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HomeMy WebLinkAbout0048 MASTHEAD LANE - Health 48 Masthead Lane Centerville A= 193 -089 JIB UPC 12534 # .2.15"p TOWN OF BARNSTABLE LOCATION y0 1114f;�Iegel Ch. SEWAGE # 93� VILLAGE G��►�ory�'l�2 ASSESSOR'S MAP & LOT --D� INSTALLER'S NAME & PHONE NO. �o�n A 44-Mo- (Y-01) SEPTIC TANK CAPACITYx LEACHING FACILITY:(type) jo,' � � "(size) /0 NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC:W:A T::E: BUILDER OR OWNER DATE.PERMIT ISSUED: 3 _ —•--� DATE COMPLIANCE ISSUED: q 0 ' Y VARIANCE GRANTED: Yes No r � xca,� Ln THE COMMONWEALTH OF MASSACHUSE17S BOARD OF HEALTH TOWN OF BARNSTABLE Certifirate of Compliance THIS 4S�TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ................................**-''*--- --- ----- ............. ...... ....... ....*.......................*....... by ..................... . ......... e'-tt . 1-tak, at ............... ...... ...... ........ ------ -------------------- -- - ------------------------------------------------------------------------------------------------:........ has been installed in accordance with the provisions of TITLE 5 f The State Environmental Code as described in - I- - ........................ ......... dated .................. the application for Disposal Works Construction Permit No. - --�i 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....... Dispnoul Workii Tomitrurtion "ern I Permissionis hereby granted__.__-__ - ......to Mes........................................................................................ to Construct or Repair an Iividual Sewage Disposal System atNo.................Wk ..'g...... - --------k.v--------------------------- ------------------------------------------------------- ............................ Street as shown on the application for Disposal Works Construction Permit No..16- y./.2-2... Dated........................................... ....................................7. ..•........................................................ Board of Health DATE................. ...................................... FORM 38608 HOBBS 6 WARREN.INC..PUBLISHERS APPRUvEL; Cwq=vation Depart,c-,:-:t ... .............. THE COMMONWEALTH OF MASSACHUSETTS V-BOARD OF HEALTH' TOWN OF BARNSTABLE Appliratiou for Diripwial Nfor1w Towitrurtion ramit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal Sysle LA jC..... ....2 'D................. Location- -\d css o A&�:� - • 6 4t,,No. e I,- f ............:t�!........................................ ....................... .................................................... ....... ON A .......................... .... R" 4.�4 1.-............................. • ............................../. ..................... Installer Address PQ UType of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms---------------------------------------------Expansion Attic Garbage Grinder aOther—Type of Building ............................ No. of persons---------------------------- Showers Cafeteria Other fixtures .................................... ------ < -- ----------------------------*-----------------------------------------------------****------*........ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic 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...................................Pit..._.___............*-------------*.................. ..... Date......................................... Test Pit No. I................minutes per inch Depth of Test Depth to ground water..._.................... Lr4 Test Pit No. 2................minutes per inch Depth of Test Pit._._____............ Depth to ground water_........_...........__. ......................... ............. .............. r...................................................................................................... ......................................................................................................... 0 Description of Soil............................!�tk..!Y.......7.k W U ......................................................................................................................................................................................................... W .................................................................................................................. .......................... --- V.......... -------�,. --------------- :1.1 . ....... U Nature of Repairs or Alterations—Answer when applicable..-_.-.-_-TA; el., - ------------��4, ............ f,..................... ..................................................................................................................................................... .............I.................................... 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 Compliant Xeissued b, the board of health. Signed ............ ................ ...................................... ...................................... Due Application Approved By .............. are .....D -'..........................................................I......... ......