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Home My WebLink About1708 FALMOUTH ROAD/RTE 28 - Health 1708 Falmouth Road Centerville A = 209 - 004 0 S M E A R No. 2-153LOR UPC 12534 smead_com - Made in USA 4cvcr.Foco� = m l$si-CONS FUR USED W TM PRODUCT LINE ✓�' OFTHE M PROGRNdOF REQUIRFMEMS CERTIHEO SOURCJNG WWW.5A@ROGRAM.OAG Fim .............�_* THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -------- TOW tJ ........OF.......QAQij�J F_"A13L 0qr ------------ --- --- --- ........................**-----------------------------**--------*.... Appliration for Bi-spoiial Works Tonstrurtion ramid \ Application is hereby ade it to Construct or Repair an Individual Sewage Disposal System at: Location-Address or Lot 110. -1 POYA OT & Address 0 .................... --------------------------------------------------------------------------------------------------<--- -------------------------- .... Installer Address U . Type of Building Size I .t....16_6 i35...Sq. feet 7-, Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder a Other—Type of Building ..Rl_-JAI�n..... No. of persons............................ Showers Cafeteria Other fixtures ----------------_ ....................................... 7......................................... ................................ '�6 D - i I)...........................Design Flow............A, ............... W .. ............ Total daily flow................ -9affam. 9 Septic Tank—Liquid capacity............gallons Length___............. Width__............._ Diameter__._____.._..... Depth_._..___.__..__. Disposal Trench—No..................... Width.................... Total Length------------ ...... Total leaching area....................sq. ft. Seepage Pit No-------I-------------- Diameter......1.�....... Depth below inlet...._.!A....... Total leaching area...Z0 Q_9.9q—. 4-. C_F Z Other Distribution box (X) Dosing tank ( ) )..4 Percolation Test Results Performed by.......................................................................... Date---. ................................ 1_4 . 1,11 1 . . 1 Test Pit No. *I................minutes per inch Depth of Test Pit.................... Depth to -------------------- Test Pit No. 2................minutes per inch Depth of Test Pit..............__.... Depth to aro ............. ................................................ ......................................................... . . ............ 0 Description of Soil............................................................ ------------I------- ........... .............................................................................................................. ........................ U ------ .......... ----------------------------------------------------------------------------------------------------------------------------------------------- . ... . U ............. Nature of Repairs or Alterations—Answer when applicab .. . ................. -ems:- ------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITHE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in' operation until a Certificate of Compliance has bee issued by the board of health. SigneSig d..... ......... ........... -------------- 6------------------------- -------------------------------- Date Application Approved By.- .... ...*0..... . .. . . .............. .... ---------------------------------------- Date Application Disapproved for the following r re S:.............................................................................................................. .....................................................................I--------------------------------------------------------------------------------- ----------------------------------------------- Dat Permit No.... . ................ Issued__.. uA............------. r Noq..(..<-....... Fss.. ......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH --°-�- ----------------OF..-...QA Q;JST A13L�..._.... Appliratiun for Dispvii al Work.6 Tans ratrtiun Punfit Application is hereby made for a Permit to Construct ( ) or Repair (1(,) an Individual Sewage Disposal System at: Cl. .l.{ A,l. }l U 4 1:1� ) I; 4 • ! ^ ..................... . ....................................................... ..... ........ ... = ._ ........._ J Location_ ,� -, or Lot No � !a U �. .? J>1f..11J��/1u�C_ IRD ro ........................ ............... ___.f...._..n.._._......... ......_......._.... ........"___....__....................................__1........_._.......... ......___..._ W ��- ��....--��•F�-- '-°`'•�-- •--•--........-•------ ------------------------------------------•.Address .. _• Installer Address...............•-------•-----..._....------ Type of Building Size Lot..., �J�._ .`. ...Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building .'ZF L'__.... No. of persons............................ Showers ( ) — Cafeteria ( ) Other Qxfures .._..-•••---•--•------ -----------------------•---- ----------- W Deslgn Flow gaf}ercrPei`gegse -g�. Total daily flow..--------) ........................ 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-26 n_I__gtf-ft. G P Z Other Distribution box (X ) Dosing tank ( ) a Percolation Test Results Performed by.......................................................................... Date................... --------------------- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water----_-_______-_----__--. fX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ al -•••-•--•-•••---••••••••••••-•-------••---•-••-•----•-••.....---•••--.....----•-•----•......................�- a 2r _9�,rr .................... O Description of Soil............................................: ,, ,>s .rr. ... . ... ............................................................................................................................................ ••>:.•c. `4:"'(`, U Nature of Repairs or Alterations—Answer when applicable__ L AC VF_ ? U?"P`P�°'X 1 S 'C -----------------------------------------------------------•-------------------•---------........-----------------------------------------...._ .,a Agreement: -{g;T�.:.......::; :<=��'�•: The undersigned agrees to install the aforedescribed Individual Sewage Dispos t_ t accordance with the provisions of.7T' p 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 board of health. Signed - .................- •---o...--------•••----••-•---- •-------••••••......_-••-•..... J 4 Date Application Approved By.L.�._X7!_L'- ,'- ------- -.e----- -I :--_- Date Application Disapproved for the following re ns. •-•---•--•----•-•--••---•------•------•-•-•--•-••••---•---•--•--•-•••-•-••-•-••--••--•-•-...-•----•--.......... ......................................................... /�, Dat • e Permit No... 9... ....... . ...•.-.............._... Issued_--• _---•- / t�/ ....------. D e THE COMMONWEALTH OF MASSACHUSETTS /� BOARD F H�E�HEALTH..... (/....liU...�,/� .......OF. ! ,ti[•.•Y...... ....:. ...... Trtifirtttp of ToutpliFatta THIS ft�TT C IFY A , Tha t the Individual Sewage Disposal System constructed ( ) or Repaired ) bY--••-•-- . -- --- ns ller _•- W-F - • at.S D,ee.. installed in a0 ar l the --1"C� � •�' O .T State... Sanitary �---'--�f-a'---�--•--�.------- h n ' descr oa lr the p 5 Y application for Disposal Works Construction Permit .'o....�"�-'-.. ............... dated___..__../._� .. . _ ._... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUA ANT THAT THE SYSTEM WILL FUUNCTIO/N; SATISFACTORY. DATE. ................. ................................................... Inspectalr ..� - ??yl ............. THE THE COMMONWEALTH OF MASSACHUSETTS BOARD QF. HEALTH�u ... OF.. . .�.... 1 .. ................... 4nAf FE :... JO �t��un I urk� un fin ' Tarn rani Permission is herebyrante .._ .. _. _ ......V. !.V�� . g �_.... to Construct ) or Repair ) an ipdivid# Sewa e Disp Syst at No. -- -. _ � __. .. treet as shown on the application for Disposal Works Construction Per No.. . .... . ate �__.--/"' ........... . vl� -- ' ....... _ 9 -DATE.................I=.. ��........................ Boa of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS , J�5� TOWN.Q BARNSTABLE ��' ®9 LOCATION' e A 9c /Z, EWAGE # 90- F VILLAGE (' WTpc2 11 1L� ASSESSOR'S MAP LOT IN- 09 a v r toi.s 916 INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY f- LEACHING FACILITY:(type)4 i 1 (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No e r . 0 � � 7' .. E �V �� R � V � � �\ ` r � �� i.