HomeMy WebLinkAbout0153 GUILDFORD ROAD - Health 7
153 Guildford Road
Centerville, MA
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE
Appliratiuu for Biipuu�al arks Tour U 7- ovum
Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal
System at:
153 Guildford Road Centerville
................_................................................................................ ......-------•---••-•••-•------------------•------•---------•-----._...................---------•-
Location-Address or Lot No.
Engdahl
........--............__........................................................................ --........................--------•-•-----.....-•----•-----..............-----------..............
Owner Address
W J.P.Macomber Jr.
•.....................................•--------•---•---...........-------•-•.......--•----•------- ...•-•-....................-•------•---••...------.----- •••--•-•-......---------•-....-------•--
Installer Address
d Type of Building 3 Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms______________________________ ___ Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons............................ Showers Cafeteria
Q' Other 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-•••-.•-•--•---•-----•-•--•-----•--•.....
0.4
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--------_...............
a --•-•--••--------•------•----------------•---••-•-----•-•-••---------------
-•-•........
.---.--------
--------------------------------
-------------
•----------
0 Description of Soil............................................ .....................................- --------------------------
x aa;ric---E_Grave Z
v ---•••----••-•------•-----•-•••---••---•-•-•---•---•--------••---•---•------•---•--•-•--••-•-••-----.....••--•----------•--•-•-----•----•-••-....-••----••-----••••.........................•••-----•-•.
-- - -- ------------------- - - - - - - -------------------------------------------
.
U Nature of Repairs or Alterations—Answer when applicable._..............................................................................................
.......................................................-................................................................................................................................................
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 gee issued by th bo rd of health.
Signed - ----- ---�-- ---- ...............................-- -----5/.......................
Dace
Application Approved By ................. . . ...... ... 5-' Date
Application or the l reasons: ..................................................... .......... .. . -- --- ..
----- ........................................
pp Disapproved f owing
-------------------------------------------- ---------- -- ----- -- --------------------------------------------------------------------------- -
Permit No. .......� Issued
Dace
Ts.
r ., • �®
ff
No.... FE$�....3C.CC..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
• TOWN OF BARNSTABLE
Appliration fnr #wvasal Worko Tnnitrnrtion ` rrmit
Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal
System at:
153 Guildford Road Centerville
... _............................................................ -------... ..........................................
Location-Address or Lot No.
Engdahl
.......---------------------•...............
•-----------------.--.-.------------------------------ ---••----.--.......-•------....-------••----- ...............................................
owner Address
W J.P.Macomber Jr.
........................ ........ ............................................
� Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling A No. of Bedrooms.............3------___._-__--__---___.__-Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures --------------------------------------------------------------------------------------------------------------•----•---------•......•----------------
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.
3 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. I________________minutes per inch Depth of Test Pit.................... Depth to ground water...................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
04 -------------------------------------------------------------------•-----------••-•--•...--••-------....................................................
..•--
0 Description of Soil---------------------••-----•-••---------•--
xSand Grave 1-----------------------------------------------------------------
c.� -----------------------------------•---•-----------•---------------•------------------------------------------------------------------------------------------------------------------------•-----------
W
...................... . a ------ ---- fy---------------..........._.....
x -- -- -- ----- --------- -----------------------------------------------------------T-=1'3C�_.-gallon 7eacn pit . a
V Nature of Repairs or Alterations—Answer when applicable.__......................................................................................�...
----------------------------•--------------------------------------------------•-------------........--------------------------------------------------------------------------------•--.....----•-•.
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 `Lf---- .. .......................... 55-/(492------------
Date
Application Approved By ---------------- ---------. ..... . ,_. �� 9
J7 t`............................. .`........ -----................. Dare
Application Disapproved for the 7fllowing reasons: .....................1.1-------------------------------------------------------------------------------.................................
---------------------------------- -- -------------- ----- ------------------------------------------------------------------------------------- ----- -----------------.......-- ........... ............------.................
Dat
PermitNo. .. �...V-�----------------------- Issued ......------------------------------------------------- e-----
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Ger#ifira e of Grayliax><.ce
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( xx)
by J.P.Macomber Jr.
---------------------------I..........................................................-----...................................--....................................................................................
Installer
at .--153 Guildford Road Centerville
- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
has been installed in accordance with the provisions of TITLE 5 of T,he State Environmental Code as described in
the application for Disposal Works Construction Permit No. ---------!"�`------.r 9.-SG....-. dated ................................................
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
q c/ TOWN OF BARNSTABLE FEE...$ 3p.
.....................
Diaposal Evrki5 T.onatr inn ami#
J P Macomber Jr.
Permissionis hereby granted--------- ------- ------......----•-•--.-----------•-------------------------------•---------------••---------••------.................
to Construct ) or RepairX({X an ndividual Sewa e Disposal System
at No.._1 .. uiidt'oerd Roca G�entervil-
---•----------- •-•---•-•-------------------------------•--•••--.------------....---------------•-------------------------------...------------•---••...........
Street 3 /9�
as shown on the application for Disposal Works Construction Permit No..;..__-_/.........._ Dated..........................................
a
_ --------------------- .........................................................
DATE. - •-------------------------------- Board of Health
FORM 36508 HOBBS&WARREN.INC..PUBLISHERS
TOWN OF BARNSTABLE
LOCATION /j- SEWAGE /# r a
VILLAGE �/�j��;/;%/ �- ASSESSOR'S MAP & LOT��B- u/�
INSTALLER'S NAME & PHONE NO. .�
SEPTIC TANK CAPACITY 00 C)
LEACHING FACILITY:(type) (size) /AV c7a. B
i
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER ,_
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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