The URL can be used to link to this page

Home My WebLink About0111 CONNERS ROAD - Health 111 Conners Road Centerville - A = 251 .034 No. 4210 1/33 ORA 17 ME �0 doavu SIK 1000 No. - -- .. Fimic X THE COMMONWEALTH OF MASSACHUSETTS 0��0�e Fa® ® T. f� oF......... . . --...---•- A liratinn for U niia1 lark, Cnnnitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System- at: � ... . .� -•.................../....`...-- -•-••------------------------•----•------- (/� .... j r,..Do LOcati I/ s or Lot No. I .......... X/ i ---^............................. r Address a •-----....... .... lea------------------------------------ ------•---...... Installer Address QType of Building Size Lot............................Sq. feet V Dwelling_—No. of Bedrooms................................. .Expansion Attic ( ) Garbage Grinder ( ) ............... No. of ersons__-.._.._._............._.._ Showers — Cafeteria Other—Type of Building _____________ p ( ) ( ) Q' Other fixtures .................................................. Design Flow................................... --gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capacity/3-6 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 b ... Date........................... 1.4 Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water--__--_-__________------ fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_--_______-----_._--_.-. P4 ---------------------------------- ------------------------------------------------------------- .---- -•----•---------------------- •--------------------------- 0 Description of Soil........................................................................................................................................................................ U -----------------------------------------------------------•--------------------------------------------------------------------- --------------------- ------- W ------------------------------------------------------------------------- ----------- U Nature of Repairs or to do —A s er when applicable._ 0il �?.-<..�..._. `� -------•---• -••••--•---- �C- 4�- ----------------------•-•----------•----------.......-------•-----------------------------------•------------•------••------- Agreement: The undersigned agrees to install the aforedescribe Individual Sewage Disposal System in accordance with the provisions of i1'liE 5 of the State Sanitary Code The and rs• ned furtl: agrees not to place the system in operation until a Certificate of Compliance has been i the rd of healt . Signed-- ---•- . ....... -•••------------------ ------------------ _-- Dat Application Approved By._____ ____ __ _ ._._.._ _ _..._ _ ___._ "�1 ��}} • �� -- ----•----- -•-- -V�D' a -----• Application Disapproved for the following reasons:................................................................................................................ ............................................. .............................................................-------------- --------- ----------........................ 7 Permit No. -----------------• -------- ?v------------------ Da Date Fus...( � ....... THE COMMONWEALTH OF MASSACHUSETTS ` �� .OAR® ®, � �LT�„�11 .........OF............. ... v�.l...."t f ............ .......-. � Y Appliration for Uiipooal Works Tonotrnrtion thrmit Application is hereby made for a Permit to Construct O or Repair ( an Individual Sewage Disposal System at: -•-------------------------------- ---- ---------------------------------------------- Location-Address or Lot No. r 3..................................... ...••.....------------•-•-•---.._......-----•..._..........-•-----•-------••------........----•--- .— Oav er f Address a •---........� ............................. --------------------------------- ----- Install =ler Address Type of Building Size Lot............................Sq. feet Dwelling No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) GL4Other fixtures -----------------------•-----•-•---•• ......................................... W Design Flow................................. ........gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity/_.506gallons 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. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ raq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •---•--••----••--------------•-----••••••-•---•---•------•-•-•--•-•-•-..................-••-•-------.......................................................... 0 Description of Soil........................................................................................................................................................................ x V .....----•--•--------------•••------•-.....---•--•--•-•-•-----•------•----•----•----......._...--------....--------•-----•-----------•-------------- 14, ---- ••. -•-- . . ------------------------------------------------------------------- -----------------------•----•-•----•------ -V Nature of Repairs or to ations—A s)yer when applicable.1.6 '�......—.._.. .-.. ..