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Home My WebLink About0141 CLIFTON LANE - Health 141 CLIFTON LANE Centerville: A = 247 — 120 S M EAD No.2453LOR UPC 1204 sm"com • Mob In UTA m.umows�aouau� saao+o k ASSESSORS MAP NO: ' PARCEL NO: / THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH p TOWN OF BARNSTABLE Appliratiuu for Uiipuial Workii Ton Application is hereby made for a Permit to Construct ( or Repair ) an I dividual Sewage Disposal System at: ......e 4ZO ...... .G` ................. ........... ........... .. - ... ._.. ....--•-- L c ddress or Lot o. caner ess .51�'.... ...... . ..................... .... c��11L ---------------------- 04 Installer Address . d Type of Building Size Lot_,�Q__g2j8 q. feet V Dwelling—No. of Bedrooms............. ........... _...............Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons........_................... Showers ( ) — Cafeteria ( ) dJOther fixtures ---------------------------------------•-------------------------•------. ---------------------•-•-•--•-----------...--••••-•--...._..••••-•----•---- W Design Flow_____________________________._gallons per person per day. Total daily flow_________�7Z_310 W WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter----------_....: Depth................ x Disposal Trench—No_____________________ Width.............._..... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ W Test Pit No. I................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........................ a •----•-••---------------••-----------•-•----••--••------••--•---•---•--•-•-••.......--•---•-................................................................. 0 Description of Soil........................................................................................................................................................................ W U -•-------•-----•-----------------•••-•-•-•-------•-•-•--•---•---•-•-••----------••--------.....---------•••-------------•--•----•--•------•---------................................................... W x -----------------------------------------•-•---------------------------•------------•---•----•-•---•------------•--------------------•-------------- --------- - U Nature of Repairs or Alterations—Answer when ap livable__ 1_4Q__._____1 ,t /T � 1€ ------------ 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 Complianc as een issue y t board of health. Signed ------ - -------- - ----- - ------- �— ---- - Dace Application Approved By ---------------1 ....�.. 4 Cf -..3..r.�.... .. --------------------'--------............-..............-...-....-. Dace Application Disapproved for the following reasons: ...... .............. ..------....................------------........-- -- .....--------........ ----------------- ------------------------------ -- -------------- -- -I......---...------------------ -- --- ----..... -- .---- --....---- ------- --- ---------...................-- ---............... ................................... Dace PermitNo- ..------7.0k......... ------------------------- Issued ........................................................ Dare F . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ApplirFatiou for Dhipati al Workii Tonstrnrtinn �JrQm Application is hereby made for a Permit to Construct ( y) or Repair an Individual'Sewage Disposal System at: f ----..C......... "i '' `c -------------------------------- Loc n-Address or Lot No. / F f G�G/tea,! l_ , u ................ .� ............................ ..........--......---•----.--•-------------••--� = aG �G—GOwne V �. �ZG�i .E7 ��lJ i fAf/.ess Installer Address � Type of Building Size Lot.•_Z<,'L-_- --6-_-_Sq. feet w U Dwelling—No. of Bedrooms___________________ ...Expansion Attic ( ) Garbage Grinder ( ) a`a Other—T e of Building No. of persons............................ Showers YP g ---------------------------- --(•---)--- Cafeteria (---->- Otherfixtures ------------••. ---••••• •••--•-••••-••••----•••-•---...-•---•---••••••--••--•-•......------•--•-•--••••. 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........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---_•-_--_----_•--_____. a ----------------------------------------------•------------------------------•------------••-------------------------------- •---•---------_-----..------ 0 Description of Soil..............................-----•--.........-----------------•-----------------------------------------------------------------------------•-•-•-•••..........------ x V ..............................................................-•••-•--•--•-------•-•••••...._..•----••-•--•---•••••-•--•-------------•••-••-•--•--•-•••--•-••------••...........----•---........-•--•-- W ----------•-----------------------------------------------------------------•--------------------------------------------------------•-- ----------------.--•----•---------------------------......... V Nature of Repairs or Alterations—Answer when applicable.___.•�O�--___--_��._s"��f.2✓ _ef � /€ � ....�fi1 G �SS/ G�--------------------------------- 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 t e board of health. r Signed ---- / Date ApplicationApproved By ------------- ..... ...............................---------------------------------------- --- 9- - Date Application Disapproved for the following reasons- ------------------------------ -------------------------------------------- --.....----------- ................---- ....................................... Dace PermitNo. ------- - ........�.-..... ....----............... Issued. ------- -- -- -- -------................--..........------- Date 'r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certifir to of C antyliance THIS IS TO CERTIFY, That-the Individual Sewage Disposal Svstem constructed ( ) or Repaired (� ) by --------------------------------------------------------- �} 7-7 .......... .0................. ------------------------------ --------- -- -- ---------------------------------- Insmller at --------------------------------------------------------f�ff---- .................. `G/... .cJ .....................................011 it/N--.S IhCQ has been installed in accordance with the provisions of TITLE 5 The State Environmental Code as described in the application for Disposal Works Construction Permit No. ......> off-- 4-.34::)............ dated .............................................. .. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED`AS A GUARANTEE�THAT THE, SYSTE (I RY: �I � ( < DATEM WILL FUNCTION SATISFACTO , _ ----- Inspector ...................... ��:.--.-'----.-.---..---_..�------.�-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No..&-13� FEES 11ispnoal Workv Ton.5trnrtion rrnti� Permission is hereby granted................]—� L4 .___ l1Sr .....-----••--•-••••-••------------------••.............•--..... to Construct ( ) or Repair (�<) an Individual Sewage Disposal Syystem Street �j, / as shown on the application for Disposal Works Construction Permit N -1 kh...... Dated.......................................... 3 �a ------------------� -�-.. ........................................................... Board of Health DATE FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS TOWN OF BARNSTABLE G LOCATION, Zlog/t-c SEWAGE # leA Q�6�.(., VILLAGE SSESSOR'S MAP & LOT,;? -,� 1 INSTALLER'S NAME & PHONE NO.,i�'�E-��1 SEPTIC TANK CAPACITY a, rrLEACHING FACILITY:(type) /7— �/l _(size) NO. OF BEDROOMS 3 RIQYS EL R UBLIC �WT _BUILDER OR OWNERS ' '`/ DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No p3H s