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Home My WebLink About0040 GORHAM LANE - Health 40 Gorham. Lane Centerville -' A = 193 - 102 i No. 42101/3 ORA ESSELTE 10% 0 0 C ASSESSOASMAPNO�Y� 9� . --_ PARCELNO',�__._.1 No.�------••-• Fss....$....3 0.0 0.. 9 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH // TOWN OF BARNSTABLE e m- Goa Appf ration for Dhi-pit ial World, Tomitrnrttnn ramit Application is hereby made for a Permit to Construct ( ) or Repair Y*X ) an Individual Sewage Disposal System at: I -.0...Csarhan-..Lane'...Centesuille----------•----•..... ..............................•---•---•--•--•------------------------•--..........------•----•---- Location-Address or Lot No. MCBride -----------------------------•----•-------------------------------------• •-•-•••-----------------------•-•-•.......---------------•--•-----..........---..........--------- Owner Address ..--•-.............................................. Installer Address d Type of Building Size Lot............................Sq. feet U DwellingXX 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. 1:4 Septic Tank—Liquid capacity............gallons Length---------------- Width---------------- Diameter---------....... Depth................ W Disposal Trench—No. .................... Width.................... Total Length-------------------- Total leaching area....................sq. ft. x Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ .a Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water-.-__--------__----_.-_. G% Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water.._--_------____--_.-__. ---------------------------------------------------•---•--------...............-------•-------••-•--......................................................... ODescription of Soil....S.an_d.._&...Graval-----------------------------------------------------------------------------------------------------•------------------------- x U ---.....-•----------------•--------------------•-•----•-•--•-------•.----------------------•-------••-•----------•-•---------•--•--------------•-------•-•---•----•-•--............................... W -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable--Add---ane---1-0-0-0-- al-1-on---ieachi-rt it to--an---existing--•tank---&•--gi-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 Compliance has been iss ,debby the board of health. Signed .------ ......�........ -------------------- ----2-/-1:..1...9... ....:...... ry4 Application.Approved By .. ....... ...... ..... - ----- -------------------------- Applicationo ,. ... _. Dafe Disapproved for the following rear n ...................:-------------------------- ................................................... . .... _-.-... - - --------------------............. _..--- --------------- Permit No. C/...' .- Issued .......... ate........ � N01 / �o 00 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / TOWN OF BARNSTABLE V y �� Appliratiutt for Uitjipnittl Workii Towitritrtiutt runfit Application is hereby made for a Permit to Construct ( ) or Repair T,.X ) an Individual Sewage Disposal System at: df) nrrra...T,anc�r C'�xic�xgi 1-1" ... MC Bride Location-Address or Lot No. ...----•--- Owner Address a T.P• M&comber•_,Tr_, I istalIer Address Q g Size Lot............................Type of Building Sq. feet Dwelline- No. of Bedrooms._...._.3-_--._-•_________________-_._-__Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( —) - QOther 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. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ••--•---------•----------------•---•----••-•-••------...---•---••-------•-......•---•--•--------•---........................................................ D Description of Soil--- Said...&---.Gra.ve1 -------- ------ V .............................................--•--••--•-------•---••••-•---•--------••-•-••--•---•-----•••-----...---•--•-----•---••.................................................................. W ------------- ---------................................................................................................................................................................................ U Nature of Repairs or Alterations—Answer when applicable_Add...one---.9_B10.0.__cna 1 on.._1 toan .eXifiting...t^al-ak---j&---T3?.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 Compliance has been issued by the board of health. Signed . �-------------------- �.. �........ ,% � Dare �� ?'" Application.Approved By ..�..v. � .�fV---. e L..l..� -L./ //Yi.�� (_............ /_.-..Y...: Application Disapproved for the following reasonVAI.................�'----------------------- - ..........,------..........------.--................... ......� ......... ------ ------------------------------- --- ..................../.K -----------.._---------------.................... - ........... , . Dace Permit No. ... ....,. ... .... ...... Issued ........... .... ti �. .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Ce>rtifi ate of Compliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or RepairedX(7{XX) by .....- J.P.Macomber Jr. ------------------- ----------------------_............._....---....._...-------------------------- ------- Installer at ...........40 Gorham Lane Centervi-ll.e........ - ......... _......................... ...........__.. ........... .............. ---------------------------------------------------------- has been installed in accordance with the provisions of TITLE of The State lav�i°ronmental Code as described in the application for Disposal Works Construction Permit No. ._.. ..��.. /.. ---- dated _............._..................__._..... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B CONSTRUEA AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....G .." ... `��L - ....... Inspec �� ; ........'�'l Z �...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No..d... � Uiupuual Mirkn Tuttutrurtiutt "rrntit Permission is hereby granted..-'_P.Macomber Jr. -------------- to Construct ( or Repair (X) an Individual Sewage Disposal System 40 Cornam Lan ' dn at No. '--•-•-•-•-----•••••-•--•-�...CPr+fiPT 1,J:. ............••••---..._.. -------------••---. �------------------------ ------------------------ Street .r �n as shown on the application"for Disposal Works Construction Periiiit�No._. __�r-4ated.A/1__ r Board of Health DATE............... .. .., ... ...-•!-------------------------------------------- / V FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS 0-cjT TOWN OF BARNSTABLE Y LOCATION 4'C) ,--p;aAkq7 4,0 SEWAGE # ,;;7 A� VILLAGEC e,11-krV,1/5- ASSESSOR'S MAP & LOT/,9--/� Z INSTALLER'S NAME & PHONE NOJ P, MAC'Mber -q . SEPTIC TANK CAPACITY 100® od n 4z 0, LEACHING FACILITYAtype)oT- �lv S (size)Jppo Y" NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No S � �� sue/� �'�� ,fig �'�i �� \ � ��0 i�7 � � , �� i� �3� � � �� j��'' a ��