�- l --- . ,, ------------------------- --------- ----•------------------------------------- Agreement: The undersigned agrees to install the aforedescribed/ Individual Sewage Disposal System in accordance with the provisions of TITLi� 5 of the State Sanitary Code The undersigned furthef agrees not to place the system in operation until a Certificate of Compliance has been iss ed the � rd of healtWf Signed-•-,C ........... ........................ .................. Application Approved B � L:'f. :f__......_`..... ........`.- ............................. Dlte (� Application Disapproved for the following reasons.* ............................................................................ ................ ..................................... ................... _______.-__.___.__________._______ /"'�� Date Permit No.- + ::-.., .... Issued te -------y------------------- Date THE COMMONWEALTH OF MASSACHUSETTS -. �BOARD OF HEALTH ......TOWIP! ....0F........1 j. ..�4/ ` ...!i. C- ' ..:...... Trr#gfiratr of f6unplinnrr THIS LQ�CERTI.,Y That the. nIiuidual Sewage Disposal System constructed ( ) or Repaired ( ) by........ _ ......... f / /. F ^ l Inst ... .. r / fr /' at....................................... -- {/ l_(/u •_?.....0..�� .I.�. ----- _.4.._ ..... 'f�... ...... ..•._--------•-----------•---•---•------------ has been installed in accordance with the provisions of 11" T"471 5 o rThe�State Sanitary Coda-as 'escri e�d in,the application for Disposal Works Construction Permit No.-__ _ ___,___7---�.��!'?___ da.ted_.......... �- r�_ _____._ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THA�THE. SYSTEM WILL FUNCTION SATISFACTORY. DATE.........................L<;-.-71z1•=%—C(---•................... Inspector.................... ----------•--•--------•--•--------•-•----- THE COMMONWEALTH OF MASSACHUSETTS � i10ARD OF HEALTH..--,,(� J ) �, �? OF........... ....... ....................................... FEE.„<_..4_........... ' liapos l Workii Tongtgt ion rrntt Permission is hereby granted! ~-_ ��. �+ ... _•......................................................... to Construct ( ) or Repair (� .) an pdividu k Sep=age Di go "Y?tecn Street 1� , ' as shown on the application for Disposal `'Forks Construction ermit No.tJ__�.___.___: 'Dated....... ... ..... .. ..h.. ....... ) n ...... DATE.......... =� 1� ;f .......................... FORM 1255 HOBBS & WARRE1 INC., PUBLISHERS l ASKSSOR-'S MAP NO. PARCEL Lr: CAT10N y tit SEWA PE MIT N'O. �/ l _ci- V1 E 12 /. 5 C 1 TA L L E R'Se NAME i ADDRESS d U 1 L DER 0R OWNER `DATE PERMIT ISSUED DATE COMPLIANCE ISSUED r . !4 �i IeYt 6OAf Ca Ply ,4ff Jrr�Y D o�►,�•avc. 7'-0" 'I --t0-10" „x , N 15'-0" N � F ;nj 4 .- -¢'� , 8,_3„ 13'-3" 1'-1 2 6"x 6'-8" . 1'I 10 ' �t�J�f.L v C �j �cgemr! � a x6-8 aFx6'- 1p-0" Wx `� ' `�"x---- NJ a sue' 1 -O�x- R J Cb i� O 4'-6" — 1.8-x _ �— 4'-7"—�--6'_3" 2' x 6'- " 4 �, a ------- 8•3" a _ 13'-3" 1'-1 " 2'-6"x6'-8^ i'1Q" 1'I10" —5-0" --------- oa -4"x 6'-6" O V 10,10 _0" N C!$a b 4 3'-0" N ""x W-8" _ k 2'0° �6-0— 3'7" 2'N Bk 1 753 Po 273 "491 32 e SAMPLE DEED RESTRICTION WHEREAS, 61- ribs of/61Cc�y�l�Cly/icrad ��q�crv; jl� MA (owner's name) (address) is the owner ofILI Catitiees /fe/ located at te--I& (address) MA (hereinafter referred to as /t/Cb" and being shown on a plan entitled "Subdivision of Land in c Ae✓v,I(`MA, Property of 4v- et al, duly corded in Barnstable County Registry of Deeds in Plan Book' Page tat z4 WHEREAS, r.r,•h!e',* as the owner of said lot has agreed with the Town of (owner's name) Barnstable Board of Health to a restriction as to the number of bedrooms which can be included at this property,as a pre-condition to obtaining a building permit for this property; WHEREAS, the Town of Barnstable Board of Health,-as a pre-condition to authorizing the issuance of a building permit for the construction of a single family home on this lot is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry o ee -,-by recording this document, VS AM 2 s" .ro NOW, THEREFORE,G/'Y10cF does hereby place the following restriction on (owner's name) his above-referenced land in accordance with his agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: 1.1/1 Co-yo-o-ifoodmay have constructed upon this property a house containing no (address) more than 7-6-e-a (3) bedrooms. ✓.k• G. t j�arLa�♦ E 2. .ors-f/�Oe� agrees that this shall be permanent deed restriction (owner's name) Me- affecting l`1 located onCrsH,*e-*-s MA, and being shown on the plan recorded in Plan �k s� , Paged 4 3 ,IOhn L ,�6r�br/ For title oi0-' IW✓t seethe following deed: Book 73.E , Page l�� (owner's name) I Executed as a sealed instrument this day of. &ter /`7, C� MY (date) d ed�r G2 � ✓ Y` �G� TOWN,OF BARNSTABLE LOCATION 6 y)�C[� ,-Il SEWAGE # VILLAGE c�-n-W-ViG ASSESSOR'S MAP & LOT':�"> -04 INSTALLER'S NAME & PHONE NO. 0 i12 SEPTIC TANK CAPACITY P ► �o� LEACHING FACILITY:(type) ( (size) t' NO. OF BEDROOMS PRIVATE WELL O BLIC WATER BUILDER OR OWNERhr. 2 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No yy R � ,,�` a __.+ - .. � � / � � �-� z, Y'' `4� �. ., , �3: ..