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Home My WebLink About0131 OLD POST ROAD (CENT.) - Health 131 Old Past Road Centerville A=209 063 Sul �► UPC 12534 ot�.2�-153L0� ° MYIdI�IM ASSESSORS MAP NO, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Di-ripoml Work,i Ton,itrnr#ion Prrntit Application is hereby made for a Permit to Construct ( ) or Repair (V�an Individual Sewage Disposal System at: �. .�..._..: �.��.. ...................... ........................•---------•----------------- ----...._.._-. ------------------------ .. Lo ati n d ess or Lot No. t .� ----------------- Owner Address Installer Address d 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 ................•------------------------------------- ----=---••-----•---•------------- --------------------------------------------------- -cl 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 ( ) aPercolation Test Results Performed by.........................................................................- Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......_____-___--_--___. a •••--••••-••----------••--•--•-••-•--- --•••-••-----•-•----•••-••••-•••-•--••-•••--•............................a..----------------••--••-------•••----.--•-- 0 Description of Soil........................................................................................................................................................................ x v ---.....-•-••••--••••••--••....--•---•---•••---•----•-----------•--•-•••----------•••---------•----•----••--•------------------------•--•------•-•--••-•---•••-----•••--.............---•-•-----•--••••. \` ------------ U i�to�r,� of Repairs or Alteration — sorer when applicable.._ ce- � i � ! ..�,'" '! om -_-e'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 p i c has y the board of health. Si ne ------ -..... ...._....... ... ...................................... oil l gZ3...Q� Dare Application Approved B ------------ = ... ...........Z ... ... ............................. . ....�c�.1..:... Dare Application Disapproved for the following reasons: ........... .................................. ..... . ........... . --- . -----------------------------------------------------------------------...----......----------------.----------------------------------------.-.........................__-----------.--------------- --------------------------------------- Permit No. .....1... ..`-`�'� " __ Issued .... �� 7`'.............. ..... .......... Dare ANo. '........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE _ ,21pphration for Di-nipwial Wnr1w Tomitrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( P_7�an Individual Sewage Disposal System at: ...................... ............................ ' --------------------------------------------...-------- Lo ati ,-Address or Lot No. r-------•-•-- ............................................. . ------ -------------- Owner Addres --------------------------------------- Installer Address Q Type of Building x Size Lot............................Sq. feet U Dwelling— No. of Bedrooms------------L/ -----_--__-_Expansion Attic ( ) Garbage Grinder ( ) a Other—Type T e of Building ............................ No. of ersons-_.---___.________-__--.---- Showers� yp g p ( ) — Cafeteria ( ) QOther 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 N I Performed dr in Test pi o. ch Depth of Test Pit................... Depth to ground water........................ rZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •--••--•••---•--------------------•••---•---------------•---•-•••••-•-•---••••-••••---------•-•-••••......................................................... 0 Description of Soil.............................-.......................................................................................................................................... x A x --•••---.........•---------------------- ---••••--.........---------------•-- -------------------------------------------------------•------------•-••-•-•-•------•-•--•--......-.................. U N to e of Repairs or Alterations—Answer when applicable _ �rk�-� b41� - u ------------------------------------------------. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE15 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Co p i ce has een_issz�by the board of health. d Signe - r 1.2- -------------- Application ace Approved B % t �--� / ._-..----.----- ....Z�� PP � .... .......... - - ...-... to Dare Application Disapproved for the following rearons: ............................ -----------------------------------------------------------------.-......---------------.-.-------. - - - ----------------------------------------- -------------- .----- .-..----------- --------------------------------------.............-................... ............. .......... ---------------------------------------- Permit No. ..... ............. to 9.P:✓ .... - Issued ..../......�.... .. .�""..� -- Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C'IEr#ifira e of Tomplianre Systemconstructed ird �"��:�5 IS•TO CER3��-Y That the Indlvld 1 Sewage Disposal Sys e ( ) or Repaired ( ) by .... �L-.�1 -.....--.. - ... - - - _... - -.._... -------------------------------..._-..---- Imraller at ..... 3..1............... -L.n---..-.--- - '-....-.. - has been installed in accordance with the provisions of TITLE of The State Environmental Code as described i the application for Disposal Works Construction Permit No. 02�47- _ .. ._-_-_._.. dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE A AS A GUARANTEE THAT THE SYSTEM WILL FUNCTJON SATISFACTORY. DATE.... .- Inspector....`_..... --` of f l' _..._. ------------------------------------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f TOWN OF BARNSTABLE �7 L FEE.7— Permissionis hereby granted---- ------------------------ ----------------------------------------------•..........._.............----..... to Construct ( ) or epair ( t � �Individual age Disposal tyst�tn '_. I�'1� Street as shown on the application for Disposal Works Construction Permi yP---------___----- ...................... Board of Health DATE---------------------- --{-----•--------- t FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS TOWN OF BARNSTABLE LOCATION ` k SEWAGE # ASSESSOR'S MAP & LOT gff 0�� INSTALLER'S NAME & PHONE NO. �-�� SEPTIC TANK CAPACITY� q r i LEACHING FACILITY:(type) La 3/ S (size) NO. OF BEDROOMS PRIVATE WELL OR UBLIC WATE BUILDER OR OWNER Q�-LPk��J DATE PERMIT ISSUED: 2 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No _ _ _ �, i- f . � .� �, � �� 1.� �(.�! e _ ; �J�'��'` �� . - �� .-- " 1� r b