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Home My WebLink About0023 ASHLEY DRIVE - Health 23 Ask ley Dr ( 7Z - oS� N aMEAD KEEPING YOU ORGANIZED No. 12534 2-153LOR SFOORESTV BU MIN.RECYCLED INITIATIVE CONTENT 10% Ceffled Fiber Sourcing POST-CONSUMER www.sflpmgremorp SFl01190 MADE IN USA GET ORGANIZED AT SMEAD.COM S r r TOWN OF BARNSTABLE �> LOCATION 23 We 1)12 SWAGE # VILLAGE (� d eZ144//P ASSESSOR'S MAP & LOT ?a_ 6-4 INSTALLER'S NAME & PHONE NO.Z, "accmaApr i-sCoh7-7to SEPTIC TANK CAPACITY LEACHING FACILITY:(type) P,''t- (size) OG ,.I- NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: g DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No r Y � ! -, , • { \\\ // \\\ / \ �� / � � � � � � �� o � / \. L" 'T ION' tY3 SEWAGE PERMIT NO. V i L L`a G E I N S T A LLER'S NAME i ADDRESS BUILDER OR WNE DATE PERMIT ISSUED ,._ v DAT E COMPLI' ANCE ISSUED t- '« , �,b �� o ��'�� r u0o� a��r � _- -- J ASSESSORS MAP NO: `3 PARCEL NO: O No... Fx$..... 2.Q....QQ. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............Town_..............OF......B a r n s t a b l e ... -- ----- ------- Appliratinn for Bi-spuiial Works Tnnitrn.rtion trutif Application is hereby made for a Permit to Construct ( ) or Repair QCX) an Individual Sewage Disposal '- System at: - 1 ............;j3_.1zh1ey..fix i.Y�....e n t e ry i 11 e 's ....------ ---------------•-----••------------------•...............------...------------------......--- Location-Address or Lot No. ..............$tu en,-Luciani .....------•--------------------------•-•-------- ..........-•...................................................................................... Owner Address ,W1 --------------J_..P.t.Ua(;!.QM2eY................................................... ......-•-...••-•••---•-----•------•-•--•--•....--•--------•--•---....--------......------------••- Installer Address UType of Building Size Lott__--------------------Sq. feet �-� Dwelling To. of Bedrooms._________________________________________Expansion Attic ( ) � Garbage Grinder ( } aOther—Type of Building ............................ No. of persons............................ Showers ( ),,—.,Cafdteria ( ) d Other fixtures ................................ --........•.............................................................................. Design Flow.................................�,:_-----gallons per person per day. Total daily flow............................................gallons. W Y-.,,, WSeptic Tank—Liquid"capacity..........ngallons 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 ( ) 0-4 W Percolation Test Results Performed by.......................................................................... Date......................................... Test Pit No. 1----------------minutes per inch Depth .of Test Pit•---____--•--_._____ Depth to ground water____---.-_____-----._--" frq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water............_........... J w .............................................-..............:......................................................................_•------------------- --•-- 0 Description of Soilaand...&• ...Gx_a pal.........................................................................................................----•---------------...----- U -•-•--•-----••••-•-•-----------•-•----•-----•..........................................---•-•-••-•------------•----•------•--•-•-------•-••---•----------•-•--------•-••-----------•-----•----•----... W U Nature of Repairs or Alterations—Answer when applicable.................................................. 1-10 0 0gallon i t----------------------------------------- ----------------------------•----...-----------------------•------------......------------------------............------...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITLEE 5 of the State Sanitary Code— The dersi ned furth agrees not to place the system in operation until a Certificate of.Compliance has be issued e of heal . Signed-- -------------•-- ---•--•• Date Application Approved By................ ------------------------ D ate Application Disapproved for the following reasons:............................................. .....•........................................ •---....--•--- .0'r ---------------------------------------•-----•-•-----•----------------••---....-----------...-- Date Permit No......-. ------------------------ Issued-.----------------------- -- - — Da•_to ` r Z1 1,Cf THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ToWn,.. .................OF....Barnstable App iratinn for Disposal Works Tomil.rn.rtiun tirrmit i Application is hereby made for a Permit to Construct ( ) or Repair 4X ) an Individual Sewage Disposal System at: ............Z3_.._N51.& ve-_Centerville . ............ --------------•--------_..... _....•----•....-•••---------••-------...........-----•-----------..__..__..._ Location-A.ddress or Lot No. .St heM_Luciani .................................................................................................. Owner Address a J.R, jacor .•--•- Insta;ller Address Pq UType of Building Size Lot____________________________Sq. feet ., Dwellingxx No. of Bedrooms-__........................................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. 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. 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........................ P ---•---------••.............•------------------....-•••----..._....-----.........--••--•-•-•••--•--•......................................................... DDescription of So7? ___ ._Gravel _.._..-•-•-•--•---•---._......-••••-•••-••-••----•--•---••----•-••--•----•--•-•--•-•-----••--••-----•----•••-•..............••-•--_. U -•••-•••----•-•--•-••••-•••-••••-•---•---•---•--......••--••............•••- W UNature of Repairs or Alterations—Answer when applicabl ..-- _ - A -I000...4airr&i pit a ... -•-••-------------------------•------------••--------------------•••----------•-••-•-•-._.._...•--. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TTTLEE j of the State Sanitary Code—The ndersi ned further agrees not to place the system in operation until a Certificate of Compliance has bee issued t e b of healt . Signed -• - --•_1 22/..8------ :: Date Application Approved By............... .. Date Application Disapproved for the following reasons:-----------•---•---------•-••---••--------••---------------•--•---•----•--------•----••-•-------••-__.....-•---- ------------------------•--------------------------------•-•------------.....--------••----•--------...-•.---...•-•----•--•-•--•-•-----------•-•-•-••--------•-----•-•---•-----------------•-•-•--------- Date PermitNo....... •-:.... ......................... Issued_...................................------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnsta3�le ..............................O F................................................................................._... Trrtif iratr of Tomplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired... Y"X ) by_.._.._..J.°tom._..Macomber ......................•---••-•-•-•------......•---•---------•---------------•-.........-----•----......----•-------•----•----••-•-•--•--••------•-----•- at___..._.__.73_.Ashley Drive Centerville Installer • - . - • . ..-..••-•-••----...-••-•••.....-•--•-•-•-••...._----••-•-•-----•-•---•-••••-•••-•-•--------•-•----•••••----•••-_.. has been installed in accordance with the provisions of T I T'r OI The State Sanitary Code as described in the application for Disposal Works Construction Permit \To._-__ a._---.-0....._.._._. dated------------------------_------_•----.--__---_. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE..................... ............................. Inspector...................... --•-•-••...............•----...._.......-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable ' 11 ...............................O F..................-....-.......................--.._...............-................. 20.00 4�-- FEE.......-•-•--••-•---•-- �i��a��1 n�k� �nn��rilan rrnti� Permission is hereby granted_....)'P'-••--•--•-----....Macomb.e r to Construct (� �) or ReQair. X) n divi u _wage Disposal System at i�'o. 73 Ashley Sri e center �.�TS� s ----•--------•--._.....•••-----------------•--...----------.-••••----------------------....•-•-------•-•--••--•---•-------•----------•--•••_.........._____ S:r eet as shown on the application for Disposal Works Construction Permit NIF!"3-ae.---_•_-_ Dated.......................................... --•%--...•...�, .n--......--•----•----.....--•--- Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS � I