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Home My WebLink About0017 HIGHLAND DRIVE - Health 17 Highland Drive Centerville A= 189-120 S M E A D No. 53LOR UPC 12543 smead.com • Made in USA 2 O v .............. THE COMMONWEALTH OF MASSACHUSETTS .�� BOAR® y :j=.A 1/. ^- ----._ . .. .. OF...... . ...TH.... . ..................... Appliration -for Bii laiittl Warkii C owitrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Loca'on.Addre s or Lot No. -------. «---------------------- wner ess ddr W a ^ Installer ddress UType of Building Size Lot____________________________Sq. feet Dwelling.CLNo. of Bedrooms_______________d ..._..............--------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons____________________________ Showers ( ) — Cafeteria ( )' Q' Other fixtures ..___..__. W Design Flow_________________________ _____________ gallons per person per day. Total gallons. WSeptic T<<nk Liquid capacity./ gallons Length................ Width_.____..-....__. Diameter---------------- Depth._.-_.-_-_.:.... x Disposal Trench g _ .___. Width____________________ Total Length____._..._.......__. Total leaching area..............------sq. ft. Seepage Pit No. _..._..1.._...- Diameter.................... Depth below inlet.................... Total leaching area------.--------•__sq. It. Z Other Distribution box ( Dosing tank ( ) Percolation Test Results Performed by------- ----------------•-----•-•.....--•........_..........----------_.. Date------.-------------•-----------..---- Test Pit No. 1________________minutes per inch Depth of "Pest Pit._._.__..........___ Depth to ground water-----------------....... (4 Test Pit No. 2................minutes per inch Depth of Test Pit________..______-_-- Depth to ground water__.._._____.__._____.._. 9 -------------------- -------------••---•-----•-••••--••••••••------••-•----••--••............••--•-.......................................................... 0 Description of Soil---------------------------------------------------------------------------------------------------------------------------------------- -----•--•------------------------ x Nature of Repairs ------------------------------------------------------------------------------- ------- ------ ----- --- U p or Iterations—Answer�whhep icable..__. .. -._. __.._. _... 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 riot to place the system in operation until a Certificate of Compliance has beeed by th board of h th. 'igned. -----=- -------..... Date Application Approved By----- = ...... --------- Application Disapproved for the following reasons:--------•----------------•-•-----•----------------..........----------------•----...-••---......--•••-......---- -----------------------------------------------------------------------------------••....--•-•------•---••-•-•-••-•-----•----------•-••----••-----•-----------•--------•-•---•----------------••--•••-- • Date Permit No......................................................... Issued......1.� .&- -?-- •A1/----- ....... Date 101 LOCATION 5EW&C,E PERMIT UO, /V 141 j IWSTQLL.ER•5 1J&ME ADDRESS BUILDERS tJ &MF— ADDRESS - - — — — — — — — — — — = - - DIaTE PERNAIT 155UF-D —� DATE COMPLI &MCE ISSUED : . r 1 I> c? 1� No. e ..... FEI.. THE COMMONWEALTH OF MASSACHUSETTS BOARD F H A TH Applira$iun for Di,gVuiittl Works Tunstrurtion Punift ;.. Application is hereby made for a Permit to Construct ( ) or Repair ( )..an.,-Individual Sewage 'Disposal System at AW .......... �!` '�` R A--------------------------- ----------------------• .......... -�i/' --- ...................... Loc 'o Add00 r, s or Lot No. op wner • ddressOOW ^ a p Installer ddress d Type of Building Size Lot.........:..................Sq. feet U Dwelling�L No. of Bedrooms______________ ________ .___Expansion Attic ( ) Garbage Grinder ( ) 0.1 Other_Type of Building ____________________________ No. of persons..__.._-..-----•_-------_.-- Showers ( ) — Cafeteria ( ) A4 Other fixtures ._.... w Design Flow--_-•q..............f _.� g�gallons per person per day. Total daily flow------------L.0.'. " -------.---gallons. WSeptic Tank Liquid a pacity --____ allons . Length................ Width................ Diameter— Depth---_-.--------. x Disposal Trench _____--•.-.