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Home My WebLink About0050 HARRISON ROAD - Health 50 HARRISON ROAD Centerville A = 229 — 073 S M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR susrAINABLE MIN.RECYCLED INITIATIVE CONTENT 107, CerGfied Fiber Sourcing POST-CONSUMER W-811propramorp &W1290 MADE IN USA GET ORGAM7.ED AT SMEAD.COM Pi"MCCEL NO.; No.. '.-G Fins.....�®......._...__. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..............OF......10,44VSZ;;�k61 '1 Alip iratiou for Uhipoii al Works Tomtrurtiun Prrmit Application is hereby made for a Permit to Construct ( ) or Repair (111�an Individual Sewage Disposal System it: ..... ,a � �� .. ..----------•--- -.... L.,c on-Add s or Lot No. �eP /Ll o'le— Owner Address W � Installer Address d Type of Buildings Size Lot____________________________Sq. feet U Dwelling—No. of Bedrooms____________________________________________Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ____________________________ No. of persons............................ Showers _( ) — Cafeteria ( ) Q' Other fixtures _______________________________ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ 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_-:______:____:______- , (rq Test Pit No. 2................minutes per inch Depth of Test''Pit.................... Depth to ground water........................ O Description of Soil........... ' ----------------- ...................................................................................................................... . V Nature of Repairs or Alterations—Answer when applicable. / ............................................. __..!r_____________________________________________ ---------------------•-•----------------------------------------...---------------------........................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of ii`i'L: p 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 e bo eolhh. Signed- -- __ ___ _-a_...__ -=--�..._. ate Application Approved BY -------------•- - - ---•-_............................... '-----� Date Application Disapproved for the followin r�easons:.............................................................................................................. _ ---------------------------------•-•----...-----------------•--------•-•-------..._..----...---------•---I-----•--...------------..--.•.--------------------------------------------------••--•••-••-•--- - Permit No.........:.. --,I-D Date ..I----..........-----•----------------- Issued_.........................................--............ Date TOWN OF BARNSTABLE LOCATION 'lt2 SEWAGE # VILLAGE � ?/�C�v /,(r,Gs� ASSESSOR'S MAP & LOT ,-,? -073; INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY ,/ a LEACHING FACILITY:(type) f— A?- A (size) Am NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER �/�JJ� DATE PERMIT ISSUED: .-.� + DATE COMPLIANCE ISSUED: -- _1hr7 P? I VARIANCE GRANTED: Yes No ��5�� -��c�- ` +; �� ► � r ,� i �� i si � , ,, o � ,� �p�� r� i - L- No—si— FEZ THE COMMONWEALTH OF MASSACHUSETTS ' ' d BOARD OF HEALTH . ' . _�/V.......... . OF........L,J... �` 4� 1 PR..� Appliration for Di-4pasal Works (ions rurtiutt Wrmit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at ----------------•-----•----.......-----....------•-------------•---.........----------• d Loca on Address or Lot No. f , Zu......... .._.�......... 4r --•------------- -----••----•-------------•-•---•----•---•--- --•--------------------------------------------- Owner Address W Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling o. 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........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_-_-_-___-_-___---__---. GL, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -= --••--------•--- •-•.................................................................•-•-----.....------............--•-----...................•---- � N O Description of Soil........... L� ...........--------••---------•-----•------------------------------•------------------.............................................. x W UNature of Repairs or Alterations-Answer when applicable__-____-. '_ `p1 _____________________________________________ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of or the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued bynthe board of health. Signed_ Y �` ! t' � i s TdA ate Application Approved BY........ 51 ..