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Home My WebLink About0021 CLIPPER LANE - Health 21 CLIPPER LANE Centerville A = 189 - 008 .. SMEAD i KEEPING YOU ORGANIZED No. 12534 2-153LOR I1 SUSTAINABLE MIN.RECYCLED' FORESTRYAink INITIATIVE CONTENT 10% Cenified Fiber Sourcing POST-CONSUMER www.sfiprogram.org S"1g90 MADE IN USA GET OMAN=AT SMEAD.COM �- 0OR No.? THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Apphratiuu for Bi-aipwial Mirlw Towitrurtiuu Urrutit Application is hereby made for a Permit to Construct ( ) or Repair X(X ) an Individual Sewage Disposal System at: 21_ Clipper Lane Centervill-e . -------------------------------------------------------------------------------------------------- Location-Address or Lot No. . ....................... ---. - ---------------------------•--•-- ---- -----------------------•--•---------•-•-------••••••-••-•--•--•----•-•---••------------••-- Owner Address - ................................................................................................. M Installer Address VType of Building Size Lot............................Sq. feet Dwell ingX&N o. of Bedrooms----------3-------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons.....2.................... Showers ( ) — Cafeteria ( ) Q' 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........................................ ,aa Test Pit No. 1________________minutes per inch Depth of Test Pit-------------------- Depth to ground water_.___-_____.____-_-___-. (i Test Pit No. 2................minutes per inch Depth of Test Pit..-___--..______-__. Depth to ground water........................ Ix ---------------------------------•-•----•-------------------._...........---•---•-------------------......................................................... 0 Description of Soil........................................................................................................................................................................ v ---------------------Sa.nd.---&...Gr-aval-.........................................................................................----•------------------------------------------•---- W VNature of Repairs or Alterations—Answer when applicable._.Omi,t---Gesspoo.ls..---lnsta.1-1---1--3-0-0A-------- ---------------------galleon...tank—.1---di-st-r-ibuti-o-n...box...1- 1-30-0----ga,11oa---1-each---p-i-t--_---•--------------- 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 e has bee is ued by the boar of ealth. Signed .. Date Application.Approved B�, .. . . ............ ......... �/r/. .-..-..... c? Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------------------------------------------- .........................................------- --------------_-- - ---- _ - -------------. --------- -------- --------------------------------------------------------- - ---------- ------------- ---------------------------------------- Permit No. ss7. z .... ............. Issued ...... Dace f r . 9-- oNJ., FEjc.%.....3.0-0.0... af THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Di-tipagal Nork,i Tomitrnrtiun Vamit Application,is hereby made for a Permit to Construct ( ) or Repairx(7{ ) an Individual Sewage Disposal System at: 21 Clipper Lane Centerville ..........................................=--•----------•------••••---•--•••------------•---...... •-••------------ Location-AcWress or Lot No. tvalter MorseleY ......................_.......................................................................... --•-•---•-----•--•--•------••----•---•.....-••-------........---••----•-•--•----•.....••-..•....-- Owner Address aJ.,p_,_Magornber.air&............................... ..............................•-----................................................••---......... Installer Address UType of Building Size Lot............................Sq. feet Dwellingt-'XNo. of Bedrooms...-__----3-------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons------2-------------------. Showers ( ) — 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 ( ) 14 Percolation Test Results Performed by--------- •----- -•---•-------•--•-----•------•--------------------------- Date........................................ W 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------------------------------------------------------------------------------------------------------------------ ---•-•-----......---•-----------.-..----------------- U ........... ...•----..71M�----&.. ra��'1 (� -----•-----•------....-•---•-------•-•..............................•-• W ----------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------•------------- U Nature of Repairs or Alterations—Answer when applicable._emit_. P�sp�c�.1_ .0,__Tn to l_1 1,-10,0(1--_,,_,- --------------•----• a l`?'� '�k 1 - 15.1. .i htat�_�t?...h� 1.-1 f? 1.l.gt?...]..each .x�i t ...................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE S of the State Environmental Code —The undersigned further agrees not to place the y pCompliancehas been pis/ssueedd by the board ooealth.system m operation unti `a Certificate Signed ��?r`��/� �-- .................. --- _ 3/2 0/9 5, - - ---. -------- Dace Application.Approved B _-. — c h`� --_✓emu?............. .. .... --------_--_.---..--------....-.._...._- --. .--------Date Application Disapproved for the following reasons: .................... .................._._...................... ........ .....---...... .. -- --------------------------------------------------4 ........---...---- ---- -------------- -------------------- Permit No. .-------i------------ ------e-------------------- Issued ------ ��.p..... Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C ertifirate of Compliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (KXX)o by .-.-...-.. J.P.Macomber Jr. -- ..............-- _....--..---..-..----------.-----..--------------- ------ -:--ir- at ---------------- Clipper Lane Centerville --------. --- ---- ------ ---- ... ---------------- has been installed in accordance with the provisions of TITLE of The State 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 FUNCTION SATISFACTORY. "-;;e 01 DATE l ... - Inspector ..--- -. - ....-------------------- - - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE �* No./:..-----•-vl � FEES.d,•3 n...10... Biiipaq tl Workv Tnnutrurti.an rrntit J P.Macomber Jr. Permission is,, hereby granted. l-------..-------- ---------------------•-------••--••---•-• ••---------------•--•---••--------•-•---•--•••--•-••-------•---•.......--•-..