HomeMy WebLinkAbout0192 PARK AVENUE - Health 192 Park Avenue
Centerville
A= 207 —021 00,1 h ;
S M E:A D
No. 53LOR
UPC 12543
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No..L.1..� ..—c.� �T ®.. .
THE COMMONWEALTH OF MASSACHUSETTS
_ BOAR® OF HEALTH
. .....O F....Z A.'2 46 QL C,: p . .. .. .....S..................................................
Appliration for Disposal
Works Tontrartion Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair (K) an Individual Sewage Disposal
System at:
2 c � L----S.M.. � ..........................................
o on.Address 18o ye Aw LcLtNo. ( _
-------------.................-... ............•---..._•••--••-•---•.--.----.-•••- .......... .--•------_..... ......... ........_......._..Owner Address
W
Installer Address
Type of Building Size Lot.-1Z.,_Z5(t------Sq.�et
U Dwelling—No. of Bedrooms...........................................Expansion Attic Q�[C) Garbage Grinder 0)
AFAR MT No. of persons............................ Showers —
a Other—Type of Building ____ __ __ p ( ) Cafeteria ( )
dOther fixtures .................••-----._._._...----•----••-•-•---......-•-•------........---•-----•--..._...-•-....
W -----
Design Flow___.______. ...................... allons er erson er day. Total d�ily��iow____-_-g_-_ _ gajl'ons.
If
g - g P P P 4
WSeptic Tank—Liquid capacity15-W gallons Length__1t�� ?___ Width..4-8...._ Diameter................ Depth..�'6._..
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------- Diameter.......B......... Depth below inlet.._..CQ_......... Total leaching area...g9Q....sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
~' Percolation Test Results Performed by..V7A _M�-. _. _ C.1 ________________________ _ _��0.___._..._...
C- ._ Date
Test Pit No. 1___-.Z____-_-minutes per inch Depth of Test Pit-__.13.`.......... Depth to ground water-A6T_t-s�qq kLme*o
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a --•-----•----------------------•------------------•----•-----------•--------.....-----------••_.............................................................
0
Description of Soil ® ' is Pa50, ` �.... ..N
U ----------•----•----------•-•---......••••-----•--.....--••-----------------••.. -------•---------------------...--------------------•--•----•-•---•......_...._..------
.IL.Fi� c .Q_-�`...A6 �Ct.M.G:_ :�"---.�----'�'g-..3---------------------------------------------------------•.------.......-------- 4
U Nature of Repairs or Alterations—Answer when applicable............................................................................................... +`
..-----•-----•-----------•-----•-----------------•-•--•----•-•-•--------•-•----•--------•---....-------•-----••-•-•--------------•--•-----•-----•-------•--•------•-•-•------•............-•-...----•-.. 1
Agreement:
The undersigned agrees to install the aforede 'bed Individual S a e Disposal System in accordance with
the provisions of TITLE 5 of the State Environ en 1 Code—The rsigned further agrees not to place the
system in operation until a Certificate of Complia c as be issue y etboard of h alth.
Signe w �/
+:
re
Application Approved BY ..-.. ... :.... - /. "'- f.
.........
Dace
Application Disapproved for the following reasons- ----------------------------------------- --................-- ..........----. .----------.- . ....----------....------
............. .. ................. .. ................. . ................. .... ..... ............. ........... . ..................................-------------------- ----------------------------------------
are
Permit No. ..... 2------------------------------ Issued .........
Dare
LOT NO. : ADDRESS : lQ(o ?eay Aoe- as ,
OWNERS NAME:
SEWAGE PERMIT NO. : q/' ---NEW: REPAIR:
DATE ISSUED: DATE INSTALLED:
INSTALLERS NAIIE: ( 006T t (j C 1"a
INSTALLATION OF: t5oo cR--T(ArJ1, - �a %000 C�-c L_5 Qlt5
14ATER TABLE : FINAL INSPECTION BY:
DRAWING OF INSTALLATION ON REVERSE SIDE :
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LOCATION SEWAGE PERMIT NO.4-i2� P,4gic I L L A G E
VISTA LLER'S NAME i ADDRESS
R U I L D E R 0Rj� OW���NER /
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED �_�� �
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD: OF HEALTH
------..``......r` t..................O F........ ....................................................
Appliration for Dispa iial Works Tooldrnrtinn Prruat
Application is hereby made for a Permit to Construct ( ) or Repair ( )) an Individual Sewage Disposal
System at:
.................................................... ••-• . -•- -•...................................