-----•. ,,Date Application Disapproved for the followin r asons:................................................................................................................ Date PermitNo..................... .............................. Issued.................. ..--------........ ...._. Dattee ' THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH lr.. ..............OF. ............._................ .. ......... Q=Vfiratr of Toutph atta T IS TO�CER PFY That thqe/yIn¢{ry/¢�vldu 1 Sewage Disposal System constructed ( ) or Repaired ( A I1?caller s at .x!�( ............................ ............... ---• ...... ' -----------------•----------------------•----....----------------- has been installed in accordance with the provisions of TIT'r 7 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No....... �._-.�.l�_.._.__ dated_...____'_-. ... _. ---------- THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. � DATE. ...z )-7 /6 .........................-.......................... Inspector--_................-----------------•---------••----•-----.....-•------••---•------- THE COMMONWEALTH OF MASSACHUSETTS A 01 BOARD OF HEALTH `1� O . .........:e.:' .......:y:'vr...........OF.. .--- .�4.,�..n..�,�.l.-..r�� .................................. FEE .--=�-.'✓?•--.. No... S ....`�1..__ : . Permission is hereby ranted-_`_s x •" " t�` f� _`AfN�r 'y � to Constrj�gk . ) or Repair ( "Y a}n Individual Sewage Disposal,System 4 at 1\TO.` `_ '� yhA r. .f_._ 'l L:rt ;. .........'_x ✓rr j/"-..'adr'..�fi....%.' ". •?ID:::w..'.--•---------•--------------•----•----•----•-•-••-- Wiz-. •-- Street as shown on the application for Disposal Works Construction Per it No.-_!?�........... Date z`b.--.Q..../.................. .............. . --- . Z oard of Health DATE......................... -------. .......................................... FORM 1255 .HOBBS & WARREN, INC.. PUBLISHERS - S 1020 _ _ 1 Iva 9;x, 4� Le oi4 7711�- ., AsBuilt Page 1 of 2 TOWN OF BA/JRNSTABLE LOCATION Q.. S�"�� lf1�J, 0/ SEWAGE #_- 74?d VILLAGE ASSESSOR'S MAP & LOT;2gq-,07� /j INSTALLER'S NAME PHONE NO.' SEPTIC TANK CAPACITY LEACHING FACILITY:(type) Z (size) j NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: i DATE .iCOUPLIANCE ISSUED:' 'q i VARIANCE GRANTED: Yes NO cc-,,) < it i r � , i i http://issgl2/intranet/propdata/prebuilt.aspx?mappar=229073&seq=1 5/25/2017 No................. ....... .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE H Appliration for Uhipoiial Workii Tonotrurtioaa - rraaai$ Application is hereby made fora Permit to Construct ( ) or Repair ( 4,�n Individual Sewage Disposal Sys7t at: 5 - ------------------------------------------------------------------- -------------------------------------------------------------------------------------- ----- Lo ion- ddre or Lot No. - ---- ---'E------ - ---- --- ----- ------•---- ............................................................----------------••---- er ../. .....t!_.J'!n_A�._-'---"-"'1' -•--•-- •.=1'��_'. Address yt • �' ' - Installer Address d Type of Building, Size Lot............................Sq. feet � U `Dwelling No. of Bedrooms_ ____________________________________ _____Expansion Attic ( ) Garbage Grinder• ( ) as Other Type of Building ............................ No, of persons._______-_._______-______-__ Showers (- ) — Cafeteria ( ) Other fixtures -•-- ----=---•--------•-----•-.--•-- Design Flow...........................................gallons per person per day. Total daily flow_-__.__-___:._____-.________ _ gallons. Ra r' Sepric.Tank—Liquid capacity_.__.-____gallons Length---------------- Width.......... .._ Diameter___.. ..- --_ Depth .._-__...- . W , x `Disposal Trench—No_____________________ Width.................... Total Length-__-..____--____-. . Total leaching area. _. -__ _. .____-sq. ft. ' -Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area----.__...........sq. ft. Other.Distribution box ( ) Dosing tank ( ) �a Percolation Test Results Performed by-------- -------------------------•--------•-•-•-•-•---------. -------- Date...------------------------------------ . 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------Q. .0------------------------------------------------- ---------...----------------------------- x ; ' U - i.... -------------- -------------------------------------•----•--•--------•------------------------------------------ ------------------------ - ------------------------------ U:, Nature 1pepairs r Al ations nswer when applicabl .____/_217 7--�� _-___ __ �. . _.. Ate . ---- > a...:.: .::::::::::.::.:...:: Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued the board of health. 4 Y. ... ----- Application Approved By---- .fv-A .