERMIT ISSUED "26- — — —
D D.T'E CONAPLI &MCE ISSUED : — — —
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
_................O F.. . ................................
Apptiration -for 4%ipwial Workii Tonitrurtion Vaniit
Application is hereby made for a Permit to Construct ( ) or Repair ( i/f an Individual Sewage Disposal
System at:
Lo do _Addres o Lot No.
Owner Address
a . . .... P ---- •--.._..---•••--•.....--•-----..._... ....--•--------------------------------••--
Installer Address
U A
Building Size Lot-----------------------------Sq. feet
Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ------ ..................... No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ------------------------------------------------------
W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic Tank—Liquid capacity------------gallons Length................ Width................ Diameter-----_.-.-._--_ Depth----------------
x Disposal Trench—No- -------------------- Width.................... Total Length-------------------- Total leaching arca....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet------------_....... Total leaching area------------------sq. fi.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by------ -----••--------•-......--••--••....................•-----•••.•••. Date------------------------------------
Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water_..---.-.-_-.--._----. -
11 Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water--------------_---_-___.
O Description of Soil--------------- ___
V -•-----------------------•--------------•-•----- .........................................Z----_---•-------------- ---- ------------•--•-------•---••-•----•-----------•---•_----------•------------
---------------------------•--------------------•-••----•-------•------•---.........--'-----•--•---------......-------(_--•--•------------•------.-----.--,---_-..--•-------••-•------------••----
V Nature of Repairs or Alterations—Answer when applicable.._ ..........................................
------------------------------------- � ----------P!9..C/lVic._...
,r -._.._
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article NI of the State Sanitary Co The undersigned further ag es not to place the system in
operation until a Certificate of Compliance has b is ued
by the board o^alt .
�.
Signed... 9.. � �
Date
ApplicationApproved By-------------------------------------------------------------------------------------------------- ---------------------------------------
Date
Application Disapproved for the following reasons-------------------•-•--•• -•--•--•-•-•--•=-•--•-............_..-•-•---------------•--••--....---•-----••---•--'-
-----------------------••------••--•----_--_-----•---•--•--------------------.---------•-•-•---•---------------------------------•-•-•----------••-•------••-----------------------••----------•--------
Date
PermitNo......................................................... Issued--------------------- .................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. . >>'r.. ....
Appliration -for Biipoottl Works Tonstrurtion Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( 1- an Individual Sewage Dispo l
System at:
............u. .._ ,rt>.._/..:... r.-�_=�� 1_ . .•... _ar <. _ 1 � t
_ r...--
,1 Location Address or Lot No.
! iJ a
..... ...Owner..-•---......••. ......... ..... ............................................Address.--•----•---••-••--••••----•-••---••-------
w &0,s z1�� �1 ifis r,jig_�Ir'.t r���v�PIW
Installer Address
Q Type of Building Size Lot_--------------------------Sq. feet
V Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building -_......................... No. of persons---------------------------- Showers ( ) — Cafeteria ( )
dOther fixtures -----------------------------------
w Design Flow--------------------------------------------gallons per person per day. Total daily flow...........................................-gallons.
WSeptic Tank—Liquid capacity------------gallons Length---------------- Width..........-..... Diameter------ ------._ Depth..-..._-_...-..
x Disposal Trench—No'..................... Width-------------------- Total Length-------------------- Total leaching area.--------------.....sq. ft.
Seepage Pit No--------------------- Diameter-------------------- Depth below inlet_--__-.-__-----_--- Total leaching area------------------sq. ft.
z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by--------------------- ---------------------------------------------------- Date.....----•-----------------------------
a Test Pit No. i----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water--......--.------.---.--
fZ4 Test Pit No. 2................minutes per inch Depth of Test Pit......--............ Depth to ground water.------.-__._...-.--.--.
04 ....-----•-•--•---------------------------------------------------•------------------•----------•----•------...-----------------------------------.. ........
O Description of Soil.---------- r71^,/
x ---------- -- -<Z------------.....---------------------------------------------------------------
U -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------- ---------------------------------------------------- --------------------------
U Nature of Repairs or Alterations—Answer when applicable��e .?r n__ ,M .,r_--- ____________________-______-______...
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been"!�issued by the board ofih'ealtliI / l
Signed----(71 ��- t, �� / #_
----------•----------`-�'�- �.— _ 7
Date
ApplicationApproved By------------------------------------- /------------------------------------------------------- ----------------------------------------
Date
Application Disapproved for the following reasons:---•-•-•---------------------------------------•------•--•----•-•-•-------------......----------•------------•--
•..........--•.............••••--•---••--•-------------------•••-•------....-----•.-----.--------------•....--------•----•--------------------------------..---..----•------------.•--------------------
Date
PermitNo......................................................... Issued----------------------........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
0.1rrtif irate of f.1,11mlifittnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal/System constructed ( ) or Repaired (/,--y
{ `� Installer
at-f__..Ll.'7Er1%U--...... /_ �1, a. s•f� = !� i -" /r z
has been installed in accordance/w th the provisions of Article XI of The State Sanitary/ Code as described in the
application for Disposal Works Construction Permit No.---.�.5p5---------------------- dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..............................................----------•---•-•---•-----••... Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
i
BOARD OF HEALTH
...,let�'t jam............o F' l I-i;, 1./i 1/1-4
` .
No......
Binpotittl Norkii 'Tlomitrurtion Permit
Permission is hereby granted._t. - `- r1_ !�.�� f/°r' _l r//N:()__f____
....................
to Construct ( ) or Repair (j,-) an Individual Sewage Disposal System
at Na� f/ _l/1:7 �t-- 'il'`�`� /l__ 't/i_?J!!(?_. y /Ep }?�/ ' i.!h....................
Street ✓
as shown on the application for Disposal Works Construction Permit No .......... Dated Dated....2 -.1'.. ...................
'7 .. 7� sod of Health
DATE.
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS