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Home My WebLink About0089 EMERSON WAY - Health 89 Emerson Way, Centerville, A= 188-021 — I No. 42101/3 ORA ESSELTE 10% 0 0 0 0 -- - No.... _.... / Fes$. .( ......�..�-•-- THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliratiou for Diripniial Vor1w Tomitrurtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: Loc. ress or Lot No. J� W � L O j � Address F ---'•l/l/-- _• .---•---_ .- --•----------------•-•--._._____-----__...___ ............... -___i___--------------•-----•-.-.-.-.-•----------------.......------.. Installer Address UType of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms.________________________________.__Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons------------_--------------- Showers ( ) — Cafeteria ( ) a' Other fixtures _______________________________ _ _ W Design Flow--------------------------------------------gallons per person per day. Total daily flow-_------___-_._._______-....................gallons. 04 W Septic.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........................ fT Test Pit No. 2................minutes per inch Depth of Test Pit-_-._-_-____-_______ Depth to ground water-.-__-_---____-_-____--- 9 ----•-----------------------•----------•--•-------••--------•-•-•-•-------•-------------------------......................................................... 0 Description of Soil.........................................................--------•-------------------------------------.--._-___------------------------------------------------_------ x x U Nature of Repairs or Alterations—Answer when applicable._.._l,_ t` .._ �___...._: "..___._.___ f_ ._....._ ._(�a� ............... ----- � -�--- --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 h be sued e and of he lth. Signed /.. G�i- J� 3/D�, n g Application Approved B Application Disapproved for the following reasons- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------..........------------------ ------...------------------------------- ---------------------.-.._................-..------- qDace Permit No. ---------- l -.......oZ, ��'.J-...... Issued .......................... Dare n TOWN OF BARNSTABLE LOCATION _8�7 EY►'1 cam n Itil4. SEWAGE # s a 3 VILLAGE C EAi I C2v:1 1 c ASSESSOR'S MAP & LOT/88—Da INSTALLER'S NAME&PHONE NO. GO mpw— `JM-S-690 SEPTIC TANK CAPACITY ison G,)/o LEACHING FACII.rrY: (type) Ct.l r r-33bs—CJ (size) NO.OF BEDROOMS a BUILDER OR OWNER )l o6F e C2g-- y PERMTTDATE: 3` `9 S COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private.Water Supply Well and Leaching Facility (If any wells exist on siti;:or within 200 feet of leaching facility) Feet . Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility)_ Feet Furnished by V C X9�� Q Vic, ,tf THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 2 TOWN OF BARNSTABLE � ` �i n nl nrkg Tnnitru#ivit rrrntit Permission is hereby granted....... _. 1 ... _ ...{-s...................................................................... to Construct ( ) or fR,e+pair (!- Tan Individual Sewage Disposal S ,strem6 (// ._......._'� ---'`. ._ _ :`1....._.... .0----Strcet(7—p0, `1 ''1 �J.!•/........................................ as shown on the application for Disposal Works Construction %mit No.;�._�_'�g�_ Dated__.._ _.-__7-_-.�..�........ �i� , a_ r— -------------•------------------ Board of Health FORM 36508 HOBBS h WARREN.INC..PUBLISHERS THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( byf`` r.°`'/ .../c ---5------------- --- ----------------------------------------------------------------------------__---------------:--------- In at - --------------------------------------- has been installed iaccordance with the provisions of jITI.E 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. --- .�T.,�._- dated ..... -.— ....... .'. �. .... .. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFA-TORY. 7DATE ,')...` Inspector ----------------------- ------------�. �----------- -----•..-------_...._------------------- --------- ..._... .. . No..... �` - - � Fxs.... ......�........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for UI,rapwial Warkii Towitrurtion Urrmit . Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal '. System at .............../..�....5......... ...... . ..... ..........C. .... LoCa os -Press ` ............( ..--�-•�f-----..-----•....... -----••-----•-----......•••----••---........ Lot No..-••----••---•-•.................••-•---- Owner,`- '.. f.jt Address Installer Address UType of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms____________________________________________Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) QOther fixtures .....i'.....--a-'.........--------------------------------------------------------------- ------------------------------------------------------------- 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 b .. ' __ Date........................................ a Y ,-.y.t.� ---- -----------------• ••... ' Test Pit No. I................minutes per inch Depili of Test Pit.-.--..-_--__-_--_ Depth to ground water...--.-._--_____--_--.-. Test Pit No. 2................minutes per inch Depth of Test Pit--------------------iDepth to ground water........................ w. I ' . ,e r T" a -•--------•---------------•------- ----------------------------------------•-----------•••-------.•=----------•---•-...--•-•-•-•••-----....•-•-.......... Description of Soil.......:....................... � �' O ' t` ! ., .. t . . t,.... r r. t ..r..... ...+.' -` ----- -'---------- Ay U Nature of Repairs or Alterations'=!Answer when applicable_-_. a a_ .._---- ............ Q ............... Agreement: The undersigned agrees to install the aforedescribed}IndMdual Sewage Disposal�Sys em inaccordance-with. $f t - the provisions TITLE 5 of. he State Environmental•Code—The undersigned further:agrees not to`place the system in operation until a Certificate of 0 Z Compliance has be n i^ssued by the board of health. 21 Si ned f % -- --- .�. .6'?............ Application,Approved By -------- ..< -y ( .......7 _.n.' Date Application Disapproved for the following reasons: q _ Date Permit No. /...s. -- C ------- Issued . .............................. . ....... Date C IJ-0 TOWN OF BARNSTABLE # LOCATION 89 Eme2SG n wri. SEWAGE # 95-cRW3 VILLAGE OLDIE ev t.I I G: ASSESSOR'S MAP & LOT 18-Oa/ INSTALLER'S NAME&PHONE NO. GOMPa:�Zt.MaW �lac3-S6�/O SEPTIC TANK CAPACITY 15-00 6oh LEACHING FACILITY: (type) CUlrc-338SA,3 (size) oI ra X NO.OF BEDROOMS_ BUILDER OR OWNER ©G�/� C2c2sn y PERMTTDATE: ` `9�'' COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility). Feet Furnished by r tt [by LE 1 ,y ._w_..Z#'rIS�r0ki i 'dee lD 1 c.1 ' V - �, A x(p