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HomeMy WebLinkAbout0036 BIRCHILL ROAD - Health 3 6;r(krll Rd CeAftrV1(I'e S M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR OFORES RN�� MIN.RECYCLED INITMVE CONTENT10 0 Certified Fiber Sourcing POST-CONSUMER® i wwwAprogromor0 S"1290 p���WDDE IN UUSAA�,C�^/�/�� GffORG NY1L�LYA1 SIYIGM MU Nog FIc$ ......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Alip iration for Diij-puiitt1 Wurkg Tomitrurtiuu lirrmit Application is hereby made for a Permit to Construct ( ) or Repair )(X)� an Individual Sewage Disposal System at: 36 Burchill Road Centerville ..........-•-•----.....--•---•--.........-•--•----•---•----•---------------------------------•---• ----•--------•--------••••-----•-------------•••-•----•-•-••--•••-•-------------••----------.----- Location-Address or Lot No. William Thomas ......................_.-..---.....--••--••---------•-----------------------------------•-••---. -•-----•---------------•------•---••----••-•-•------------••----•••----••---..........------•---•- Owner Address a J.P. Macomber -Jr. Installer Address UType of Building Size Lot.................... Sq. feet ►, Dwellings No. of Bedrooms-------------3---------------------.----..Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ---------------- -----_____ No. of persons------- _------- ---__----__ Showers ( ) — Cafeteria ( ) a' 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--------------------------------------- Test Pit No. 1................mtnutes 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 ----------------------------------------------------•••----•---•-------------------•-------------•---....------------- ------------ -........ ...... ------ ._.... 0 Description of Soil........................................................................................................................................................................ v - Sa.nd...&...G avel w x -- ------------------------------------------------------------------------------- .................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable..-Omit...Ces-spootls..---Instal-1...-7.-1-0-0-0........ gald?on_-tank, 1_.-dstxibution..bQx.,.1.-_1.Q.QO...cja11nn---Leaching...P.it....................................... 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 Complia e has bee is�ued by the bo rd of health. Signed - - ---- . •--- -- - --. ,----------------------- .3..1 6..9 5 ...-... Date «� Application.Approved r2 ... .........:. ------- -... .--- ----- --------..._.._...----------------------------- .:.. � Dare Application Disapproved for the following reasons- ------------------ ------ --------------------------------------------------------------------------------------------- ............... ._............................_..........---------------------------------------------------------------------------- Permit No. � .��`.._............. Issued ....����-,-- _....... -... Dare 30 00 N09n . � Fr�s. THE COMMONWEALTH OF MASSACHUSETTS_ BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiott for Di►ipoittl Mirkg Tattotrurtion rrmit , Application is hereby made for a Permit to Construct ( ) or Repair}(X)� an Individual Sewage Disposal System at- 36 Rurchill Road Centerville ....................•-----•-•-•-......------•---•-•---.....--------------...----•-----=.......... --•-----••---------------------•------------•-••--•---------•--------...----•-......----------••-- Location-Address or Lot No. William Thomas ......................_.......................................................................... ................................................................................................. Owner Address aJ.D. Macomber Jr. Installer Address UType of Building Size Lot............................Sq. feet �-, Dwelling X No. of Bedrooms..............I-------------------------- -Expansion Attic ( ) Garbage Grinder ( ) p`,a Other—Type of Building ____________________________ No. of persons............... ........... Showers ( ) — Cafeteria ( ) W Other fixtures ------------------------ -•--••------------------ WDesign 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........................................ W � Test Pit No. 1----------------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-....................... a .-•--•---••-------------•---------..._.................--------•------...-•-••--•-•......................................................................... 0 Description of Soil..................................................................................................................................................................--••--- x Sand...&...Gravel v W x -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable._lJM-it_..CE-'-RS_ 001 s_._...Tnsta__l.l...1=10.0.0........ gal&on tanks 1 -distribution-_box•,_1--1 090•_-gallon__-J: aching--nit.,_____________________________________ Agreement: r 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 Complia e has bee issued by the bo rd of health. Signed ...-... � ....3-/1 6..9 5 .. .�........ --- ---- ------ Dace .--..r• Application.Approved ......� .. .. ... C "'z'� - }� .. ..... ..........._...--..........-...........-........... Dace Application Disapproved for the following rearons: .................... ---------------------------------------...........-..-------.......-------------...--------- ...... .............................. ................................... ..... ... ..._............ . . . .........-------------- ... ........ ............ Permit No. .�j� /.-_------------- Issued ...........................................'�tDace ... ^. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C ertifirate of. Complinure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (YXXX) by ..J....P....Ma.combe.r----J.r-•----------------------------------------------------------- InscaIler at 36 Burchill Road Centerville nterville...... ------------------- - - - --- - - -- ........ has been installed in accordance with the provisions of TITL 5 of he State Environmental Code ass,- escribed in______ the application for Disposal Works Construction Permit No. .- -'� .. dated '' .----- _ / ..... - THE.ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU S A GUARANTEE THAT THE SYSTEM WILL F NCTION SATISFACTORY. � - �-' i DATE..... . �.......... �� - _.. Inspect THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEE__:$.--•-30---.-...�.p No- ------------------• . .---- Diapao l Workn Tuni#rttrtion "rrntit Permission is hereby granted.J.-.P-.�?acomber- Jr/ -- ---- -------- ------ to Construct k ),or R pqi 0 an Individual Sewage Disposal System at No. --•. -• -•-••-•••. •. •-----•• ---- 36 B1rcehirllX oad Centervie •.............ll-•----. stre as shown on the application for Disposal Works Construction Per r ___._jf� Dated__�'`��--_�C" �,-- /4 4 Board of Health DATE---- --------------•-----------•-- ----------- FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS r I TOWN OF BARNSTABLE i LCf�ATI0N ✓I 2C.�t ( � SEWAGE # ,-, VILLAGE0,..A4,e>C V l t ASSESSOR'S MAP & LOT1f'7 ",aR7 INSTALLER'S NAME & PHONE NO. 1N1A ,e;r 5Oki 1 K SEPTIC TANK CAPACITY (OCR LEACHING FACILITY:(type) t4— (size) QUO CD NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BU&-CeR OR OWNER �L DATE PERMIT ISSUED:" Ct DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �� fb p c 3a.N t 4 . f,6 ASSESSOR'S MAP NO. j `� PARCEL r I ON S E W A G E PERMIT NO. 4 a ;),, YI.LLAGE INSTA LE 'S MA IL AD.,DRESS B U I L D E R OR OWNER 't DATE PERMIT ISSUED �. DATE COMPLIANCE ISSUEDI� � y % 6i�� a / � _ _ � ° j � rJ;� �� f � i II1 4 \ �4� v 4 ,�� �� .. •� / ARSESSORS MAP NO: No.. _ � PARCEL NO.: F s.............................. THE COMMONW A ;T4 ACHUSETTS BOARD OF HEALTH 4 ................:_...._.--*....---.....O F.........................--------........------------------------..._....-----------•---•- Allp iratiun fur Diipu,sal Warks Tonstrurtiun ranfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: r% .............................................. ..................................... - „ Location-Address LoW /f 1 Owner less W < 'C................................................. ............. .. Installer Address Type of Building Size Lot_ 1_© ..........Sq. feet U Dwelling L;;No. of Bedrooms________________________________ .Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of ersons____________________________ Showers G� YP g ---------------------------- P ( ) — Cafeteria ( ) Q' Other fixtures _________________________________ Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W.W Septic 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_ _ .. ,4 Test Pit No. 1________________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........................ ............l..--••-••••--•-••-•...................••--•--•-....-•---------•......----•-----...-......................................................... 0 Descriptionof Soil ..................................•............................................................................................................... U ...........----•---------------••--•-•---------..__...._..-----•---•---•-•--•---•-•-------------•-------•-•-•---•-•---------------...-------------•----------.....--••--•---•------....._••----------_.. UW •••--•-----------------------------•----•••-•-••---••--•-• ................................................. ........................•............ -......................... Nature of Repairp or Alterations— nswer when applicable r � ? tom- - ---------. a��:,..