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Home My WebLink About0555 MAIN STREET (CENT.) - Health (2) 555 Main Street, Centerville A= 207-149 — p No. 42101/3 ORA jQ a ESSELTE 10% O O O O 16, TOWN OF BARNSTABLE LOCATION 45'y A A//V SEWAGE # VJLLAGE eA/7e•/'K V/L 1— 'e ASSESSOR'S MAP &LOT9e "/" INSTALLER'S NAME&PHONE NO. f/� /�li C 4 14,eeoe S oN SEPTIC TANK CAPACITY l �� LEACHING FACILITY: (type) le/%" (size) `° d NO.OF BEDROOMS r BUILDER,OR OWNER �Fd .,9.�'�f/ �✓ � o PERMTTDATE: '�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 oAlhing facility) Feet 44Furnished by 6� �h S �1 9C �9 No. .. _..... r Ftms....$.... 0_.,00.. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Apphratiutt for Diiipwml Wurkii Tattitrurtiun prmit Application is hereby made for a Permit to Construct ( ) or Repair XXxj an Individual Sewage Disposal System at: 1856 Country-..Store__C�mtery 11 ___--_______�•___55S____Ma� 5� ....... ....v- Location-Address or Lot No. oxe n..Q.;..Qs.nnoz-------------------------------------------------------- Owner Address aJ_,.P_s Maco...... Jr_.----------------------------------------•---.......--• ----...-•----------...----•----•-----•-----•--------....---------•-•------------------------------ Installer Address Q Type of Building Size Lot............................Sq. feet U DwellingX No. of Bedrooms--------2----------------------------------Expansion Attic ( ) Garbage Grinder (NO) a`4 Other—Type of Building .....Stoxe......... No. of persons---------2................. Showers ( ) — Cafeteria ( ) Other fixtures ..Living---guar.tars---over...s-tox�e..------------------------------------------------------------•---------- Q . 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 ( ) .4 Percolation Test Results Performed by------- -----------------------------•------------•-----------------...... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit...----------------- Depth to ground water........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ p4 ........--•---•------------------------------------•---------------••----•-------•------------------......................................................... 0 Description of Soil............................•---...------••--•-------.......--•-•---•------•-•---•-----------------------------------•--.............._........................._....... xSand &.... ravel---------------------------------------------------------------------------------------------------............................ U W UNature of Repairs or Alterations—Answer when applicable---QM-it---Ces-s-pool&-.....L sta-1....1_1.SOLO-------- .gallon____tajak...1..7distributr6fi: box...&---1.-.1M.0....gallon.-leach-..p-i.t...................................... 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 Compliance has be n ' sued by the b ar of health. Signed ... ................. ... ............................. ...2./2. ./9. ....:.....- Application.Approved By .... .... ... ..... ...... . .... ... ------- .... .. ................ e Application Disapproved for the following rear ...... .................... . ........... . ............... --.._----------------------------------------- -. - - ....--------------------------. -. - .. D ................... Permit No. ---- -. - Issued .............. (�F ----�.... \ a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f TOWN OF BARNSTABLE Certifirate'd GrapliMkiCE --� THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (�XX ) by ...... ...I?...Macomber....Jr............................_..----.---------_.__.la ...._........_.......__.....--_..----._._----__..................._.-..._...._.....-......------.._...-..._..----- srdlrr at ......1856. Country .Store Main. S.kreat----Cen.terv.i.l]..e------------- ----------------------------- has been installed in accordance with the provisions of TITLE 5 of The St t Environmental Code as described in the application for Disposal Works Construction Permit No. ..._. ..Jr dated-_.. �5.-t-L . if THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B CONS�R D AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE... `' .: .. j _------___.__---- Inspect -..f�� 2 /` f f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE f Difilimia1 Workii Tumitrut#ton rrrutit Permission is hereby granted-------J.P.Macomber Jr.__________________________________ -----------------•------------•--............--..-•--- to Construct ) or Repair `(,Xq an Individual Sewage Disposal System 1856 Country Store Main StrP�t -ex terNri 1.1" - ---------------------------------------------- at No. ---•••--------•-•---------------••------•---------- ------ -------.-. ---±-.---- - x_. Street r / as shown on the application for Disposal Works Construction Pei ' R No. -- 'ted.�_. -... .......6...............A...n 11, ,�-•- ._. _�-elf:t-. /Y( . ��JJ Board ealth DATE-----------------i�.l .. ...•......................................... l FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS /No.�f5 _1 7. . Fss... ....38_-.�.o.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diu puuttl Work,i Tomilrurtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair )(X)o an Individual Sewage Disposal System at: M 01 1856 Countrv..Store__Cejpterville ......................................................` !� Location.Address or Lot No. -------------------------------------------------------- ............................................. Owner Address J.-.P.Ms com}aer Jr..------------------------------------------------------ ------------------------------------------------------•-----------------------------•••••--------- ! Installer Address d Type of Building Size Lot............................Sq. feet U `` .r D:wellingi— No. of Bedrooms--------2..................................Expansion Attic ( ) Garbage Grinder (iq0) Other—Type of Building -----Gt(- P-........ No. of persons---------2----------------- Showers ( ) — Cafeteria Other fixtures ..T..i. _ncx_-_ ?it _7C? r _-.nt7AX---Sf-n-r -'--_---------.--- 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 b .......................................................... Date........................................ 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........................ P4 ----------------------------------------------------------------------------------------------------......................................................... 0 Description of Soil........................................................................................................................................................................ x Sand & Gravel v -•-•--------...-•--------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------ W --------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------•---------------.-------- F U Nature of Repairs or Alterations—Answer when applicable---Omit...tv.eGsnoolsb-_.1ristal-Z----1-.-' 50-0........ .qal; ogq..tank l--distribut d)ohbox---&----1•-1.00Q.._as11on._.� c a_,.. i.r _A------------------------------------ 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 Compliance has be n issued by the I ar of health. Signed ,. e...................... . -------..2Q-/9 y Application.Approved By ............ ..t... .... .. ::.....-. ...o..... --.... .. ...... '��.��- ----6 ...................Dace.......... Application Disapproved for the following year n : - ...... .-.-..... - ........ --------------------------------------- f-- - �40 ----------- - Permit No. ... �` ------------------ ' .................... Issued r((( -- /� ------Dace---.. L11- -------------._��._._.�, -----------------------'�--- — - - --