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Home My WebLink About0006 LINDEN AVENUE - Health /- / /I dc-n PV 2 c e4 ter- VI LLB. i TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE G & /rf�G�y1Z4(fASSESSOR'S MAP & LOT.-9-08r^ OfQ' INSTALLER'S NAME & PHONE NO. zl/h a d,o 6e,.< -`Se-41 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) / o oa NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER , DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No w. ri s-N, �o'r-- a No... �:G. Fim$.... ..... a:4aa THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Town Barnstable ..........................................OF.......................................................................................... App iratiou for UiupuuFal Workii Tontitrurtiun rrmft Application is hereby made for a Permit to Construct ( ) or Repair ix� an Individual Sewage Disposal System at: ------------------ -•------•----•••----•-...............---------..........----...---.......................--------- Location-Address or Lot No. Beth K_1.e- .1? X....................•-------•----•----------------------•-- .......----•-.....--•------...----•-•--....----------•-----------•-------------------.........--- Owner Address W J.P_._Ma_.Qjnb_.z-...........----------------- Installer Address Type of Building Size Lot............................Sq. feet Dwelling No. of Bedrooms...........3..............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 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 ( ) A Percolation 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........................ P4 -----------------------------------•---------------•----....---------...........---..........................--•...-----•------------------------------------ 0 Description of Soil..............................Sa.nd...&...G.ravpa1...................................................................................................... x U ---------------------------------------------------•-•--------•------------....-----------------------------------------------------------------------------------------------•------------------------ w x -----------------------------------------------------------------------------------------------------------------------------------------------------------------...................................... U Nature of Repairs or Alterations—Answer when applicable.....1_-_1.QAII---gal1an---t-ank--------------------------------------- ---------------------------------------------------------------------------------------------•----------------1-_l_0.O Q_..ga11nn---pi_t.._-----------------------..........•.---. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Ti T LL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued t bo d of heal Signed... --. ..... .. ..................... -•-----9 Date - Application Approved By...........�.: - .......... Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------•------------------•--------.--------------------------------------------------------------------------------•--•--- Date PermitNo.------- ---------------- Issued-------------------------------------------------------- No...g........G3g Fxs........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r ------- -...._Taw:a.............OF.-.-.... . ppliration for Uhipati of lForka Tonotrurtion "amit Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Sewage Disposal ystem at: «xx .......... J" 7�?;' '8 "':i`1�_ocation Ad'des`s`r�Y2 } or Lot No. .......................................................... .•--......------.........._..................._ ........------...__....----------•••-•-•-•-----. Owner Address T .:was:....................................................... ---•--------._..__._._.....---------------- Installer Address UType of Building Size Lot............................Sq. feet �-, Dwelling—No. of Bedrooms__.____.___. Expansion Attic ( ) Garbage Grinder ( ) a3•---••----•---- aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) P4 Other fixtures ------------------------•-----------------------•----- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic 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........................................ a Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water_______________________- f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ I' ---•--•-------=-------------••------•-•----_._.....--------•---•-•---------------..._.....---------........................................................ 0 Description of Soil............................... _.. -r.:= ------------------...---•------------- W U Nature of Repairs or Alterations—Answer when applicable------1__i 000_.Ja�.y_w,�r_.__hia.l ______________________________________ _______________________________________________________________________________________._ _____________._...____ _.._._._._.__.___.____________........_. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with. the provisions of`f'i T 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 ley the(board of health. Application Approved By___________ _______ ___ ____ f` Signed D to i Date Application Disapproved for the following reasons________________________________________________________________________________________________________________ •--•----•-•-•-•----------------------------------•-•------------------•------------.....------....------.-•....._....__.._..----.._..-----•••---------------•-------•------------------•-------.....••-- 8 r — G Date PermitNo......................................................... Issued------------------- .................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T&rrtif irtttr of ToutpH aurr THIS IS T6 CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired u X .....------••-------------------------•-••--------•-•--------------------------.....------•-----.._........_...---- .-- Installer _ .. has been installed in accordance with the provisions Of TIT"- of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.--- .... dated--------------------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS t BOARD OF HEALTH "v �� T®t??�..-.......0F..............Barnstablea --------------.._..-------------------- NO..- •.... FEE......��...,�(`�,.•fl� Disposal Workv 'WrAlndrndion rrutit Permission is hereby granted.............J_._PxMacomber.............................................................................................. to Construct ( ) or Repair (X))Xan Individual Sewage Disposal System at No........... ...Linden Ave. Centerville -----------------------------.......................................... ---------------------•-------•------------------------------------••----...----_•..... Street (� 7 as shown on the application for Disposal Works Construction Permit No._ ___Q_ ,1Q__\,Dated.......................................... IdJ DATE______________i_C )-C)........................................................... and of Health i ••-------------------------------------------- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS