The URL can be used to link to this page

Home My WebLink About0046 BUCKSKIN PATH - Health (2) H6 8JCks k j q Pad C-VAf-t('virl8 5 M EAD KEEPING YOU ORGANIZED No. 12534 2-153LOR SUS TAINABLE MIN.RECYCLED INITIATIVE CONTENT10% C.rdSed Fiber Sourcing POST-CONSUMER wwwAproprem.orp samsoo MADE IN USA GET ORGANIZED AT SMFAD.W" �I (✓ TOWN CIF'BARNSTABLE LOCATION /�1 c! C' b,rl ci%�'SEWAGE VILLAGE ! ;ASSESSOR'S MAP Cz.LOT," INSTALLER'S.NAME PHONE NO.` f SEPTIC-"TANK CAPACITY LEACHING FACILITY: (size) f =`µ NO. OF BEDROOMS PRIVATE ,VELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: J DATE COMPLIANCE ISSUED:2 VARIANCE GRANTED: Yes No �—�' a. H •+• F �� >' `� �. • :i � � . i / � � i,1 7 ,��, . .� 0 ' �. :. .,. . r � _ � � -7 f No.. -�3Q FEB:.....$....20.. 00. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ........'i,omn......................OF.......-----Barnstable ApphrFation for UiipnuFal Works Tonstratrtinn nutit Application is hereby made for a Permit to Construct ( ) or Repair XXX an Individual Sewage Disposal System at: 638 Main Street Centerville .... ...-- .............. --•-------- Location-Address or Lot No. ---------------H a r old d- M a c N e e 1 X......................................... Owner Address a ................J.,.F.sMacmmber................................................. Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling-XNo. of Bedrooms---.........6.................. .....Expansion Attic ( ) Garbage Grinder ( ) . 04 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........................................ Test Pit No. 1................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........................ a ••••-•-•-•-•---------------------------------•-----•-----••--•••••••......-•-------••-------._....--......................................... ---------------- ODescription of Soil........................................................................................................................................................ -•-•-------•••- x Sand & Gravel U •-•••-•-----------•--••-••--------••---••-••.............•-•-••-•-........--------•-•-••-•••----••••---•••••--••------------------••-•-•----------•---•••-•-•------•••••••-••-•--------•-••------------ ------------------------------------- --------------------------------------------------------------- --------------------------------•-----------------------------------------------------------•-•••- U Nature of Repairs or Alterations—Answer when applicable-----------------------------•.-.:.-.-----..--•..---------------------------------------------- 1-2000 gallon tank 2-1000 gallon pits . •-----------------------------------------------------------------------------------------------------------•---------------.....---------------- ...................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i L E 5 of the State Sanitary Code— The undersigned further agrees t to place the system in operation until a Certificate of Compliance has b issued y th Xaof health Signed.. --•- ------ ------ ------$13Y.3 8......... Date Application Approved BY ^firs, Date Application Disapproved for the following reasons:...........................................................-.................................................... ----------------------------•--....-----........--•-------------•---•--.....--------------•--------...----------------••--------------------------------------------------------------------------•-••. �,r Date PermitNo.------- - - E Q...-•---........ Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................`I'flwn...........OF.............B.ar;nS.t.a.b �' �r�g��rtt#l� ,af ��ant�r�t�nrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XXX by............. 0-Mbex...........................•-------•--......------•--•----•---•-•---------.....------......................--------...........--- Installer at--------------6.1.a ... Ma.7.n... S rVi 1_le_:M�*ISa has been installed in accordance with the provisions of TITIE 5GGof The State Sanitary Code as described in the application for Disposal Works Construction Permit No............ 'Q.-._ __ Q_ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......................• ----•...&C-•------•----•--------- Inspector.............. ... ................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,_._, (�Q ............................................................ NO.t�17:..�. 2. FEE..Jr.. <.. �-. Permission is hereby granted.... .v. ' ............................................... .----•--.-•-•-------------•-----•••................................................................... to Construct ( ) or Repair (XX) an Individual Sewage Disposal System tii.�l ��:�iifi ,i,>t-YF']r�..J .y yr, '12 i '3 ) ?J' at No ._ „_. 1 h,.e • ° �v_._.��., .ass Street as shown on the application for Disposal Works Construction Permit N -1;1 j�....._ Dated........................................... t, .............................. BoaPd of Health DATE---...----�--"--�✓'--..�.-�-------••---•----•-•..................... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS ` 73Q F>cs. a,) THE COMMONWEALTH OF MASSACHUSETTS { BOAR® OF HEALTH ------....mom ,;.�.._.... .........OF ............ Apli irFa#ion for UWpoiial Works Tomitrnrtion Frrutit Application is hereby made for a Permit to Construct ( ) or Repair (y+en Individual Sewage Disposal System at: ..................5 R..M .,•'• - - �'�v 'vr=t~ d ?- - •---------- ?]' Y�1 a pgLocattiiyon-Address or Lot No. ..................T6ACrar-o.�S'?..:aF�a:.SN.ee.1m...................................... ..........------....._....._...............--- •---.........------......._..._.......•....•._ Owner Address a '%T vn a:Mn ------------------------------------------------ Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—Mo. of Bedrooms..............6...........................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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch, Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..-____----_----__--__-. P1 -------••----•-•-------------•----•......---••-•....._....••••-•-•-.......------•-•-•-•---------•---......................................................... 0 Description of Soil........................................................................................-------------------------•--------•---------------------------•-•••--•----•--- Us�t..D �1 .....................•------•--........•--------•----...---•---•---•-••---------------......................._._ W UNature of Repairs or Alterations—Answer when applicable.-----------------------------------------------------------------------------.................. .1-2000 =- 3 ? ztank ---1 t - --- --- - ---- Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal S stem in accordance with ' TTa•1v—, the provisions of l l i IE 5 of the State Sanitary Code— he utrsigned further afire. not to place the system in operation until a Certificate of Compliance hasn sub by t 'd of1 '.� �` Signed{ '� ----•-........•..------ -------•-•-----.....--c----••-•----------- ---------�y--ray•-s�.-----•- Application Approved By........... "` Date Date Application Disapproved for the following reasons-------------------------------------•---------•-----•--------••--•......•------•--------•- -•-•-•-••.....-•---- ..... ................. ...... ....•------•--•---------------•--•--••--•-•----......---• ------------------ Date Permit No......... ... Data