-----...,-------------------------- - ------ Date Application Disapproved for the following reasons-------------------------------------------------------------------------------•-------------------------------- ----------------------------------------------------------------------------------------•------------------------------------------------------------- ----------------------------------- ------------ Date ' dv. PermitNo......................................................... Issued----- -,-r�- ----••- .....T--_----•--- ate rf NV FEE...:..cr...... ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 3 k _...... � ti...........OF----- .........:.:........... Appliratinu -for Di_qpofitt1 Murkii Tomitrurtiou Pumit Application is hereby made for a Permit to Construct ( ) or Repair ( e--�-an Individual Sewage Disposal Systerp at f� .. �' 7L1 � � , Location-Address or Lot No. ----- --------- :;4.............. .................................................................................................. Owner ---••------- ............••................Address — Installer Address Q Type of Building / Size Lot............................Sq. feet U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons___._--_-_____-_-_.____.__ Showers ( ) — Cafeteria ( ) Q' Other fixtures ---------------------------------------------------------------- ............................................. -------------------------------------- 1116 d Design Flow--------------------------------------------gallons per person per day. Total daily flow----------------------._______-__-.-.---_--gallons. 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----••---•----------------------------- ,� Test Pit No. 1________________minutes per inch Depth of Test Pit-------------------- Depth to ground water-..------.-_----_.------ �14 Test Pit No. 2_______________minutes per inch Depth of Test Pit.................... Depth to ground water........................ DDescription of Soil-- - ---------------------------------------•---------------•-------------------------------------------------------------------------------------- x ------------------------------------- ----------------------------------------------------------------- ------ --------------------- ---- - ------------------------------ U ture of Repairs or Al er<- ions—An er/�hen pli _le. �� -_-- � �L�•L .._.. � Y_... ------•-•--------------------••------•--•--•----•---•----------------'-------------------------.. Agreement:The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Com61ins bee issued b the and o health. . . . ..._ ' Date Application Approved BY ..._ (�•�� -------- ---- ��$.. ` ate Application Disapproved-for the following reasons:-------•---------------•-----.................................................................................. ...........................................................................................----•---............---•••-----•---------.....---•------•---------• -•--_..... .............................. �Dat PermitNo........................................................ Issued.------ -D.......... • F.r x THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH riW10Z,<.... ¢ .-AT watifirate of Tlimphat rr TH S IS`T CE IF That th ndivi al Sewage Disposal Si, tem constructed ( ) or Repaired (� rt.-...:. b ;, �� In ---------------------------------- I - at. ......../S.1. ----- •-••--• . T/Le t bas been install in, accordance with the provisions of Article XI of The State Sanitary Code s described in the application for Disposal Works Construction Permit No......... —----------------- _ dated..------ Y/$./7�...------_--•- THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT-`BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL F NCTIO SATI-SFACTORY. DATE............. .. ----- � --_�----------------------•-----•-- Inspector------- --------4------------.....-- ------------------•-.................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / � �.........OF.... ... ------------- " No. -. �J�!. FEE. ... BisV0 1 ork',..�� ugtrurfivu ,rrm-t . r _ Permission is hereby granted--- ----- ---- ---- ----- "___.. `�`. ° '� ------- 2 a.:._ r........... ______ to Constr ( ) Repair n Indi Idual Sewag is sal Sy m at No... L . -_. !Jti�..... -- ................................... - . Street- as shown on the application for'Disposal Works4Construction •Pe No. Dated......?/$--/—/,7............... . ........................... - w .� oarHealth� d of DATE . :. . 1255 FORM HOBBS & WARREN. INC.. PUBLISHERS f