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Home My WebLink About0053 CENTERVILLE AVENUE - Health 53 Centerville Ave Centervil lc A= 226- 117 SMEACrl No.2-153LOR UPC 12534 smead.com • Made In USA 0 w aoo9-or�3 0��No.--HMO Fee----- ----- -------- BOARD OF HEALTH TOWN OF BARNSTABLE ZippCication-for Well CongtructionPermit Application is hereby made for a permit to Construct ( ), Alter ( ), or R air ( )an indivi 1T"It Location — Address Assessors Map and Parcel —Owner Address ------ ------- ------- Installer — Drilleu Address Type of Building Dwelling Other - Type of Building----------- No. of Persons-- _------------- Type of Well ?V C' --- — Capacity---------------------- ---- Purpose of WellT_S(J�_=o Q - -- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate.o mpliance as been issued by the Board of Health. Signedat Application Application Approved By — — - - dt rJ Application Disapproved for the following reaso _ date Permit No. 0 � _ — Issued----- -— - ---- -------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by— ____-----------_-__—_—___.------ Installer at has been installed in accordance with the provisions of the Town of Barnstable Board f H alth Pcivate Well Protection Regulation as described in the application for Well Construction Permit No. ��° t` UU ated---------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------— — - - Inspector-- ----- - v- �+ 4/ 7 W�j�o D0 No.---------------- Fee---------- -------- BOARD OF HEALTH TOWN OF. BARNSTABLE zipp[icat ion;iorVelr Conotruct ion Permit Application is hereby made for a permit to Construct ( ), Alter ( ), or Re air ( )an Fm d 1 Well Location - AddressI Assessors Map and Parcel -- Owner Address --- - - - �- Installer - Driller Address Type of Building Dwelling -- Other - Type of Building No. of Persons--- _----_____—_—_—______ Type of Well V C' --- - Capacity----------.-——---- --- Purpose of Weller Y-t V i Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate of Cbmpliance has been issued by the Board of Health. Signed -- ----- 0 -- — --- � date b Application Approved By Application Disapproved for the following reasons date 10D Permit No. --- , Issued----------_ --- ----- - da--te ----__—______------ BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by — ------------------------- Installer -- ----'—at___— -_— --- --- - --- - --- -- - - ---has been installed in accordance with the provisions of the Town of Barnstable Board f H alth kivate Well Protection Regulation as described in the application for Well Construction Permit No. , THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE _ -_ __ Inspector------- -- ---- —------ BOARD OF HEALTH TOWN OF BARNSTABLE Yell Con5truct ion Permit s °—D6� No. �,. , Fee ----------- Permission is herebyranted g 7/ ! tZ to Constru"�t o X), Al +,�°r Repair ( an Indivi ual Well /r street as shown n the ap lyioi�for t Yell Construction Permit (.l No.-- � -/l%----- Dated- --' z—. - - - --------------------- � 7 Boa of Health DATE— !L I Stanton, David From: McKean, Thomas Sent: Friday, April 17, 2009 5:14 PM To: O'Connell, Timothy Cc: Stanton, David; Crocker, Sharon Subject: 53 Centerville Avenue Hi Tim. After 4:30 this afternoon, while we were meeting with Ms. Wilson and Mr. Mycock, Sharon informed me that there were two men waiting for me at the counter. Our meeting had not yet ended, so Sharon passed on the following information from me to the applicant(s)at the front counter: 1) The applicant was advised to submit a revised plan showing elimination of one of the four bedrooms (provide a minimum four feet opening in the wall between the two adjoining bedrooms). 2) The applicant was also advised to record a three bedroom deed restriction at the Registry of Deeds. This document will enable the owner to maintain the"chapel"rooms shown on the floor plan. Once you receive these two documents, the permit may be approved. 1 B1€ 23633 F's:123 1566 vi Sdoes hereby'place the f.: NOW THEREFORE, ' (L_ (owncrsQnani' following restriction on his above-referenced land in accordance with his of Health which restriction shall.. agreement with the Town of Barnstable Board , run with the land and be binding upon-all successors in title: P V-eW Uf may have constructed , _ (address) u on th lot a house containing no more than r_( (3) bedrooms. agrees that this shall be permanent deed (omees e name) located onS3 l� *-:,,�e�,�.,� _MA, and restriction affecting�1GS.� _ ' being shown on the plan recorded-in Pian Bookt 5 , Paged y g Or on Land.Court Plan e For title of see the following deed: Book Page Qr Land Court Certificate of Title Number ' Executed as a sealed instrument a ,, _daY of a o o Qwner's signature .. . Qwner's signature Owner's signature , COMMONWEALTH OF MASSACHUSETTS ss ! 20 Then personally appeared the above-named. known to me to be the pers n who executed the foregoing instrument and acknowledged the same to be .free act and deed, before me, : Notary . ' Public :r,,cL My Comm Sion expires: 01 o I ••; (date) deedr �''.....•••' 1 h` BARNSTABLE REGISTRY OF DEEDS r 00 Fimic THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...........................----------......O F......................................------------------------.._I........................ App iration for Dispnsu1 Works Tnmstrnrtiun jhrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Q_,_;... .. a ..... -- (V - .. 3 �� ..... ` Lrocation-Add L r Lot ............ ...... -..........................•.... ........... .....C21, .Y..:..�'d�..�]......-- . Owner r d7 A dress �/� , (t r3( Install r / Address Type o ilding ec�� Size Lot............................Sq. feet aDwelling—No. of Bedrooms.......... .............................Expansion Attic ( ) Garbage Grinder ( ) p,, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Pa 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..'r................ Total Length.....................Total leaching area....................sq. ft. Seepage Pit No....a........... Diameter.._<P............. Depth below inlet....y............. 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.....................__. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 -------------------------------•--•---•-•-••----.........------------.....................--..•..---................ -......... •--------- •--•------------------ ODescription of Soil......................................................................................................................................................•----------------- x U --------- ---------------- --••--------- --------------------- .....----------------------------------------------------------------------------------------------- •----------------- •------------ ------------ -----------------------------------------------------------------••---•••----- --- -------------------------•---••-----....i ;_.1 U Nature of Repairs or Alterations—Answer when applicable_______ _ l!w-sf-'....._ ?..�-. ._.. -•-----------------------------•----------------------------••-•--------------------.....---•-••--•-----------------------------------------------------------------------------•--•---•-------.....---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i sued by t e board of health. r Signed-- ..----- ate Application Approved By.............. ... ----- 1�.. ..... ....... . . -- .................. ........6....... - ........ Date Application Disapproved for the following reasons:-------•-------------------------------------------------------------------------------------•-------.......-•-- ..............•------•-------•--------.....--•----•----------...---•---•-------------...--••--------••---------------------------------------•--------•-•--•••-----------•-------------•----••---------- Date PermitNo......................................................... Issued---------------------•----• THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................O F................,......................................................................... Apphrattion for Uiopos al Workg Tonotrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systemat--- ................... .........................•---••-•-- - ............................................... .. �S s^•"'S��`1:�:!7 '�" tion-Addrz + � w..e or Loc� a^fAi' •- t NN — — ..!P Y1... --•.................................. ..:: !._ L. ........................ �. . -----.. -.-... ... .. - ..............4. 1.42 . Owner f ddress Installr Address Type ofilding Size Lot...........................Sq. feet Dwelling—No. of Bedrooms........ .............................Expansion Attic ( ) Garbage Grinder ( ) P4 Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures -----••-------------•----------- . .......... 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 irlet.._q.............. 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..................------ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •---•--------•------•----•-----------•--------------------------------------•---••-•------------•......-•------=--•-----..............-----•-••-••......---- 0 Description of Soil........................................................•---------------------••-----------------------•------•------------------------------------....-----------.----- x V ...........................................................-----•-•••--••--•-------------•.....---------•-•------------------------------------•---------------•----------------....--------•---._....-- •--•....................•--•------•-•-•-----•-•---••---••-----.....--•-•----•-----•--------.................... ............................................... -•-- U Nature of Repairs or Alterations—Answer when applicable________ ___ K_.__,,," .... '`"�r�?""_____._&_'�1.... .__. . -•--------------------------------------•-----------------••------••---------......-•--.........---------------------------------------•--------------------------------------------.....-----•...-----• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI.% 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 tAe board of health. Signed .... [[k- /rk "•' '`_- � _ ate ........... Application Approved By..............�.e.-. '• �----••---•-- �� ..............�-------- Date Application Disapproved for the following reasons____________________ __..----------•--•-----•----•.......................................... ............._ ---------••---------••-----------------------------------•----------------•---------•---•-.----------------•------•-....--•---------------•----...--•--------------•---------•------------•-----•-..... Date PermitNo....................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH !., +............OF... .!s-y. ....................................... Tnrtifiratr of Tomplittnre THIS ItS~Ty0 CERTIFY, That t�he.�du�l Sewage Disposal System constructed ( ) or Repaired ("") bY-•••--••.....•--- 1e M.........._.f�''�'�-: ._......_. !4-----------------------;y.. 'Iryst at----_--�-- c4e" 7G�" E= ----•-./ je----------- -------tf-�..-•------------------------...._.__.......---•----------------.......-------------- has - been installed in accordance with the provisions of TI 5 of The State SanitaryCode as described in the application for Disposal Works Construction Permit No._+_�_... ...1-:7s0............. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector--. - ? ................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH, �.. /.l�E, ) �..............OF...... ::� -- .................................. �. FEE........................ uiopoo 1 Vorh,5 Tonotrudion "prrmit Permission is hereby granted___.;-..... . ' .. _ .-............................................................................. to Construct ) or Repair!?_ )c n Individual Sewage�isposal System atNo..........................C 9. . ...... ..... .56....... .•.........1^ ! .= ---------------------------------------------------------------••---•------...... Street as shown on the application for Disposal Works Construction Permit/N�o..................... Dated.......................................... ---------------------------------Y / �B ealth DATE---------------------- �' FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 134eD Gw�►� `B€D ILvoo-, � z /1 �G(.OStL V L � r ✓� I� I 0 J AMA) oms v�4Tfo Ga -'rep c � o I?(L UU I IQ-.e-- �1 ITv V-aj►ti 'Poch I l/ O F.-:F—'j I r� CAR , 1 Cat � Vic,. L T ION a ` SEWAGE PERMIT NO. ew� le e- _ AG E INSTA LLER'S NAME i ADDRESS T B U I L D E R OR OWNER hQ M IN/C,4 nJ DATE PERMIT ISSUED DATE COMPLIANCE ISSUED { �J