Loading...
HomeMy WebLinkAbout0229 FULLER ROAD - Health 229 FULLER RD. , CENTERVILLE A=189. 070 lill UPC 12534 ° NASTIN0G.MN ASSESSORS MAP NO PARCEL NO: 10 06 No.. ................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF •BARNSTABLE ,� lirtttil�tt for Diapnilttl 11orkiiC�lQat �r�trinttrmi Applicatio. is hereby made for a Permit to Construct ) or Repair (/,eran Individual Sewage Disposal system at ?l /1 - ocation.Addr�ss or Lot o. Ica' t — 1 EHc ......•------------------------•----•-- ..................------•----..................................--.-.-.---...........-.-.......... ......................__.........._.... caner Address �C�( �ny r� .................................................................................................. Installer Address Type of Building Size Lot............................Sq. feet Dwelling . of Bedrooms.-..�...................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ....-------••----•-•---•-•--•••...................••••.-•...........................-••-.-••..................................................._...... Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid capacity...u :...gallons Length---------------- Width................ Diameter................ Depth................ Disposal Trench—No. ..................�,-Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. 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........................ Test Pit No. 2................minutes per inch Depth of Test Pit..--........--...... Depth to ground water........................ •------•--••-----•.................•----•--••----..................•---.................••-•-•...................................._........... Descriptionof Soil.......................................................................................................................................................................... .....-•••--••-•---•••---•------------•........................•----•---•--•------•--...........---........._....••-----••---••••--...........--•--...................................._........--....... Nature of Re airs or Al eration Answer when a li able........... .......................... 12.3vi. 2Y---/ssP©-1(;0�t-•� • -n i..fr a ..........................-.... . •......................................... Agreement: The undersigned agrees to install the aforedescribed Tndividual Sewage Disposal System in accordance with the provisions of TLITA i 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 he board f Walth. Signed /Z . ....................................... .31,30A:F -•---- Date Application Approved BY ...........;.. .. .............. .............. �G' Date Application Disapproved for the following reasons:-----•-•-------••-----•-------------------------•--•---..-----.-..----•--•----.-------.---.-.--•--•----.------ ............................-•--................... ._.........,..........•--........_................Date.............. Date Permit No......� Issued_ � _,�•.- .•----... L .._. r!. ............. Date -:� ASSESSORS MAP NO: `CJ PARCEL NO: 0,270 o0 No.-------------------•-- Faa.3!:....w..._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF •BARNSTABLE " Appliration for Din-Vuilu1 Worko Tunntrur#inn Permit Application is hereby made for a Permit to Construct ( ) or Repair (P-ran Individual Sewage Disposal System at., ! �E'�/ z / ................................... fi........ / c �—Location Add, s or Lot No. 7C ' __ raC.Q ......................................... ......•........................................................................................... ............... . �wner C Address ................ �3 ` .IJ.x Y� (1............................... ....--•-•------...---•----....._........................................_........_...._........... ` Installer Address Type of Building Size Lot............................Sq. feet Dwelling ' 6. of Bedrooms....5��...................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ...................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Other Distribution box ( ) - Dosing tank ( ) Percolation Test Results Performed b Date---------------------------------------- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •---•--------------------------------------------•-•-------•---•--------.....•----............_.....--••-.............••---••••----•-............__.......--- Descriptionof Soil......................................................................................................................................................................... -•----.....•-•-••---.....-•------•--•------••=--.......-••--------••••-------•-------.....•----••••.._....•••-•---••-••-------•-•--••-•••.............•---•..........._............--••--............. ti ............ .......................................•---------...-------••---------••........•----------••---•-----•••--••.........-------•-•-•--•••......•--•-•-•••----•--••-•......................._./ Nature of Repairs or Alterations—Answer when applicable................................. 1-0.Cf' i 1 Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI:'id 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 f palth. Signed.Y/ ..................................`: .....; ��. C� ... �i � Date Application Approved I •----- `✓� �,� Date Application Disapproved for the following reasons:.............................................................................................................._ -- Date .. " Permit No....... .... Issued-✓ ....... ��6.... ---...--- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN of BARNSTABLE �ertifirttte of fanm�rlittnre . THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by......................•••.............. .......--------•---••--•------.......---...........---•-•----...-•---........••---................................-- �y('� I Installer at........................ -"!_.":l•-• u.�.�.P��_..�� QI "•------•- .. ..:............... . ' Sanitary c ...._.... application for DisposalWo ksConstru tion Permit No.� �� Th ate dated....0 �,3U/d '_bed in the installedhas been accordance with the rovisions of TETLE THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector..................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF' HEALTH TOWN of _ 00 9-,✓✓ ��,Sf BARNSTABLE No...... FEE........................ ................. Diupnttl Works Tnnntrurtinn Permit Permission is hereby granted................................ .... _ _............ rn,�v to Construct ( ) or Repair ( �an Individual Sewage lsposW System atNo..••........--•...............r. .. .._... =. .. ._....... C 1 j 01 as shown on the application for Disposal Works Construction Permit/N`o��4............. Dated........ .— :. --------------------------------------------- Board of health DATE................................................................................ ZZ I TOWN OF BARNSTABLE `Lt�CATION c�/�/ Ty /e2 Jam/ SEWAGE # _1 S 6 2 ULAGE.�Pn�w�/�c ASSESSOR'S MAP & LOT I FL0 7C) 1`.'INSTALLER'S.NAME.. s&PHONE NO: vcG C 7 , . s.: ::SEPTIC TANK CAPACITY Tc: 330 � X 3 �y ';`LEACHING FACILITY: (type) .C'��/.. C-. (size)_� OF BEDROOMS . &btr* 7 wcc r `<>BUILDER OR OWNER PERMITDATE: 3�Q� 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 ,a 09 9-s. a IS a1nP , �Q� ' '