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HomeMy WebLinkAbout0073 CAMP OPECHEE ROAD - Health (2) 7n CgMP oPteckee z/0- 0©3 /// S M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR SUSTAINABLE FORTY MIN.RECYCLED INITMVE CONTENT10% CertifledFb rSourcing POST-CONSUMER wwwsfipropranUrp SF$01= MADE IN USA GET ORGANIZED AT SMEAD.COhl No................-....... Fics...$1,5�...00...... .—c 7 THE COMMONWEALTH OF MASSACHUSETTS ~BOARD OF HEALTH .. Town.....OF. Barnstable.. . Appliratiuu for Uigpuual World (foutitrurtion rrmit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: _____.. .. --------#73 Aqq -Address or Lot No. James F. Pendergast 73 Camp Opeechee Rd. Centerville, Ma. 02632 -- - .......................................... Owner Address W A & B Canc© ......................................... . .350--Main._St.___W.___Yamouth.....Ma.__02673 Installer Address Type of Building Size Lot............................Sq.-feet U Dwelling No. of Bedrooms .................................Ex ansion Attic a g— p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons...............__........... Showers ( ) — Cafeteria ( ) dOther 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........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •-----------••---------------•--...............---------.................-•-------------•--------------....------...........-••••-•---•..................... 0 Description of Soil.........................................................---------•----•-•------------------------------•------------...--------------------------•.._......--•----•--- V --------•---------••-----•-••----•------- W U Nature of Repairs or Alterations—Answer when applicable_.1000_-gallon septic__:tank and 1000 -................ =.FAQ? ..............................••.... ............................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI lU4 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i sued by the board of health. Signed_ . . ------------------•--•--••----•---• -----/.a.:.3!= r ... Date ' ApplicationApproved By.................................................................................................. ........................-............... Date Application Disapproved for the following reasons---------------••--------•-----------•--------------------..................................................... ........ ................•----------...----•-••.....�-------•--•-------••------------...................-•--•-•-----•...••••------•---•-•-------•-••-••---••-----•-•--------•-----------•--••---.----- Date ti 9 -_ .• Permit No C 2 `^ w, •--------------- Issued........................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................Town OF......BarnStable ............OF......APXAStable ............ Trrtif iratr of Tomplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (X ) by A & B Canco 350 fflain Si, _ W. Yarmouth, _Ma._.02673 -••---••-•---•---•-•-..._...... .---- --••- --•• ---•..............•--•-....................._.._...._ Installer at.. 7.3 Camp...Opeec.hee...Rd. Centerle,_.Ma._.0263� ...._.. ._..._... ..-- ....... ................... .•----•. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit .............. dated.......�.m (.... ......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..........IV ...................................... . Inspector.............L1\./x=............................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No �2 ....................Town OF.......Barnstable Fad" J _ Roposal Works Tontrurtion Permit Permission is hereby granted........! ... :.._ to Construct ( ) or Repair an Individu Sewa a Disposal Syst at No....7„ ._.-._��'..!r�+►��P.....f.� t. .E"'. .. .r---.._.Z 3:'&mz�l-. }... �1................................... Street qq e� as shown on the application for Disposal Works Construction Permit No 5, ..!./...Z Dated../1/� .Cr......... CPO Board of Health DATE It ,. ) --••••................. FORM 1255 A. M. SULKIN. INC.. BOSTON JX 03nSSl 1311bIldW03 31ra —fig a3nSSI 11Wb3d 3 1 V a t��, 9 V3 NMO NO d 3 a 1'1 n a SS3 » aaW Z 3 W V N SA31.1 V1=SNI 3 SV1-1 1A 'ON 11WV3d 3 !) vm3s NOIIV301 5 ^�. \,�, ay � �` �� �� i \/l, y � •4 ' ,� 1 No......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town....OF...Barnstabie...... Apphratiun for 11folio, al 19orks Tonotrurtion Vrrutit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: .....r ... ,Opttghee,Rd.•,Centervi lle ..Ma• --- .........#��3 .......... --• •----•-------------•--.............................. Location-Address or Lot No. -• James F. Pendergast............................... 73 Camp..O,p�echee Rd. G ntervxlle��.Ma. 02632 •----...._.................... .... . .•. ..... ---.....__. ..... ........... Owner Address W A & B Canco ,350 Main St. W. Yamouth�_,Ma•_•-026.73--• __ ............................................. ....... ...... Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.........1................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria 04 Other fixtures -•------------------•-------•-••-------..................-------------------••----•-•---•--••-- ....._.._.... d ..................gallons per person per day. Total daily flow........----------"............... W Design Flow..............•-----...... ga P P P Y• Y ..'.'.."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........................................ ,`4a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 --------------------------------- .----------- ........... .----------- ............. ..... .-......... ..... .------------- *.... .-------- ....................... ODescription of Soil......................................................................................................................................................................... V -------------------- -..... ......- --••--•-••---•--.---•- -------------•--......-•----.............---•----------------------------•---------------.......--------•-•-------------..................... UNature of Repairs or Alterations-Answer when a plicable..ZOO..gallon... eptic_ tank. and 1000____,____. ...............Stone..packed.overflow...........•----. -_r3 u v ..... ......... ......... ......... ........... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 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 by the board of health. Signed...................................................................................... .........................._.... Date ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons:........................................................................................................... ....................................................................................................................................................................................................... _ Date Permit No.... ._.... Issued............... - ...... ---........_....