HomeMy WebLinkAbout0011 BENT TREE DRIVE - Health 1 ? Beat'Free Dave
Centerville
A= 168-033
N SMEA
No.2-153LOR
UPC 12534
smead.com • Made in USA
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CERTIfIFD
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c��_ PARCEL NO.: � 6�
No....tl 2f� Fes$.............. .
THE COMMONWEALTH OF MASSACHUSETTS
JQ BOAR® OF HEALTH
------...O F
b � ......................................................
Appliration for Dispaiial Works Tnntrnrtinn lirrmit
Application is hereby made for a Permit to Construct ( )'or Repair �k) an Individual Sewage Disposal
System at, 5
pp Lo*c/ation-Address or Lot No.
Owner dress /
Installer Address
UType of Building, Size Lot----------------------------Sq. feet
Dwelling—No. of Bedrooms..............................•_______..Expansion Attic ( ) Garbage Grinder ( )
._
a Other`—Type of Building ----------------------------_No. of persons...'.. ..................... Showers ( ) — Cafeteria ( )
Other fixtures ................................:2 y.............................
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 ( )
� Percolation Test Results Performed by---••-----------•----••...............•--•••......--•----•••••-•••------- Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-----------------_......
f= Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water______-__--____--_--____
P4 ..............-'..............................................................................................................................................
0 Description of Soil........................................................................................................................................................................
/ ```` ------------
U Nature f Repai s or Alterations—Answer when applicable.----___ X..S1t i!-.____...._l�_��._9a/.___ .......................
_�......_ -
W _
pp r
Agree ent
T e undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iT"t.-.., 5 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 and of health.
Signed------ ••. h�..... .. �........`.................. --•• � ............-....
Application Approved By.........�CL,. 1 -�t1
Date
Application Disapproved for the following reasons:--------------------•-••------------------------------••----------------------------.---------------------••---
Date
PermitNo..... ..�-v .................................. Issued.......................................................
Date
ti
No... .......!.. �
THE COMMONWEALTH OrjMASSACHUSETTS
BOARD OF HEALTH
I.W tA..........OF..... 5...........................................'
a
App iratinn for Disposal Works Toustrurtiun Prrutit
Application is hereby made for a Permit to Construct or Repair an Individual Se�s�a ?Disposal
PP Y ( ) P ( ) g
System at:
J/-----. eel ....... !./l e. = . v;l� , �r%>
Location-Address or Lot No.
.. ¢y ............................................... ............ .....---...........__________-__
//Owner /, dress �i C
a / �... ......--� G!!-Q_;Zer-------------------------................. ....•-- i•i-L'�f�.1 �••e4�1Y�Q-tI-- lj2S
Installer r Address
Type of Building Size Lot............................Sqt(feet
Dwelling—No. of Bedrooms.......3................................Expansion Attic ( ) Garbage Grinder ( )
pa, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria�( )
Otherfixtures .------•----------------------------------------•-----....----------------------------------------•----------••------•--••--••-•-••••........--
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
R: Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth__________.__.
xDisposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................s4t.
Seepage Pit No...................... Diameter.................... Depth below inlet.................... Total leaching area..................sq-ft.
Z Other Distribution box ( ) Dosing tank ( ) r^�
aPercolation Test Results Performed by.......................................................................... Date...................... ..............
,_l Test Pit No. l________________minutes per inch Depth of Test Pit.................... Depth to ground water_-___-_-s� ._____ --_.
rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_--______--_____-_---
---•••-•--------------------
ODescription of Soil........................................................................................................................................................
U •------------•---••-•---------------•----------------------•------•--------------------•-•-•---•-•-----•--•------•---••----•------•---------------•----•--------•-----------•---•-------•-•-----
--------------------------------------------------------------------------------------•----------•-----•------------------------
U Nature of Repars or Alterations—Answer when applicable.____- .��1I' -v�___9R1__._ __F.r9.�.rd___A
•-•••-•-•••• --t::.Q --•--------------------•--........-•-------...--•------------------------------•--•-------•-------------------------
Ag ee ent-
e undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance w�th
the provisions of TiT p 5 of the State Sanitary Code— The undersigned further agrees not to place the systemlin
operation until a Certificate of Compliance has been issued by the kloard of health.
Signed �d1_+.,�.n...... ._4—C"44-__________________••-------- .._ '_� .
-Date
Application Approved B
�C
PP PP Y-----------L-�- - ------ f -•-� -
Date
Application Disapproved for the following r ons:..........................................................................................................
.•••-...--•--•••----------•---•--•----•--•-•--•----••-.._....--•••-•••--------•-••--•-•••--•----•••-•-•••---•---------•••-•-•-------------•----••••--r
Date
PermitNo.....�. I .......................... Issued_.................................................
Date
'ter THE COMMONWEALTH OF MASSACHUSETTS f,
BOARD OF HEALTH
�'V'.V.iv.....................OF....... . � ��:.lY ......---..---............
......
Trrfifiratr ,af Bout#ltanrr
THIS,�LS TO CERTIFY, Tha the Individual Sewage Disposal System:constructed ( ) or Repaired
by =:-}� 1CtN.Sf1 4� .......................... `'�-•---------------------•------•------- "`......................................................
nstaller.
�--ce•^----- --_---- 7
at.•---••••---�-•............. - t-�/I....-•• =' -------------------------------•------•-----------------•-------------------
has been installed in.accordance with the provisions o 'i i i"' j of 1he State Sanitary Code as describekin•,the
a lication for Disposal Works Construction Permit-No___________ __'____
PP P F da ed =� -4-• JL.---- r}
THE ISSUANCE OF THIS CERT�F CATESSHALL NOT BE CONSTRUE® ASS GUARANTEE TI i4'f-YHE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
_ BOARD OF HEALTH
J
�?
ipo1 Works T�anrttruan rruti
Permission is hereby grant •-•----.t-' r�;'`e.----.. __ .
to Construct ( ) or Repair )�p Individual Sewage Disposal System
atNo. f l - - l__r3-C4---------a,_,............... ------..-•---------------------•------------------- .........:.
Street
as shown on the application for Disposal Works Construction Permit o S,c_ Dated.........................................
.. •-•-• �° ........................
b ••-•..... ...... "(�'1'—CiBo�rd of Heal h,
DATE•--•-•••-••••--•-r
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
�. TOWN OF BARNSTABLE
LOCATION 1 t3ed� -fRee- dt SEWAGE #
VILLAGE C e� CK ✓/��� ASSESSOR'S MAP di UZ 'J
INSTALLER'S NAME & PHONE NO.KeViW Sm611'fR
SEPTIC TANK CAPACITY 1000 T /
LEACHING FACILITY:(type) Aef (0,45 (size) 160
NO. OF BEDROOMS__PRIVATE'WELL OR PUBLIC WATER
BUILDER OR OWNER 12
DATE PERMIT ISSUED: �' 7
DATE .COLIPLIANCE ISSUED: 542-
VARIANCE GRANTED: Yes No
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