�-�� ----�'��-- --��--------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with the provisions of iITLi4 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 th bo,r of health. r. Signed ` . .... Date r Application Approved BY .._..-----••••-•--•------•-...._••-_. .... �__. --.....•-•---•............. -----•--�••�-�-� t�. i Date I ' Application Disapproved for the following reasons ____________________________________ _...--•---•--..._..--•--------------------•----------._..._..-------...---....._...---•-----•------------•-------------•---•-------•----.--•--------•-•- ..-•............................................................. ---•-••-•-••--------Date 0't PermitNo......................................................... Issued_... a ...................... Date THE COMMONWEALTH OF MASSACHUSETTS / ,�l BOA F HEALTH .. \ .f-._..-...OF.....:::.................. . Tntifiratr of Toutpliattrr THIS IS TO CERTIFY, That the Individual Sewage Disp l sal System constructed ( ) or Repaired �( i 7 �t✓ck - ,- e r 7(7a ��f r c.`, Instt-�I ( � at---•---------•----------•-----------------------•--------• ----------•- -- --------------------------- ---------------------------------------------------------------------------------------------------------------------------------------been installed in accordance with the provisions of TI T IF 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated......____-___ ._._..____.______...._.______. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNC ION AT/IISFACTORY. DATE... �'•---------------------------- Inspector............4..................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF............................••••-•••• No.. ...............a ........................................ FEE.........•••••.......... Disposal Works Tons#rttr#iott Permit Permission is hereby granted................... (I I-r!r c` I U ��f r - -----•--*--------••••---••...•-•..... ... .............. ......... to Construct ( ) or Repair ( � an Individual Sewage Disposal $ysteeml at ----__ -..__---- =- --- .......... Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......... .......___......._..._........ ....................•--•••--•------------• ; ..... ..:_..._..-------•----............. S 1'Z ) ��j iBgard o Health ------- DATE.................. -------------------------------------------------- FORM 1255 A. M. SULKIN, INC., BOSTON No......................... a Fas........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................:........................O F........................................-----.--------.................................... Appliration for Biopoottl Works Tontrur#'ton "prruti# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 4&6'f'1 --•.:... ».,: .. ff .• •--•-... ;.................................................... 1 /.� � �1�tio %lddress l .Lot . / Owner tddress a ale/ l /. � fry . ---....._.. Installer Address /t � Type of Building Size Lot."a. D�V.r.�................Sq. feet Dwelling-L70'No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a 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--•-•• '2 - b� �� ............................. 1.4 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fT Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x .....-• ------•---------'----' ---------------------------------------------------------------------------••----------- ODescription of Soil =�``• '�•---•-•---•-••.................:........•--••--=----------•----•-----------•-•---------...-----------•------------.....................---•--. W ------------------- -.-•-•---•---------------------------------•-----.--._-.-..----•--...-•--•------------------ ....................-...................-.......................................................................... ----•----- U Nature of Repairs alterations Answer when applicable.. rG{ r j ................................../1 : (. - .....- -------------------------- Agreement: ..uA ....•-••••.• ..... "-'Nts.'":.....•--.._..---•-•••-•-••-•--------------•------•------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITL U 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 y the board,lof health. Oil _ Signed........_... 7 ... .....—�.... ...»......-.-'----------------•-----..._ ..-•---'�Date... _„.._. Application Approved B �15 5 �' _ �G' �v..... PP PP Y .... .�-.._..- -- --•- +. Date Application Disapproved for the following reasons: ....... ..................» --.........-•--•.........................................•---•-----'-------•--•-•---.._...........--•-••........................-•-----•-•---•-------------•----••-•------------••-•-•••-••-•••-•-....... Permit No--------------------------------------------------------- Issued-_-/ ` �?.....................a Date