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HomeMy WebLinkAbout0022 BENT TREE DRIVE - Health 22 B..enttree Drive Centerville A= 168-050 No. 42101/3 ORA ESSELTE 10% (a a o a o No. Fee 175 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer::: ,. Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ApptiLation for MI OSal 6pstem Construction i3Prmit Application for a Permit to Construct( ) Repair UpgradeA andon( ) ElComplete System :�Indiidual Components Location Address or Lot No. �� /1��' 7a� er's Name,Address,and Tel.No. _ rU �,. MA.M I Assessor's Map/Parcel - 06 zffi -v 4LffV=:::e 1 CA Il r Installer's Name,Address,and Tel.No. Designer's ame,Address,and Tel.No. Agl L-0 _j Type of B lding: Dwelling No.of Bedrooms _3 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 .1,0eX4 A_ 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 Hea . Si ed �=---�r Date /2 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. /to — L15f Date Issued t No.G7"" / r v + Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION = TOWN OF BARNSTABLE, MASSACHUSETTS application for D1 oosal 6pBtem Construction Permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. Z QQ,17` -T ee �� w*ner's Name,Address,and Tel.No. y _ Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's`Name,Address,and Tel.No. j + i Type of Bedding: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures i Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date j Title Size of.Septic Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) f 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 HealtIV ; Signe �- o ,, ; .._.. .--'- Date 12—72 —j/ Application Approved by Date Application Disapproved by Date for the following reasons _+ i ' jyj'ry'yy, (/^(��, / •j�+7� RI {(may Permit No. ! ! Date Issued "4 r,' �',n THE COMMONWEALTH OF MASSACHUSETTS ti ✓ BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) I Abandoned( )©©by at has been constructed in accordance r with the provisions of Title 5 and the for Disposal System Construction Permit NQ*/k -'/5 K--dated _ p Installer � � /4�r � Designer [�/� h.� #bedrooms fit`- Approved design.flow f 1 N and The issuance of this permt shall not be construed as a guarantee that the system willt/function as designed ,.1 Date i Inspector `�`f tir1 s'vT t r No. —}i Fee . THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposat 6pstem Construction permit Permission is hereby granted to Construct( ) Repair(1,1) Upgrade( ) Abandon( ) System located at °J�. A:.'-F 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. is Provided:Construction must bwcompleteed within three years of the date of this permit Date /r��`J/ Approved by �a TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT g did i INSTALLER'S NAME dz PHONE NO.i-P rl A49,p,Gel- SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) ., NO. OF BEDROOMS- -PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER L2icr0o � DATE PERMIT ISSUED: qQ DATE COMPLIANCE ISSUED: _ i VARIANCE GRANTED: Yes No - z _ O i Q ti s7 . t TOWN OF BARNSTABLE LOCATION ;,.A l3e/V 7' T'f? Z t SEWAGE# IQ 16 fSX {,VILLAGE p- e— ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. s�P,r SEPTIC TANK CAPACITY /6 b D LEACHING FACILITY:(type) j TS (size) NO.OF BEDROOMS � �1 q W d /fir E f 'I PI OWNER lv v PERMIT DATE: z COMPLIANCE DATE: 1 / Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 0 A l -.� 131- A 3-2d� A 4 Fis.1...3l.00 No.. .t;.1._. .. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH APPROVED TOWN OF BARNSTABLE Barnstable Conservation Department ,-Ppliration for Diripwial Wnrk,g Towitrnr inn dltI Date Application is hereby made for a Permit to Construct ( ) or Repair (XX) an ndividual Sewage Disposal System at: 34 Benttree Drive Centerville .............................•------.........---------......------......----•-...--•-•-........--- --•-•-•-••-----••---------••-•....-••--------------•--•-------..._....-•-.....---................. Locstion-Address or Lot No. Lewis Bacon ..-•-•-•-------------•----•-•-•-------•------------.........--------------------------------•----- •-•--•-----..--....-••----•----------•----------•••-----•--•-•-•-.....................---......._. W J.P.Macomber Jr. Owner Address Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—XNo. of Bedrooms----------------3--------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons----,...............-------- Showers ( ) — Cafeteria ( ) 0.' 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 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..--.................... Test Pit No. 2................minutes per inch Depth of Test Pit...----.......--.... Depth to ground water........................ Q+' •-•-------------•--------------•-•--•---•-••--•--•••••-----••••--••......................-•-•-_...--........................................................ 0 Description of Soil...Sand....& Gravel W U ........•-•-•-••-•--•••••-•--•-------•------•--•-----•---•--•...-•-••---•-•--•------•--•--•--•-------••••----------------••-••---•-----•-•-•-••....••••--•-•••---•••---------------...---•-•---•---•----. W ••--••••••------------------•----•-•--••--...........---------........--•...........----•-.•••-•••------•-•-•--------•--------•----•---•----•---•-------------••---...........................-•----•-- UNature of Repairs or Alterations—Answer when applicable-1-1000 eae gallon lhin� pit packed in stone. Adding to existing; tank. & pit off distribution box. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed .. 2 .. ........................................ Date.-.. ® Dace ApplicationApproved By ... .... ....... . ............ . o....... ..... .. ........................... Dace Application Disapproved for the following rearo . ............. ................................. . ........................................... .......................... ....................----.-........................... .. ----------------- ...—....-..-------------...---......"-.- -.-...-...... .2..—.........Date.....-............ Permit No. ............ r�� .. .. Issued .......... ...� .-- f 3 ... ... ............... Dac t �j No....�.-- Ficim ...30..00... THE COMMONWEALTH OF MASSACHUSETTS 'BOARD OF HEALTH TOWN OF BARNSTABLE -T� 5 3 Ali.pliratinit for Diripngal Wor1w Tnnitrnrtinn W'rnnt i Application is hereby made for a Permit to Construct ( ) or Kcpair (XX) an Individual Sewage Disposal System at: 34 Benttree Drive Centerville ..............•----.........-•--•-...................---•--•--------•--•--•--.......------------. --•-••--------••-•-•-•----•••-....._..........------•--------......-•---•-------•---••---------••- Location-Address or Lot No. Lewis Bacon ......................_.......................................................................... --•-•----------••••--•-•-------•-••---•---••-•--------------•...---••-------••----..............-- W J.P.Mae•omber Jr. Owner Address Installer Address go 11 type of Building Size Lot............................Sq. feet .., Dwelling-XNo. of Bedrooms________________3--------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) al 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 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........................................ ,.� Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Li, Test Pit No. 2................minutes per inch Depth of Test Pit__-_____--.___.___. Depth to ground water........................ a ----•-••.......-•-------------•-•--------•----•------•-•-----------.......-•---•.........._.................................................................. 0 Description of soil...Sand_...& Grave l --------------- x ----------------------------------------------------------------------------------•--------•--...--•-•------•--._...._......•••..-------•--..... x U Nature of Repairs or Alterations—Answer when applicable._-1-1000 gallon leaching pit packed ......................................................................................... in stone. Adding to existing tank & .pit off distribution box. Agreement-. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. I t \ 5/11/93Sned ... r ;' r .......................... . . ...... Dare ApplicationApproved B ...............................................0....... ✓�if� l� ------------------------- --- ---- ----- ------------------ Due PP PP y /// Application Disapproved for the following rearo6 . . ........................... ..... .. ................................................. ........................ . .................................... ..... ------.. .�........../.. ..................... -----. -------- ......._.........Permit No. .....�......`��'..�../. .............. Issued ............. j Dacr.�..... J;--..... Dace...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired �XX� by J.P.Macomber Jr. ........................-------------------------------------------------------_ ------------ ----.._......------------------------------------- t-taller .. BentTreeDriveCenterville --- a t 3 ... . ... .... ...- .... - ......... ...- has been installed in accordance with the provisions of TITLE 5 of The State nwironmental Code as described in the application for Disposal Works Construction Permit No. ... -... dated ........................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE AS A GUARANTEE THAT THE SYSTEM WILL FUNCT//IIGON SATISFACTORY. DATE ---..__.... .5- -1.../..'. .3......_..........._..._...--------.._........_ Inspector ..... _..........._........_................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE N 0.9., FEE._ ... 0-•00.. �i��.t1�tt1 nrla� �un�tr�rtuan �rrntit Permission is hereby granted_._._J.P.Macomber_ Jr.__._. Ito Const uct ( ) or Repair -rX) an Individual Sewage Disposal System at No..3�... ent Tree Dri e Centerville.------ _-- ----------------F ----------... . ............................ �/-�Street q� a/ as shown on the application for Disposal Works Construction hermit No._-.. _.-_� )� Board of Health— DATE............ �� �.. ............................. FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS TOWN OF BARNSTABLE LOCATION SEWAGE - a� VI .LAGS ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO.J hInAco,r,�erfS vy� SEPTIC TANK CAPACITY LEACHING FACILITY:(type). (size) ,0004c NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER , DATE PERMIT ISSUED: •f' _L3 DATE COMPLIANCE ISSUED: b - I ` 7 VARIANCE GRANTED: Yes No �,� �-a -- - - � .� � � �� �� , ' �� �. � ` i3yi z3 3 0 �, � � ��' �9 , � O 1 �a TOWN OF,BARNSTABLE LOCATION SEWAGE # VILLAGE Ile- ASSESSOR'S MAP & LOT Alog (Od INSTALLER'S NAME & PHONE NO. fsewi l., SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: �' � q-3 DATE COMPLIANCE ISSUED: - VARIANCE GRANTED: Yes No i 0 .. Q 61 , % SC r ` q