Locatio Address or Lot
Owner Address
W
Installer Address
Q Type of Building Size Lot..: _" ------Sq. feet
U1-4 Dwelling—No. of Bedrooms...... .................................Expansion Attic ('11;>`) Garbage Grinder ( 93
Other—Type of Building No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures -----------------•--------------•---•--•--------•-----•--------•-----------------------..-•-••-•-•---
Desi n Flow................:�......................._gallons per person per day. Total dailyFflow......._...........-...................._... Ions;
W g g P P Pt Y
1:4 Septic Tank—Liquid capacity A�__gallons Length-]0:C?:._ p r. _ Width_Q.'�_.... Diameter..:_.__.._. Depth
W Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
x
Seepage Pit No..................... Diameter....-__?......... Depth below inlet.............. Total leaching area... .....sq, ft.
z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by_--'t�-a--------------
1� pground i�'u i t:-_c Qu-.A
:wt2iJ,
Test Pit No. 1___._. ^___.__minutes ermch Depth of Test Prt._____`r_.__.______ Depth to ound water........................
Gt, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water............_...........
P4 -•-•---•----•-••-•--•••--•-•----•••••••---•-•--•....................................•----•-•--•-----•---------:,, ---•-----------•-•----..............--_-••--
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Description of Soil-•-----------•----------------------------------------•-------•------.....---•----�-----=-------='=------------------'�--------------------------•--•-----•--.._..
U (
-W (?- iG 4� C-D 0 &-A A15IJ s i►i°�f LC) k
ram, •----•----------------------•------•-- .......................................... .....-................................................................................................................
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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by the board of health.
Signed ................................. ----------------------------------------------------------------------- ----------------------------------------
�I ��." �.�•` Date
Application Approved By ..... ....`.R. .�.'.. . "`' "'/'f `..r.-�...
r i/"..... f .. - .......................................
Dare
Application Disapproved for the following reasons- ....................... - ----------_-- ---------- -----------...........------. ---..........---- -- . --
............. .............................. .....................................................:........................... .................................... ---.... ---......-- ........................---.-...-------
;;�o ate
Permit No. --------- 1.................................... Issued .........t ..", ��
........
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
d.
a l..'ow.a .•s� OF
tom. kr Y i 4 i...... .. J
%Certifirate of Grayliana
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( y )
by ----- -- - ----------------------- -- - - --------------------------------...............---------------------------------- ------------------ -------------------- --- -- --------
,,�-• _ Installer -tee.
at .......� 1!�..............t`..". r..- '*/ �--..---_ ---�..�`q-�:i.V.�.-.e L(E ......
has been installed in accordance with the provisions of TITLE 5 f The ate Environmental Code as described in
the application for Disposal Works Construction Permit No. ..... ./. . ..��.'.............. dated --- - "'--Zf°�7 ...qe. _...
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
✓.�. OF..........I—...................�......... . ................................
No...�.................. FEES
Elispaxgat Works Tonutrndian rrntit
Permissionis hereby granted..............................................................................................................................................
to Constru t ( ),or Repair ( X,) an Individual Sewage DisposaLSystem
atNo............. i i.. �.;C �........ . .----•-------•-•---------•---•----------------------------------•----........--•-
Street ...
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as shown on the application for Disposal Works Construction Per t No............:........ Dated..'_...___...._._.._... ...__..._._._..
B .........
oard of Health
DATE .. / -------------------
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
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LOCATION SEWAGE PERMIT NO.
Alt
ILLAGE ,
—77
IN..STALLER'S NAME s ADDR_ESS
Q U.I L D E R:., OR OWNER ..
//
l y
DATE PERMIT ISSUED
DATE . COMPLIANCE ISSUED �_,� `
No. :. _ / 7 a Oc V ` U� 1
THE COMMONWEALTH OF MASSACHUSETTS
i BOARD OF HEALTH
Town....:...OF..........B2rn.stable
...................................................
Appliratinn for Uiipniittl Works Tnntrur#inn Vautit
Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal
System at:
#1-9{r
.. ls,.. ,M �.....C8I1l ED377L.�.�.E.�...MH... .......... #1-9fy-
..................................................................................................
Location Address or Lot No.
M... Frank Horgan Jr. - .Park A..Vq..........----Cgntgryil3�.a..Nl,
A & B Canco ,�----
Owner Address
W ....._3SQ- aixl...S.t....... ....Xaxtaojaxh„Xa..........---••---
,� ---•------••--------•---•.......................••-
Installer� ., Address
Type of Building Size Lot............................Sq. feet
1.4 Dwelling—No. of Bedrooms...................... ...................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—Type T e of Building r No. of persons............................ Showers
f� YP g ---------------------------- P ( ) — Cafeteria ( )
Q' 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........................................
W
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
LT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
•-•--------•----------------------------------------------------------•.............--------•........------•---........----•--------•..._......_..----•.•--_.
0 Description of Soil.......................................................................................................................................................................
W
U
W
UNature of Repairs og Alterations—Answer when ..........
--•---•-----------------•---------------------•------------------•-•---------•-----------•--------•---•--.........
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with
the provisions of iI'LU 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signed_ '� -•--••..-?- to
f D to---
Application Approved By........... ( '—' C�
------------------•-
Date
Application Disapproved for the following reasons:--•-----------------------------•--•-------------•---------...------------•-----•-•---••--•..._......-••--•----
Date
Permit No..........�?. -- -----0
--------------------- Issued........................................................
*c Date
`-
No.�4Q... Fsm..$15!00.. ._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town Barnstable
...........................................O F.......................................
APpliratiun for Disposal Works Tonstrur#fun rtrmf#
Application.is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal
System at: •
Park Ave. Centerville Ma #196
....:..........._........_...................p....................................---__........ ..._.............................................................................................
Mr. Frank Horgehfati k .Iddresr 196 Park Ave. or Lot Centerville, Ma.
J ......................•---_...._v
A & B C anC 4. Owner Address
W 350mMain St. .. Yarmouth ---•--........,,Ma.
Installer Address
U Type of Building 4 Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.................. :.........................Expansion Attic ( ) Garbage Grinder ( )
a Other—Type of Building ............................ No. of persons............................ Showers
( ) — Cafeteria ( )
Q 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........................................
4
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
LLI Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Wa ....--•-----•-••-----•-•-•--........••----•...............•-••--•••••••-•-.......••••--•.....--•............•----••-•--•-••-----........_..............._....
Description of Soil.......................................................................................................................................................
W .........••--•-••...............••-----••-•........-•-••- . --•----------•--•---•-•--------•--------•---...........--•--••...---•-•............ ---•---•---•-----•--....--••--............-•--••....
---•----------••----•-- ..._..._..
U Nature of Repairs or Alterations—Answer when applicable.....0000gallon Leaching Pit.
.............................
.....................................................•-•-------...........-----------•-----•---.....--••--.......-----------------------------...---•---------••------................_........•--------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with
the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
igned........ _
}j, .Date . -
Application Approved By.........:.••-1 .:? . ....J I!ra.:. �,!` -:: --. ..................................C(�.
Application Disapproved for the following reasons:.............................. Date
....... „,,,,„___
.....-•---•..........................•----............-•----•--•-•--.......---.....---..........----..........-•-•--......------.............---•------•------••--•--.....•----•-•.._......••--••--•----
y Date
PermitNo.......... �-r...:...1.��................._.... Issued....................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town.............O F......Barnstable. . . . . . Mr. Frank Horgan Jr.
.......... ... ......................................................................
(5rdif irate of Tomplittnrr
TH�c S 0 CERTIFY TThhat the Indi idual Sewage Disposal System constructed ( ) or Repaired (X )
R ......_Canco 350 N1Bin S wo Yarmoutnij Ma.,
by.................. • ..........-......._-•-•-•••--•--••-•--------.__-----•----- --- - - --..._.._....... ......................_..................._.._...._
196 Park Ave, Centerville Ma.Installer
at.................................... ..... -
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Cod_eis described in the
application for Disposal Works Construction Permit No...._..:1� ?__-._I�_.__...... dated........ .....1,?.,-_....._._......_........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.......... p-• --c�-.2(j..------•---•--••........................... Inspector...........I.. �..... .. ....._..--• -----...................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
ITown OF............... 3ar�stable.--........................................................ ............ $ 15 00No......................... Fzz......................
�iu�rostt murk �onu#ritr#iun ��ermf#
Permissionis hereby granted ........................ ... .. --•--•-•....._....-••-•••....--••••••••••--......_.........••••...................__.. . _
to Constru t, ( d ar epair (,� �)�, an Individual Sewage Disposo stem
itNo.... ...... k�..*...' :---...---•---. .....,` .....--- v.................•--•--•-•-•-•--•-•--........... ..............
Street ,
as shown on the application for Disposal Works Constructionq Permit,,N0 �..:...... Dated..... ... ` ........................
............. r , .................................................
DATE...........�....�-•......:................................................ Board of Health
FORM 1255 A. M. SULKIN, IN_b.,,8OSTON
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