• Width-------------------- Total Length.................... Total leaching area.------.-_._---_•-•sq. ft. Seepage Pit No ________________ Diameter.................... Depth below inlet-------------------- Total leaching area.-__-_-.-.----.__sq. ft. z Other Distribution box (PT, 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........................ 9 " -- ----•----•----------------------•------•--•--•-•---•--------------------•-------•--••----•----------------•-------------------------------•--------- 0 Description of Soil-------------- --•---=--•••---•-•-••--•-------•-•--------•---•---•----•-••••--•------=•••-•-------•-------------------•--............._............---•---•--•-------. x .. U • = w x ----------- - ---------- ------- Nature of Repairs or- lteratlons Answer wh tcable ---- ------- -- -- - ----- U P' _. ems. .... ---------- i '1/k�Al/ r "= •f .r Agreement: A.�.-/C4 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 been t ed b tlieboard of h. Signed ... ...... •....-•---, .._. . --- -- ---- ----------•---- ................................ - Date A^ lication Approved B ... 9.4006 / � �....� P PP y,= =..../ Zate P Application Disapproved for tlae following reasons:_.. •---------•--------•••---•-•-•---------•-•--••-------------•--•---......-----__ --.......••--•---•--•---.--•----•--.....•..............`------•------•-•--•--•----------------......---................. -,-•---•-------:------------------•------------•--- • ------------- Date Permit No---------------- - ------------------•--------•--... Issued ` = Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O'F HEALTH `#. OF. - �rrfifir��r�gf f�nrm�li�nrr - . THI15 I O CE FY Th t the 4 dividual Sewage Disposal System,..constructed ( ) or Repaired by------ - --- - -- -- s.. ---------- -- - ----- -------------------- i stall at..,. 1 ', .---- -------- --, .-,.............. . ....................... has been instal ed in accordance with the provisions of Article X f The tate Sanitary Code a descr ed in the application for Disposal Works Construction Permit No............. _ --------- dated. .._ /. - 41........ THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUN TION SATISFACTORY. DATE-----------k t V -- --------------------••-- Inspector--•. ----' ------- -- ` THE COMMONWEALTH OF MASSACHUSETTS . BOARD Qf HEALT ..... ..OF....... . ......... ----....... No.._ t!i. FEE l- �i��s:vaftt rkii n6trjurf ou Van it Permission is hereby grante ----- ------ ---- -------- ----- k._..-•-•-•----•••.....-••-......----------•---•••-.._._..._......----_•.... to Constr ct ( ) r R r ( dividua ewage Disposal j�tem,�0 atNo.._-� -• .�. -�... A.. •-- `......�- •.. f,�►.......�.*-C............................................ � - StifeY ? as shown on the application for Disposal Works Construction r it No__ _ ..._ Dated__ Board of Health r _ DATE... ---y-----------...................................... --- ------------• FORM 1255- HOBBS & WARREN. INC.. PUBLISHERS • I f' INSTRUCTIONS ALL OF THE FOLLOWING MUST Br SHOWN ON PLAN DRAWN TO SCALE OF ONE QUARTER INCH TO FIVE FEET (1/4"- 5' ) AND SUBMITTED, 1. Lots line-indicate dimensions. All of very large lots need not be sho,m-only within 100 feet of wells and sewerage sites. Indicate distances in feet of anything off of plan. 1 ^' 2. _-Proposed buildings) - location size. 3. Area to be reserved for sanitary system. . { 4. Precise locationQ,of septic tank, \manholes and distribution box r' 5. Location of any neighboring.sources of water supply, stream, drain, brobk, pond, lake,, cranberry bog, marsh, or wetlands within 150" of premises/ (this includes any such items, on the. -prefu.ses-) 6. Location of proposed -,eater supply for new' building ti *. (if Town eater, show ,cater line location)k Show .� exact locations of neighboring,.sources cif pollution within 1.501 of yotur lot line. 7. Streets. - S. Exact outline to scale of buildings and location on site. 9. Side yard widths . 10. Rear yard lld'epthsbo\�� 11. Setback from street. 12. Location-test pits and, percol'pion test 113 . Results of percolation test(s). 14. Draw profile of deep test hole on"rplot plan. 15. Applicant' s signature. fi 16 . Date. ' 17. Person making percolation test. 1 BARNSTABLE BOARD OF HEALTH r A, I i 3sl p 3 �- 1, � r w.I c /A,do3) oi - ) �xio 1. 301 Ir Te L �wSeP fi