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Home My WebLink About0023 MAPLE ROAD - Health 23 Maple Road Centerville A 189 075 UPC 10259 ' No. H,�163OR .coNs �a HASTIN0S.MN I 1 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Town... ................O F......Ba•r n.st ab.l.e........--••----•-------•------...--•---•--.......... Aplifiratiun for UhipmFal Works Tongtrurtiun rrmit Application is hereby made for a Permit to Construct ( ) or Repair kX) an Individual Sewage Disposal System at: .............23..M111.�..RRr� $'--------le-------•----•- ..........................................................,....................................... Location-Address or Lot No. .............Hp_3.en...mal ex...................................................... ..........--...................................................................................... Owner Address W �I_..P__ma�Umbex...JX.X........................................ .........---...------•----.....--...-•----••-•--------.................................-•---- ,-� PQ Installer Address U i Type of Building Size L Sze Lot............................Sq. feet Dwelling`s No. of Bedrooms................3..........___.__----__--__Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures .............................................................. 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....................... rZq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ OW -------------------------------------------------------------------------•---------..........----............-------------•----.....-••----•----....---.--.-- Description of Soil........................................................................................................................................................................ W Sand & Gravel V .-------------•---••-•••............•---•-_----• ------......---•-----••----•-•-•-----•-------------••-•---•••----•------•-•--------.....•--...----........---- W x •--•---••--•-------------------------------•----•-•••,----••---------------•-----------•---•--•--•---•--•-----•--•--------•------...----------••-------•--••-----•....•---••......------••-•------------ V Nature of Repairs or Alterations—Answer when applicable._............................. . 1.-.1.QQD._.ga11oT�....frank---1--1000___gallon leaching pit . .................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue b�f the oard o ieal . Signed _/r�,e r._/� - Date Application Approved By....................... ............ Date Application Disapproved for the following reasons:..................................... -------------•---------.............................. -•----------.. -----------------------------------------------------------------•---- ..........................•.......................----•-••------•-----•--•----•-••-------------•---•-••-•--•----•----•••--•...--- _ Dat Permit No...... e y =�.`.,.,t'._�...---------•-.•--- l Issued_........................................................ Date BOARD OF HEALTH ........... .........*........OF.:...., ..................................... Tutifirat'r, nuiphana THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired XIC by---------I...........I------------ ...TP......................................... ............................................................................................... Installer ....................................................................................................................... 1 13 1 at.................................... n instilidd-in accordance with E has bee*': the provisions of 1`1 ► 5 f tate Sanitary Code as described in the application for Disposal Works Construction Permit No....V.....�- ...... dated_. ....__-_._.___._...____.:_:- ..... ..... ..... THE,ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. I- 171N, DATE................. ................................. Inspector....----------_.. tA-•-�................................................. THE COMMONWEALTH OF MASSACHUSETTS . BOARD OF HEALTH No.. FEE..... �,X)--- J Permission is hereby granted................. ------------------------------ ----------------------------------------------------------- j to Construct or Repair an 'Ifidivi %lisposal System at No.... -------------------------------------------------------------------------------------------------------- Street as shown on the application for Disposal Works Construction Permit N( Dated.......................................... ----------------------------------��. ..........................7......................... Board of Health DATE............................................................................... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS .............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ------•...................................OF....................................... r t.n"•,l ra A.VVfiration for Disposal- -W Tanntrurtion Vanfif Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: _X J zy-y........... Y ocation-�''dc�res�i�F` T.`.r�.�---------------- -------------------------------------------- Lot No.- -____--------•-•-----^_--------------___ or ......................».......................................................................... ..........--...................................................................................... Owner Address W a aUer, Address Type of Building Size Lot____________________ _____Sq. feet Dwelling—No. of Bedrooms__________________________________----------Expansion Attic ( ) Garbage Grinder ( ) a Other—hype of Building __________________�....... No. of persons............................ Showers ( ) — Cafeteria ( ) 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_--____________________- fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_______________________- „ ---------------------------------------------------•-•---••---._....------._..........._--_---......................................................... 0 Description of Soil.......................................................................-................................................................................................ x ------------------•--•••-•--...------•••-•--•-------------•--•-----•----•••-•-•••--•-•-----•-••- --•-----------------------------------------••------••-----------• W Ott .. x ................................ ................................. V Nature of Repairs or Alterations—Answer when applicable._______________________________________________________________________________________________ z y. s.. . .)1) ,I ,....._.. J,.... s.t..�, .._a.1.� iE> >'a �c°l..?0•?`�1 R.t.%:t+.t.i ,i------u>"?`�... Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITI:I� 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu d bk the board qb hea . Signed-!�- �t �1��_ s =. ................................ Application Approved B 1 Date Application Disapproved for the following reasons:..................................... ---•••-----••••-•-•----•-----•-•-•••---••-----•-••---...._--••-•-•---_----- ---------------------•----...----......_..•-----......-----• Date Permit No..--- --.?•....._.l�s1 ..................... Issued_4.-_ ....................... Date THE COMMONWEALTH OF MASSACHUSETTS i TOWN OF BARNSTABLE LOCATION 23 41e RCA _SEWAGE # VILLAGE C�nteP�(II,r_ ASSESSOR'S MAP & LOT -67" INSTALLER'S NAME & PHONE NO. hla caAi Bev-t-� 'T,c- SEPTIC TANK CAPACITY IjUbQ ct ' LEACHING FACILITY:(type) �,'� (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED_ VARIANCE GRANTED: Yes No �� B- / 1 ► a / � ► / zy� ; � � 4 00: 09 508-790-1578 J.P.MACOMBER & SON PAGE 02 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Qgg ...............70'"..........."..OF--.......AArnstable ........................................ .................... 19*1and Worko Tangtrudian jlprwit Permission is hereby granted........J—P.-Ma-comber---Ar........................ to Construct ( ) or Re.pair k�) an Individual Sewage Disposal System ............—.................................... at No....... ent.e.ryj.jjp.j_ilia ss Street as shown on the application for Disposal Works Construction Permit .. Dated ........................ ................ ............... DATE F0 R M 1255 Wool" & W"ll INC., PUBLISIl I'VIAP PARCEL THE COMMONWII�ALTH OF MASSACHUSETTS LOT BOARD OF HEALTH ........... TaUn................OF B.a X.R 3"t.,j b.j.9 Tprlifirau of (avulpffat'rt by...-THIS IS TO CERTIFY, That the Individual S19e Disposal ...... ................ - System constructed or Repaired ;X .................................................................. trtaller ......................................... has been installed in accordance with the p ...........7...................I.......................1............................I...... r0%,j sions of 1,177 5 application for Disposal Works Construction f Th- 'Ztate Sanitary Code as described in the Permit No..,..- i dated THE ISSUANCE OF THIS CERTIFICATE SHALL SYSTEM WILL FUN J�I�NJATISFACTOR NOT BE CONSTRUED AS A GUARANTEE THAT THE DATE a Y. ....................... ...... Inspector ..................... 0 L