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Home My WebLink About0317 MAIN STREET (CENT.) - Health (2) 317 MAIN STREET, CENTERVILLE A= SIIII �QECVCIFp�p �J ym � _ Za UPC 12543 N0.� 553LOR �sr.coNS°`��o- HASTINGS, MN TOWN OF BARNSTABLE �' ` ' r �.�:. LOCATION.;_;�('7 l�Ll a�r� Sr- SEWAGE# R5__ 51.46 . VILLAGE ? %rrFr✓://z ASSESSOR'S MAP&LOT 1a20 .ii INSTALLER'SSAME&PHONE NO.�77-o 39g J,gj e p4 0-c droNras SEPTIC TAIKK,CAPACITY 1000 LEACHING 1~AEILTTY: (type) T/'/;acLi (size) I Y»G O X Y X 2 NO.OF BEDROOMS 3 � BUILDER C2R<GWNER h i -,4 z qh q yd h ' I ' PERMTTDATE!_'_—l7— 9.f� COMPLIANCE DATE: 3 ' y'fa Separation Distance Between.the: '. Maximum Ad'usted'Groundwater Table and Bottom of Leaching FacilityFeet ... ..:,:, . g r: Private Water,S�piy Well and Leaching Facility (If any wells exist on site or*41"n 200 f f leaching facility) Feet eet o i Edge of Wetland aAd Leaching Facility(If any wetlands exist within 300;feet.'f leachin,g facie Feet + a, a, 7�.•- � , - Furnished by � ' , r r ! f yit ;.``' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 1 1. 5 Appliration for Diti-pa!3al Workii Tomitrnrtinn Urrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sys.t at .... .... .;.�.�..... 5�11-....... ----- -------•----••............................... ......... ...................... 0 Location-Address '�' o; t No. .. ------.. dress Qbw.�uk: = ^.a�_ _... �1A!►. `e _a....... �!�? of e.� �.. caner l< " s.�......_.. .V1�s�ar.� �a --- hey 1"-.--..•.._..._e....... 11!'�7c.. �.J..�. !1 �... 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 ( ) a' 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. 3 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. I................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........................ ------------------------------------------------------------ •------------•----•--._...._..-------......................................................... Description of Soil. , `.................. U ---•------------------------------------••---- G-------------------------••------------------------------•----------------------------------• W -------------------- ----- ------------------------ ----------......_..----- -------- --------I ---- T ............. UNature of Repairs or Alter tion —Answe whe ,a hcable -.-- ...`�..____. _ XIS- _�°�. .. `r .------ 0VA"L . .... t�1cr�t +--------- -- 'E'- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Envir ental Code —,The undersigned further agrees not to place the ` y p p y ibboar health s stem in o eration until a Certificate Sf no li eas been issue�bth of . 9� g `-°� 7�1-_ Dare Application,Approved B �.� . �.-�-�ti2 ................ N .''./... -�-R .r Da to Application.Disapproved for the following reasons.: --------------------------------------;.............--------.----.------------.---------------.- ... - - - ............. �. _ ... .... .... ,:.. Date Permit No. Lti/ " :... Issued �?.�'�. .. .................. } Dace • Fps.. .a........�..... ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE l � Appliration for Bi-nipwial Work.6 Tomitrnrtion rumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at:.......�.I.�l....m ; -------as--�•-•......�ef r v= let- - *....... Location-Address or Lot No. Psi ............�.- � . �.:�'�.s . Owner l A�3dress =' , _ !_s � '..............•. .... ...... ............._�a _ It/Yl (- L Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms________________3_--_-_-_-__--_--_-_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........................................ 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........................ a ............................................................. --•-_...••-•-••-•-•-•--......._---•--......................................................... x •••- .�..........ODescription of Soil.............="............... .............. . ......;............ ............................................................................... --------------------•••••----••-•-•---- ---- ------------------ ------_=--------- --------- -- ---•-••---•-••---•-- ...- .. - --' ---•-- uRepairs or Alterations �, � - :: :U ......... -----:- --- : �_'- 1-' - r 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 Co pliapNe has been issued by the board^of health. Sign � ... ---------------------------------------- Application. ... -=----- I-- Dare Approved B a /�' i .�-�--�. ------------------------------- ..'"- --�7....." PP _...... - �� • Dace Application Disapproved for the following reasons: ..........................................................-------------------------------------------------------------------------- . ........................................... ... ......................... ............ .. -_...__.._...............-------------------------- ----------------------------- ---_... Dace Permit No. .....1,1" - ------------ Issued .............. --71 _----<q. .................. Dace ,_ �..��....__ +v .. .._,-s�m�._:T_:•-F:�`:..J.-ter, _ a=uYmcs!.�-saw,a_-r.�•ass.�.m.a--_ .+-.c�.._-�..��-�..�..-�_�a..a.._._•+..��._....+..�._•-��—._... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Gertifi ate of Tomplianre TH.S�IS TO CERTIFY, That the Individual Sewage D s o�l System constructed ( ) or Repaired by ............ .. �`k. " -----------^:,.fir m's%dler at -------------installed in ---- ..ce with ... visions ' ' .,r-..�J...... .....r� ' has been accordance p f TITLI of The State Environmental Code as d scribed_iT the application for Disposal Works Construction Permit No. i 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 BOARD OF HEALTH TOWN OF BARNSTABLE � � No. '""' FEE-- Disposal Workii Tonstr dilon f rrntit Permission is hereby granted ............. _h1 s-ti------• ----------------------------------------•-•--- to Construct ( ) or Repair an Individual Sewage Disposal Syst at No. ,' "�'"' --� ----C-e ra... �' t `' = -��_ . . S[rce?� ` q as shown on the application for Disposal Works Constructi ermit9.....�T- 79, ted---- ��..�.L.-_�_.... ---- - 1 .. �." -- Board of Health DATE----�•=----------1--•---•--....-•---------`--`•-..................... FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS TOWN OF BARNSTABLE `/� �' its- LOCATION ?/7 Gr vio Z Sr- SEWAGE # 9,5-- S'2lo l� VILLAGE LFarFr✓:l/_ ASSESSOR'S MAP& LOT 2000 11S- INSTALLER'S NAME&PHONE NO.�[,71-01 JJ -1,e,0 L)-c C��A.N�►aS SEPTIC TANK CAPACITY /DOD LEACHING FACILITY: (type) T/?ncLi (size) G 0 X Y X 2 NO.OF BEDROOMS 3 BUILDER OR OWNER 4,12 LA t'f*z Vd A Va`9 PERMIT DATE: --/7- 9J" COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachin facili ) Feet Furnished by -�- �' 1 • Q