$3..... ....... Application Disapproved for the following reaf ons: ....................................................................................................................................... ............................................................................................................................................................................................................... ........................................ PermitNo. ........ ........................... Issued ........................................................Dam Due .�.. (/�2 I f I� • - '�- a • .... • r-�.rr ---���M ... rt r .�.�'.�... r.. - 4'4.r ra..v ♦... -_�. y n +rt. - .._.nynr_ �.� v..�. .. o..... _ -• qq� Fss..�U ............. " THE COMMONWEALTH OF MASSACHUSETTS, BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Dirii.1wial Workii Tomitritrttnrt ramit. Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at,: 'n Ll�l�(�, C�,�l(T'�lki. Locat i'n-A 9 c / 01 oLNo. ........................ -----........----- ..... ... --... ......------ e........................................ Owner Address ' ............................... ............................... /Sv G{,!�/"u- 5 . Installer Address U Type of Building Size Lot............................Sq. feet ,., Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—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. 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........................................ aTest Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ (1 Test Pit No. 2................minutes per inch Depth of Test Pit_................. Depth to ground water........................ a ...................... Description of Soil........................... of �'Y�.� .. - - ..._.......-- - x W -------------------------------------------------------------------------------------------------------------------- ...--- ---- --- U Nature of Repairs or Alterations—Answer when applicable----------- .��..__... �-!r 71' cam --- ...... ............. •---------------------------- •-•----------------- •-----•....... •-••---------- •------------------------------------------------------------•---------------......... 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 Complianc -as bee ' issued by the board of health. ................. ........................... .Signed C��..L%....�......................................':��.............�—cf j . ...Date.....-............ Application Approved By ............... .ram .... .-------------- -----------....................................... .F..' :�..-.7.?a........ Dare Application Disapproved for the following reasons: ......................... .......... .. .. . ... .. . ...................................................................... ........................................................................................................................................................................................................ ........................................ Date PermitNo. ....�•3.......... -&_D.-.......................... Issued .................................................................... Date (-OCQTION 5EWi,GE PERMIT UO. 4osue- IWSTNLLER 5 W&ME ADDRESS 5UILD.ER S Q 1 MF— ADDRESS DATE PERMIT ISSUED j9 D b.TE COMPLI &MCE ISSUED : � 9Z 7 L 3 �1 / pry No......................... p� Fim$........ ............... THECOMMONWEALTH OFASSACHUSETTS BOARD OF HEALTH Alijil ration -fur Uwvoiitt1 Murk uxuArurtiuu Vrrutit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal Syst at: ......... : ------ ...�� ------------------------•---•------•------ -----•-------------------.......----.... LocatioA,4dLess or Lot No. �- �� , Lg......................... . tea ��..a �JF3awier Address�--�--------=•-'�=x --------- �J--- '-`_ ------------------------------------------- Installer Address U Type of Building Size Lot ..� 6---Sq. feet Dwelling—No. of Bedrooms--------------..............................Expansion Attic ( ) Garbage Grinder (X/B) Other—Type of Building of persons---_____.___�_________--_ Showers Cafeteria dOther fixtures ---------- ........................................................................................................................................... W Design Flow..............37�.....__._._........_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.....6<245_ Depth below inlet.................... Total leaching area-------...........sq. ft. z Other Distribution box ( —4/ Dosing tank ( ) 0 5,/2- 74 aPercolation Test Results Performed bY............................................................ ............. Date--------------------------------------- ,� Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water-------_................ f4 Test Pit No. 2................minutes per in h Depth of Test Pit.___-____-_.-_--_- Depth to ground water......_____.---_-_-._------------ .._ Description f Soil ---L--` �` ---------- ' ----- - ------r---------I----------- G d Lt 3 / z. P j ry 1 ' W U Nature of Repairs or Alterations—Answer when applicable----------------_-----------------------------------------------..___...___.--------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------.