•.. to ConstructZ(1 C lippgrr are Centery lle e Disposal System atNo....----•---•---•--••--------•----•--••-----•----•---•--•-•--------- ---•---------••-.....••••..--•- ----------------------------------------................................................. str Ep as shown on the application for Disposal Works Construction Perm a.`j- ��jj-_ ........... ----- ;� lam ' Board of Healthe� DATE----- _` !......"• ..... ---------------•---- FORM 36508 HOBBS a4 WARREN.INC..PUBLISHERS i U TOWN OF BARNSTABLE LOCATION UA SEWAGE VILLAGE C e,,,, ASSESSOR'S MAP & LOT` INSTALLER'S NAME & PHONE NO. �� j �e•on�h � n Lvrc SEPTIC TANK CAPACITY I nQ0 LEACHING FACILITY:(type) a �t �-�� (size) /p00 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BVIUDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No w �� 3,2 THE COMMONWEALTH OF MASSACHUSETTS BOARD 9F HEALTH ..---------OF...... 6 ( . _ ................................... Appliratiun for Uiupuuttl Workii Tonstrur#iun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at:�/ • _U � .... .r1/ -----------------------------------------------------------..-------------------------•. Location-Address - or Lot No. ._.. '. .................................................................. . .................. -••---.....------------.........................._. �� Own Address _......�� lsd.................................... ..........-- --------------------------........------------. Installer Address dType of Building/ Size Lot............................Sq. feet U Dwelling;No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building _________________________•-• No. of persons............................ Showers ( ) — Cafeteria ( ) a' 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........................ (i Test Pit No. 2................minutes per inch Depth of est Pit................._.. Depth to ground water........................ ----- ---------- . •• ......•-••••...... -••---------....._...-•-......................................................... Descriptionof Soil -- -.-•--- - -----------•-------•----------.-----•----•----------------..---•--------------------- - ---.. W x -------------------- ---------------------------------------.... V Nature of Repairs or Alterations—Answer when applicable...__. .............1&01:Af �j�------•----__. ..............-......................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI'= 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 the and of health. Si ne � d ' Z1�. 1-- J--a '�i---�� Date _..._ Application Approved �� - _ L.. ,� Date Application Disapproved for the following reasons---------------•--•--•--•--------------------------------------------------------•-----•••-._................•-- Date PermitNo............�� . --..A.v------_-.. Issued:-...................................................... Date NO.S_ 2---.alt--2 - F . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �a1 .............. Appliratiun for Diupuuttl Works Tomitrurtion Vrrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at� , .. " .....l r .......�.-----��.ymz� ...---`. f! ff `;e > �0 -----------•---.....--••--•---•--•.................................................... Location-Address or Lot No. ... ' '!,: �.. --- -.. ------------------••---•---------•--- --•-...........-•----.............---.....-----_..... I' Own f Address . j�?!. a .... -• . � .... Installer Address Type of Building/ Size Lot.................... .....Sq. feet Dwelling E!L"'No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a' 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water.......................... LT,, Test Pit No. 2................minutes per inch Depth of/Test Pit.................... Depth to ground water........................ D Description of Soi1..........sS .. :' x V ---------•--------•----•----------------------------•---....---........._......---•-----------------•--------------•-----...._...---•------------....--------..........------•------•----...------------ -------------------------------------------------------------------------------------------------------------•---------- ----- U Nature of Repairs or Alterations—Answer when applicable..._Z__X��-- ........�.'�1 '. t �{l�:G . •.....--•--•---•-----------------•-•----- 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 issued by the hoard of health. Signed ".......................... ..........................�f. - Date Application Approved B_...,.._:_. ------------- Date Application Disapproved for the following reasons:-----•......................................•-----------------•----------------------------•--•-----••••-- - ................•----•-------•---•----........----•-••------••----•---------•-•------.......-•-•----•--....---...------•-----•---•-----•----------•--................................................. Date Permit No.------..... -:i. ;..K ----•-....•---......_.... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD !OF HEALTH/ ......t''. `�^'^` �!.............OF.....%�t/ df:��°±s +>..°. '.: ............................ (Intifiratr of Toutplittnrr THE 1 , TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired � 1. nstaller at......C9r...... .._./';'X �: --• t' '' ,;--....---- -----------••.............. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.... _.(r.. ........ dated........... .......................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE j SYSTEM WI L FUNCTION SATISFACTORY. - �2 DATE--•-•-•--•--��-��--••----------------------------------------------- Inspector... ----........-•---.....---•---•----------•-----•-----•-----------. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH A ; ............OF..... ....................... z No..................I..... FEE......`............... Dispag tl urko To utrttrtion V rrmit Permission is hereby granted. V'- _....lekr-a - ------_----- ......... to Construct ( )Vjolp Repair (,p'"n Individual age Disposal System atNo.... 1.... .tC. G' x�.. t. .t�;1 ? 1, -----•-------•...................................•---................. Street r as shown on the application for Disposal Works Construction Permit No.._L.��-_--((- Dated.._ �! C —..—... C� Board of Health ••-•••... DATE............ ..:..........1..----......................................... FORM 1255 A. M. SULKIN, INC., BOSTON !10 CATION C SEWAGE PERMIT NO. e L L A . �` 9D PILLAGE C fAl "e �Z v �GLe I N S T A LLER'S NAME j ADDRESS T /? /VI A C o Al f9 e k' r s o ILI S U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED L� f F '. `.:% � � , i � � � � i �� J � � � � / �. ..'� e � � �� . �� ,.�-- �, � --=---