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Home My WebLink About0043 CEDRIC ROAD - Health 43 CEDRIC RD, CENTERVILLE A--172-141 - No. 42101/3 ORA ESSELTE 10°�b O 0 0 0 ASSESSORS MAP 110: j - �� pARcaao THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratioit for Dhi-Vogal Warlai Toutitrortiou 1hrmit Application is hereby made for a Permit to. Construct ( ) or Repair �_ ) an Individual Sewage Disposal System ...---- C.QJ i C... � .... ii Lo at' m-('ddress or Lot No. .... ........................................... -•----•••---•---------•••-------------------•----•--•-...----•-------------------..o..---....----- o Je�� 40 ddress _. a Q(6•N M ! - -%- f'---------------------- --�„ f h' . , Installer Address d Type of Building Size Lot.............................Sq. feet U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder Alp 04 Other—Type of Building ------------ ------------- No. of perrsons------------------------.--- Showers ( ) — Cafeteria ( ) p' Other fixtures ------------------------------- - - d -...--••------------------------- 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---------------:.--.---- P4 --------------------------•-------•------•----•----•---•---•---•--•---•--•-•••-•---......--•--------......................................................... 0 Description of Soil............... x V ....•-•••--•-••------------•••••---•----••-•-----------------------•-•--•---•----•---------------•--•---•-----------------------------•----••...•-•--•---------•--------•-----•---------•-•-----•----••- W .............-------------------------------------------------------------------------------------- `-- - - - --- - ------------ ---- V Nature of Repairs or Alterations—Ans�v whe applicable...-__... __ g 0 pp �-+ - rJ- ---- ------------------------------------- 8•- ---�`� ----- . ------ ............................................................... 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 Complian as been issued the -health. Signed ........... ....... ...... Da e� ate Application.Approved By xfl `.......................................... .......�'�z...� .. .. Dace Application Disapproved for the following reasons- ---------------------------------------------- -----. ---............................................................ ............... .................... ------------------------------- -- Permit No. r�� Issued ----- --�- -�----� Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diti-pw3al Work,i Towitrurtiutt rnmit • Application is hereby made for a Permit to Construct (` ) or Repair an Individual Sewage Disposal,' System at: (I 3 (-e..................................................r t C c1 r zn --------------------------------=•----'.....---------......'---...--------------:.....--------- o\ddress or Lot No. Owner / P ddress Installer Address UType of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms----------______----------------------------Expansion Attic ( ) Garbage Grinder (At 0' 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 capacitv---t(—M:?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........................ rX. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----•-•------•-••'--•--•-••----•-•..._...-•---•..................••-........................................................................................ 0 Description of Soil........................................................................................................................................................................ x V ------------------------------------------•------------------------------•-------------------------------------------------------------------•-•------------------------------------------••----•-....-- W ••--••...............•---- -•-'--••••----------••-•---------'----'------......---------------------------------- • IJ--------------------- - U p -' • Via } '� �-„ �� ---------.-�-. �U-_1 �Z �.. ............... ........... ' � � � --to......--I A---•- � ----•�---• t Nature o Repairs or Alterations—Answe_when applicable..__ _- �\ ��_r 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 S boar-d-of —health. Signed ..._.....- _52 - ---------'-------- ................ Dace . Application.Approved B -y Y dz'_-f '�� Application Disapproved for the following reasons- -------------------................ ---------- .......................--------------------------------------------......... ........__------- -------------------------------------_.................------------------------....._... ' .. ............._.................._......................�---------- Permit No. Issued ..... ..._....... ----��_" f Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE QIIXrltfirate of Q-Tanylianve THIS IS .0 CE tTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( `/ ) byC c, { r..�`�- �.� _, ----------.._._..--_----------------------------------------------------------------..._... (� / Installer ! — at .. - =t �-------1 C l 4---._.. --------- ...� D1.'-'�`'. �...�...��-------------- --------- ---------- has been installed in accordance with the provisions of TITI. of e tate Environmental Code as described in the application for Disposal Works Construction Permit No. ---._..... dated . :.., ..--^.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL F NCTION SATISFACTORY. -� DATE..... ------ ..._.. - - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE /� No..rl._�-a.! ` L1.-✓ � FEE._+%�:Lrl/ Utspoott1 Workii T.a otrurt"Yerutit Permission is hereby granted-----.z._._�c_. Lv M ," "��/`�� ................................ ---- ---- -•--•-- ---- ------------- to Construct ( ) or Repair ( an Individual Sewage DisP�os-1 System - at No........................................................I t ....� _ .�..1_(...__...!�-y. _..3&ham ..l t ......_.....••-••-----•--........ I St as shown on the application for Disposal Works Construction Per ` ' o� G�__ ed__._ •.� - Board of Health DATE............................... -----"-� - FORM 36508 HOBBS Q WARREN-INC..PUBLISHERS �CrT61 &A TOWN OF BARNSTABLE LOCATION SEWAGE #5t - VILLAGE ASSESSOR'S MAP LOT INSTALLER'S NAME & PHONE NO. S SEPTIC TANK CAPACITY `O�b G A_ WSJ RdX LEACHING FACILITY:(type) (size). NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER F G k S DATE PERMIT ISSUED: �� S �4 e DATE COMPLIANCE ISSUED: �' VARIANCE GRANTED: Yes No �� kc. rz l�D s-�Irl l 40 Q aoy A 4 C� 3y. elk)-X J 6 � 4