--------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is the bo of � Sign ---- ---- --------•--•-= ._ ------••---.... ------ -- - ----- --�5 ate Application Approved BY •. --------•- ----- ------••--•---- •-- .. Date Application Disapproved for the following reasons:................................................................................................................. -------------------------------------------------------------•------------------•-•----••------•----•--------...-------•-------••---•-------------------------------------------------------....------. Date PermitNo..............................•------•••-•-------------- Issued........................................................ Date �_-------- ----------------------- No.........................�.. FRic....../v............... THE COMMONWEALTH OF MASSACHUSETTS —BOARD OF HEALTH-1// dG r-�. OF .�-?�'�`1, .....�.'r/.` ..-.f'..'..... Application -for Di_nVagal Works Tonotrnrtion Prrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal sys t r ------------------------------------------- - ----------------------......-- t N .Location � orLoo ----•------------------------................................................ ----•-----•------••--------•--•--•-•............................................................. 9aot�er © Address ' Installer Address Q Type of Building Size Lot...A..W, X_16__-Sq. feet U Dwelling—No. of Bedrooms______________-- -----_. Expansion Attic ( ) Garbage Grinder ( � ----- aOther—Type of Building _ 't' /! '_��1CTo. of persons_-_____.-_e------------- Showers ( ) — Cafeteria ( ) dOther fixtures ------------------ ------/----------------------------------------------------------------------------------------------------------------------- w Design Flow..............��...._______.__.._.gallons per person per day. Total daily flow..................��b. ........---gallons. P4 Septic Tank—Liquid capacitvA!0_0gallons Len-th---------_----- Width................ Diameter---------------- Depth_--_-__----- . xDisposal Trench—No..................... Width-------------------- Total Length--------_--_-____-_ Total leaching area--------------------sq. ft. Seepage Pit No--------/....... Diameter-___-- Depth below 'nlet.................... Total leaching area------- ..........sq. ft. Z Other Distribution box (il' Dosing tank ( ) e), J—-/2" 74 aPercolation Test Results Performed bY.......................................................................... Date---------------------------------------- Test Pit No. I................minutes per inch Depth of Test Pit-.._------__--__--_ Depth to ground water...-.----.-----.--.--... f� Test Pit No. 2................minutes per inc Depth of Test Pit.................... Depth to ground water--.-.._.._--_--._-_--.-. ---------------f p L1 {�, O Description f Soil 0� - rr+��tj ---_--... v - /o'7.�(//�' - --------------------------- --------------"�/""" - �---- - ----- - - - - --- -- -------------t---------------------------------------------•--•-------------------------- w UNature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with further the provisions of Article XI of the State Sanitary Code— The undersigned f ..yes not to place the system in operation until a Certificate of Compliance has been is mob. the boa of _ a Signe ��.� Date Application Approved BY v Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------•- ---•-•----------------•--••--...--••---------•-----------------••---------•--------•--••-•-•-••--•---•--.-•---••-•-••--------•-•--••----••....---------------------------------------------------------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS �,. BOARD OF EALTH ............................... O F....................�!�...1 (9rrtif irntr of 0.11niViianu Tf� yIS TO CERTIFY, the Individual Svme Disposal System constructed ( or Repaired ( ) by�} o s. C+v % _..0 Xi = --- Installer has been installed in accordance wi the provisions of A I XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No-----------------a_.�___/f-__.......... dated-...k"_21-../...__............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL F NC ION SAT ISFA $ORY � DATE-... Inspector--- e-- �.. THE COMMONWEALTH OF MASSACHUSETTS 6)b BOARD S5EALTH l NO..... FEE-f . .............. Binvoott1 Ton�rnr#ion rrutit Permission is h eby ranted --------- -- --a-----•--- - •Car--•-----: �^--�'_-..... g to Construe e or Repair ( ) divicl�aal S age Disposal Sys atNo. 00 / ............................ ----------- -..- --�.."'..`...---------------------------------------------- Street as shown on the application for Disposal Works Construction mit !.. -j.... _ ------- Dated-----9 i G%-.......- �� Board of Health DATE-------------------•--•--•-----•-•--- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS t) � ti E ry I�Ij , /1 F 39 VA F vZ5 E.L6 fE.6 r 400VE ;VO.4D PLOr- PLAIV L O CA T101\1: PLAN 24FeZL-A1C4 : SE/A./6 GOT 1k Of 1�274, P4I & J " J NE2E8y CEPT�FY7-,LIA7- THE EXIST- y� o ,� D i$Y�R :/NG FOUn/DATiON LOCATION /S COZZ �C U RV 45 6WOWAI 4"0_DC��_�__�'ONFOQi�J W/TN. 7AVf OU/LO/NG SE7-l3AC-X-QfQUiQEM .�IJN z.8. I9741 .�` OF THE 7i WAI OF --- Q6c. ZdA 15 34/0 V2�you? C,ao we" + T a C4OAF7;., 81 4VIG40W IL Y<f2M0C/7AIP ,07 A44.