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Home My WebLink About0168 JAMES OTIS ROAD - Health 168 -�Tat"s °�is f 7-o - I�t7 S M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR DNAM ES MIN.RECYCLED INITIATIVE CONTENT 10% CerbfiedFiberScucin2 POST-CONSUMER® www.dpmarem g S"12W MADE IN USA m ARGAMl n a smm.com 91- d�L No................_....... / Fus......� ........... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..........................................OF......;. .:'` .! ,,L. . Appliration for Uispntia1 Works Tonstrnrtinn Urrmit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: / ......... ..._.... j �� ..........a .._.... ..-�- --....------ �� Location-Address or No. ---•-----•- . --.-............................................................... ....... .. -` .............-•--•-................--. 04 l� Address .............................................. :.----�� `Z-�� . _ �4 aJ��If�� -------------- Installer Address Type of Building Size Lot............................Sq. feet �-, Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ----------------•--------------------------------------------••------- 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........................................ a 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........................ ..------••--------------------------------------••-------• ------••------•-•-------•...----•-...............-•-•------•-------. 0 Description of Soil------------�� ..........5`' �' ? Sb� ..... x A------•-- ........-............. c.� w V Nature of Repairs or Alterations—Ans er when tapplicable------:��..�--_-__------.0�b---------.�°�-_- ................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Ti 111 L 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 he board of lielth.Signed r�.. ..-- _ _. .. Z • p D1te' Application Approved BY ..> r ....... � =. ... `- Date Application Disapproved for the following reasons-----------------------------•-------------------------------------------------................................. --------------------------------------------------------- •----------------------------------------------- .---------------------------------------------------------------------------------------------- �t Date PermitNo....... Y.= . 4 •----------•-------• Issued....................................................... Date f. jy. 1 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH `b,.,)to ..............._OF.....�� iLV�S� `-Z ............................. Allp iration far Bispvii al Warkii Tom4rnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair �O an Individual Sewage Disposal System at: .........�---------------------- .- ------•-'-' •---••--•---•--------•- ...................._..._.. �........ .�...... .... .••--••-- Location-Address '�-�i or Lp No. �...t.,,.-``O �- . Address C^ .... �t VU ti IR U E ------...--•------------•--•--•--------•-••------•-•-------••--------------•--------•----•-•-•-••- .......... .......... .......... ••. Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Building ............................ No. of persons-------.-------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures ..---•--•----------------------•----•--••--••---...•--.••----------......•---•••••.._._... 14 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........................................ ,4 Test Pit No. I................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........................ Ix --------.......................................................................................................................... =} D Description of Soil.------..... - -............& --------------------� r- r �9 .St1"_ ._..._.... U -•-----•-•--•-•----•-•-----•-•------•--•-•--••-------•----------------•--•...----•---------•---....-•-----------•--•-•-------•-------------•---•-----•---------•••-•------............._-••----------_.. UW --•--------------------------------•-- ------------------•----•----------------••-•-- -•----•----•--------------------•------••---•-••--•----•----••-•-•-•••-----•----•---=�----------------- Nature of Repairs or terations—Answer when applicable._.... E. ............. .___._.._ ? .L.`. ............_.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLi� 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........�•`. �.= ...... ,.�,,................. Vilt; e Application Approved By................. f . -- ..1 .........I=-2.�--_g.`r..... Date Application Disapproved for the following reasons---------- --------------------------•--•---------------•------------------------------------•---•-•-------...--- .................•-•----•----•-••---•---•-••-•-•-----•-----•---•----•--------•---•--------•------••••--------•---•-•--•••-••-•-• •--....•--••------------------•--•-••-•------------•-••----•---........ Date C�c� LL,, Permit No.-----•.='Z.••----......-=..".' .. Issued---•---••'------------------------••---••-----•----•'-. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .... .................................................,�.Z............................... (9rdifirFatr of TompliFatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired Y by........ .......0")`'`} -----------------------------•---------------------......------------......._..--••-•--........ Installer at......L.-�5.--•••-•----J :a.+��..s-•---• .`....` . . `� `� n "_ a `t-'?L j N�.._ " -----•...................... . ---- -------------------- has been installed in accordance with the provisions of m11T.E j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.......— -----1-7"a.y....... dated________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE. .........................'�. .. .. Inspector.... ................%... .............................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No.1.2...... ay FEE..12 %Vus al vr�ii Tontrnrtivit rranit Permission is hereby granted-••••----�\C\�� ........_� ••••-•-------•-•--•---•-•-•--•---- .......................................................... to Construct( ) or Repair ( �Individual Sewage Disposal ..................................................-•---•-•----•-------'--•-'---....-•---------------•---•-------•••-•--•----•------•-•-•----•---•-•-•--•••----••---•••---•••••-- Street /a t/ as shown on the application for Disposal Works Construction Permit No.lr_-____--- Dated.......................................... X. -12 ---of----------------------------------------------•••-' Board Health DATE--------------- ` ... J.1 7.................................................. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS TOWN OF BARNSTABLE LOCATION (I,$ q-v,� ins Q=&A SEWAGE # �f2- VILLAGE ell0ttItVt,�. ASSESSOR'S MAP & LOT INSTALLER'S NAME 6a PHONE NO. Nkt10-ct 69N V' SEPTIC TANK CAPACITY k 10 0�0 LEACHING FACILITY:(type) D.- 4cob P •TS (size) &J Z NO. OF BEDROOMS PRIVATE WELL PUBLIC WATER BUILDER OR DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No _ ,F �, �, ;� � ,� �' �� .�� "' J l LOCATION ` SEWAGE PERMIT NO. Lot #247 James Otis Rd� 84-250 V I L L A G E /6 7 ' 6'/)V-P6 /,S �.✓ G GrG T.e.� Centerville, Mass. 1,76 _ 1 6 I N S T A LLER'S NAME i ADDRESS h-ct R 0,1c Co- Tpc Great Western Rd. North Harwich, Mass. S UILDE R OR OWNER Alan Small DATE PERMIT ISSUED _G pDATE COMPLIANCE ISSUED r (y 0.E-1� . � a�� 3� �,