HomeMy WebLinkAbout0019 NAUSHON CIRCLE - Health 19 NAUSHON CIRCLE, CENTERVILLE -
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No. 42101/3 ORA
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ASSESSORS MAP NO; / Z,2
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THE COMMONWEALTH OF MASSACHUS.ETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Divi-puual Works Towitrnr#iun Errant
Application is hereby made for a Permit to Construct ( ) or Repair (Y) an Individual Sewage Disposal
System at: , Ala
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..............................................5 Ala 40� .......................... ..�v
�"T� � / LosSes�"°rno, 1®r o .I t ryo. �—
...:.-•-•--------u-n se -•(�•--•--.[✓�.-..-.•-•--�-- 2s 1Y-G�1SL!.�!? �irc%o Covjlor'v���.�
a ............................... .-- / Ad!rylessO� �l................................ st
Installer Address
Type of Building Size Lot...........................Sq. feet
�-t Dwelling— No. of Bedrooms------------ ----------------------------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. 1................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........................
04 ._..•-----------------------•....................•-•••••--------.....................------...............•.*----------------------------
-•-•.----------•--•-
0 Description of Soil.......................................................................................................................................................................
x
U •--•••••••••••----•----••-•--------•-------•---------------------------•--•---•----•----•------•--•-••••--------•••••-••-•-••-•----•------•-----•------••••••-------------....-••---•------•-•-••-••----
w
-
U Nature of Rep}'rs or Alterations—Answer when applicable._.. --le j"to---- �-�g_...
5lri /•.--•-fJ�UQ..S ... Fo �� �7�jy� �. .5... �P ...................................
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 h een ' sued by the board oS health.
Signed ..._...._.......... ........................................`3 9-
--- -�— .......
Application.Approved — - - --------- ------ - - - �'1��........
Date
Application Disapproved for the following reasons: --------------------------------------------------------------------------------------------------------------------------------------
- - - ------------------
Permit No. ..... `.�.._.. Issued .-..._� i
� __ �� e %'
:.. ............
f Dare
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
t- TOWN OF BARNSTABLE
,Z ppli atiatt for Bi-tip 3Ml Workii Tomitrur#iun Vamit
Application is hereby made for a Permit to Construct ( ) or Repair (V�an Individual Sewage Disposal
System at: /
...�-------- •--/.�Ci u_s Q�, Citc....................................rr�l...----------------------••--
/ Lo n- -\ddre / / or Lot Igo '10'
.................. q SQ �P 0-?f-•-------............•... ----��5 `VGvIS`7uvi el;"e -o C"P"--; -Z"l%
Ow r Addr
a °�h 9. 0
Installer
� Address
Type of Building Size Lot............................Sq. feet
I� Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of ersons____________________________ Showers
•4..Pa YP g ----------------------------- P ( ) — 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 ( )
1.4 Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I________________minutes per inch Depth of Test Pit-------------------- Depth to ground water----_---_-_-_-__-.___..-
f14 Test Pit No. 2................minutes per inch Depth of Test Pit--._---__---__._---_ Depth to ground water........................
9 -•---...-•---•---------••-•----•--•---------------•----•-•---•--•-......•---•------------•--•--•---•---•---------••........................................
0 Description of Soil......................................................................................................................... ..............................................
x
V ---------------•------------------------------------------------------------------------------------------------------------------------------ .........................................................
W
----------------------------------------------------------------------------------------•-...--• •-------------------------- ...
U Nature of ep 'rs or Alterations—Answer when applicable.__ .-- �-'* -tu____7•.-�f _ -----------------------------------
s���----- s'vo s 7 .....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 n operation until a Certificate of Compliance h een i sued by the board o health.
/�11 -3 S5�
Signed .... ... C. ... �—-----------
K
Application.Approved - ---------------------
`!�'//'� Dace
Application Disapproved for the following reasons: ---------------------------------------------------------------------------------------------------------------------------------
.............. ... ..............-.. .......................................--...--........--------------------------------------------------...-............-.............------------ --...-------
� .---Dace=.-.........
Permit No. /
!� c
d� / Issued ... - - ��� ��/
Dace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
�
�Erti trace of Tom ltiance
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by -..--... Jv..-..h l Gr-1 f--...-------------------- -------------- ------- -. .................--..........
Insr.Jlrr -
/� ' /
at -..__----------------C.-S... �C�.t!L..S ys,-..-.CirL....a[-..---------- ��J-L - �lhe-----------------------------'---_....-----------.-.---------------
has been installed in accordance with the provisions of TITL of The State Envi on'mental ode a escribed 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....... (0------------------------- Inspector
<�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
N0. j�l 9 FEE........................
Dispolial urh13 Tun3tri iun "nutit
Permission is hereby granted (]n n `�/ ----------------------------------------------------------------
to Construct ( ) or Repair (t/S an Individu 1 Sewage ispop _System
at No................. :. AIA.vt-�4Q�•----�Jr� o------......y� /P��-til..11 -------------------------------------------------------------------
Street / 7
as shown on the application for Disposal Works Construction Pe X 14 - D�atte .__ F..�...............�......
. 6� i
i �J Board of Health I /
DATE-----.. .. --.
..............
FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS -