HomeMy WebLinkAbout0384 LUMBERT MILL ROAD - Health r
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No................-....... F>�s... ....3.0..v.QaJ...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH ✓(�� a�� Cur—
TOWN OF BARNSTABLE
Appliration for Bi-tipoottl Works Toutrnrtion Ilrrntit
Application is hereby made for a Permit to Construct ( ) or Repair)(,X ) an Individual Sewage Disposal
System at:
384 Ltimbert mill Centerville
................................................................................................. ----•-------•----•-••-----••-•----•••-----••--•---••-...---••---...------....--•-.-...-----...--•-
Locat' u-ilddress or Lot No.
--Winn^? r-nae ... 1, 1rL)---------------------------------•----
• ---� -
Owner Address
aJ.P,Macomber Jr.
Installer Address
d Type of Building Size Lot............................Sq. feet
DwellingX No. of Bedrooms...................a.................-----Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
d 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 ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I----------------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------------------------
C4 ---------------------- ------------------•...-...----------•---•----•••-------•-•-----------•----•..-.......---••--•--------•----------•-•••----••----•---•-
0 Description of Soil------....Sand...&....Gra al..--•--•------•--•-••--------•--•-------------------------------•..---•-••--•-•••••--•-----••----•------••------------....
x
U ----•----•------•------••••---•----••-•-•••-------------------••-•-•---••-••-•.------•--.......------•-----•----------------------•----------------...-•----•------------••----••-------•••------------
w
x --• ---------------------------------------•-------------------------•------------------•-•--------------------------- --------------•-------------------------•----•------•--••-•---•-.•.......-....-.
U Nature of Repairs or Alterations—Answer when applicable.-------_---'1--10-Q_Q---gall an--- �t�..." ��....................
reemenY �A �� /--- .�' ' -------------------------------------------------------------------------------------
g
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compli nce has been i ued by the board of health.
Signed ..�..... .........1- -- .......
� Dace
Application A - 6'............ - ''
PP Approved B 2. ....:.... ------- - .�..-.:......-
Date
Application Disapproved for the following reasons: .................. . ..................................-............... . - ............ -- . .
................................................... . ................................ ............._............._....._.... -- ..
o
Permit No. .... Issued -........... ..... .............. ._.:.... --�
Dace
J
TOWN OF BARNSTABLE
LOCATION ,-? , S E W A G E #
VILLAGE ASSESSOR'S MAP & LOTZ � lf�9
INSTALLER'S NAME PHONE NO. �� /'—
SEPTIC TANK CAPACITYIOCJ O
LEACHING FACILITI':(type) (size) 100 n
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER ►�tiy
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED::
VARIANCE GRANTED: Yes No
3 4
N U0,
CAL i�
I. _
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE "
GPrfifirate of Complianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired.({XX )
J.P.MACOmber Jr.___-----.:... ...._.--.. ... .. .. .. ._... ..-_ . ....._................................... ..........
by .......................... - ... ...... -
384 Lumbert Mill Road Centerville
........................................................
has been installed in accordance with the provisions of TITLE of The,State Environmental 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 . �... ����` `'�G✓...------...__....._.:. -
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
r TOWN OF BARNSTABLE $ 30.00
No.. ......��/ FEE........................
Ehopo al Workii Toat.5#rttaivit "anti#
Joseph P. Macomber Jr.
Permission is hereby granted ......----•--- ---- ------
to Construct 3 4 )LoU 0Pp (M)lain oaauC�nter Disposal
llple System
atNo.------.... --•---•-••--------------•------•----••--------- •••-------••......•-------.....------..................................................
Stree�" -� C
as shown on the application for Disposal Works Construction Permit/No.`.�. Dated-.Z.`�.�.�.. Z.4.5
/ Board of ealth
DATE... ." . ' ..............
FORM 36308 HOBBS 6 WARREN.INC..PUBLISHERS
l
No........................ FE:a... n n
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration fur Di-ripniittl Workii Tomitrnrtinn 1Prmit
Application is hereby made for a Permit to Construct ( ) or Repair�(K ) an Individual Sewage Disposal
System at:
184 Lumbert Mill Centerville
..--_....-•---•-------•------•-----...-•--••-•---....--•---•--•-----...•---•-•-•----•------------- ------•-•--•------••----••--•---•-•-----•---•--------•------------••----------....._......._...--
Location•Address or Lot No.
Di....e 1 f�l_4? -----R )n)-------------------------------------- ---------------------•-•---•-•---••---
Owner Address
J._ P.Maconber Jr.
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.-.................3----------------------Expansion Attic ( ) 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 capacitv............gallons Length---------------- Width---------------- Diameter_............. Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 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-.-___---_._-_-__-_-_.-.
fZ4 Test Pit No. 2................minutes per inch Depth of Test Pit--------_........... Depth to ground water........................
0 Description of Soil__...__._Sand & Gravel
x
w
---------------------------•----------•--------------------------------------------------------•-------------------------------------------------------------•-------------------------......-••-------
U Nature of Repairs or Alterations—Answer when applicable.---------1.-1 000 ciallon---xlit,- �,,....................
i51,
Agreement:
The undersigned agrees to-install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Complii nce has been issued by the board of health.
Signed ../. ....l.:.LP-� ------ -- -------_............. ........ 1 �1eg./9.`a....
...........�
Application Approved By,--�.-----;.................... - %"
g
/ Dare
Application Disapproved for the following rearons- ------------------------------ ------------------------------------------------------------------------------------------------------
L ... ----------------------------------------------------------------------- --- --------------
Permit No. e
.... `�` � - ........ Issued ................ `"� �� �� ..
Dace