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0027 CEDAR POINT CIRCLE - Health
27 CEDAR POINT CIRCLE CENTERVILLE A= 228-113-005 SMEAD KEEPING YOU ORGANIZED No. 12534• 2-153LOR SUSTAINABLE FORESTRY MIN.RECYCLED INITIATIVE CONTENT10% CerdOed Fiber Sourcing POST-CONSUMER www.sftprogram.org SFI01M MADE IN USA GET ORGANIZED AT SMEAD.COM No....-f. ........................ THE COMMONWEALTH OF MASSACHUSE;TS BOARD OF HEALTH ..........................................OF........................................................................................ ApVtiration for Bhipooal Works Tomitrurtion Vernfit Application is hereby made for a Permit to Construct (LKor Repair an Individual Sewage Disposal System at: ....... .................1................................................................................ Location-Addressor Lot No. tacz.. � .................................. Address ------------------------------------------ . . ...... 17..........M Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansi Attic Garbage Grinder ( ) PL, Other—Type of Building ............................ No. of persons......a................. Showers Cafeteria ( ) 04 Other fixtures ------------------ ........................ <� "'------------------------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid*capacity............gallons Length................ Width................ Diameter................ Depth.....--......... Disposal Trench—No. ...................: Width.................... Total Length....................Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. f t. Z Other Distribution box ( ) , Dosing tank ( ) 0-4 Percolation Test Results Performed by--------------------------- ---------------------------"------------ Date........................................ 0.4 Test Pit No. I................minutes per inch Depth of Test Pit.--................. Depth to ground water........................ 0:4 Test Pit No. 2...............minutes per inch Depth of Test Pit.................... Depth to ground water..--.................... 1:4 ...........*-----------------------------------...........*----------------------*-----------------------"...*..."----------------*................ 0 Description of Soil........................................................................................................................................................................ W .......................................................................................................................................................................................................... U .............. .................................................................................................. ..................................................................................... U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'LI'iILj 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliant has b n is ed by t b and of health. Si t D 77 ---- -------�/_�_---------------------------- ApplicationApproved By..... ......... ... ............................................................... Date Application Disapproved fort o ing reasons:................................................................................................................ ....................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date . 5 No------------------------- _ FEs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............................-........._OF..........I............................................................................. ApplirFation for Disposal Works Tontrurtion 1krutit Application is hereby made for a Permit to Construct (L-111"or Repair ( ) an Individual Sewage Disposal System at: L catio dd ss \�... `J.. ............................................... 1 ti........ o t No Owner Addres W o�c�� c=��TJ �.�C��•N .� ZSggIV, Installer Address Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms............................................Expansi ttic ( ) arbage Grinder ( ) p� Other—Type of Building ____________________________ moo. of persons............................ Showers ( }— Cafeteria ( ) Other fixtures . ..."�..i.--- 17\SHE P�S���CL` 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........................ (%4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water__,.....__..___......... a --------------------------------------------------------- •------------------------- ..--------------- ------- .--------------------------------- •--------------- 0 Description of Soil................................................--....----•-----------•--••---------------------------•--------------...-----------------------•--•-•-•---.......•-•--- W U .....-------•-••-----•-.....--•••------.....•-•------------------------•-•--•••--•----.......••-----•-•------•----••--•---•-•--•------•-•------•-----•--••••-------------------......---•-............. W x -------------------------------------------------------------------•--•---•--•----------------•-•------------•--------------••----••-----•------------•-•-••••-•----•-•----•------•-•---------•-•...... V Nature of Repairs or Alterations—Answer when applicable...................................................._.._._..__..._.__...._..........._...._..... -----------------•--•--------•--•-----•-------------------------------------------- .................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITILE 5 of the State Sanitary fi39de—The undersigned further agrees not to place the system in operation until a Certificate of Compliance, b eris ed by t b rd of health. ' '4� ed... -�= ' -------------- Application Approved By......... Date Application Disapproved for lowing reasons: .............•-----------------------------•-------------------------------•---------------------••......----- .........................................•---------•-•--•------•••-----------•--••------•...-•------•--•-----------.._....••-•••-----••----•--•-•-•-•----•----••--•----•-------•---•--------•-...------ Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................7 Tnrtifirate of Toutpliattrr � s TS CE-3'' RTW-V, ThatLhZIOivldue age Disposal System constructed ( ) or Repaired ( ) by.. ... ---------------------•------............------•......-•••---•-_•.•• ---•-- .................... `6"t•Ixtstaller at................................••--••--•---.....---- •---._...--------------...._-••---------- has been installed in accordance with the provisions of T /f The State Sa.nitar� deb s scribed in the application for Disposal Works Construction Permit No......................................... da.ted:_-............................................. THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................................................6 . � �1. Inspector....------..L/2--/------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH S,,v ..........................................OF... ......---•--...................-•••--.................._....................... No................•-•--•-•- FEE........................ ntrur#ion it Permissi d i.... ....................... to Constr r Rep ) an Vital Se 7 e isposal Sys em t at No...._..._... Street as shown on the ap 'ratio or Disposal Works Construction Permit ~__________________ D of /�% ................ ------ Board of Health DATE......•--------- ••-- --•-•••-•----------•------------------------------ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 4/29/2021 ShowAsbuilt(1700x2800) Cod *5 .C �'� L0CAT10N� �r n�Nf SEWAGE PERMIT NO. VILLAGE �I III STALL.ER'S NAME R ADDRESS JOHN A.AALTO 3ACKHOE SERVICE West Barnstable,Mass.02668 I�IUIL0EIt ON OWNER i3a-6 Boise J40e Ci4,1APr 1 /i 0ATE PERMIT ISSUED DATE COMPLIANCE ISSUED I - I P 1roo.r iI � t�► � I https://itsqldb.town.barnstable.ma.us:8431/Home/ShowAsbuilt?mp=228113005&sq=1 1/1 LOCATION � , SEWAGE PERMIT NO. VILLAGE / �' C Ao � 1 � a INSTALLER'S NAME i ADDRESS JOHN A. AALTO B.ACKHOE SERVICR ree West Barnstable, Mass. 02668 I`B UILDE R OR OWNER CP19le4eii/�� DATE PERMIT ISSUED DATE COMPLIANCE ISSUED lo� �\ T �'3y// n C '4 51 C i y � � I 1 coo Cie AL- OTE 15 0,. trLsV' / LEA i j AL 1 - A, t/p,. ` •Zr3' _ '; � � � -- ural.��-:, �Tc-��e�w,tSE S.P�c_►FtEtJ. 0,41 �— AL` PO%P'E_3 TCa .AA/t? �r,1 TFtre aYS !-'! NA.e.1_ ! • :. 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