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Home My WebLink About0080 PINE TREE DRIVE - Health i 80 PINE TREE DRIVE CENTERVILLE A= 188 - 108 SME/fieD KEEPING YOU ORGANIZED No. 12534 1 2-153LOR FOSESTIZY R MIN.RECYCLED INITIATIVE CONTENTIO°/a Certified Fiber Sourcing POST-CONSUMER wwwxtiiprogram.org S"1290 MADE IN USA GET ORGANIZED AT SMEAD.COM TOWN OF BARNSTABLE LOCATION �' /r�� —SEWAGEI VILLAGE ASSESSOR'S MAP & LOT _ l INSTALLER'S NAME & PHONE NO. 7Y,5 SEPTIC TANK CAPACITY lUo� LEACHING FACILITY:(type�L�i� 6.4—Irsize) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER Rob �� DATE PERMIT ISSUED: DATE . COMPLIANCE ISSUED: � —a '7_ '7 VARIANr'R PRANTED: Yes No zz A 6 X 0 A (r��5qq''pS0RS E"A? Kai): THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ------. Il�G i�,j....-------.oF.......... -.....---•---------------------- ',t ad ApplirFatilan for UtgpnaFal Works Tomitrurtiun Prrutit 1 Application is hereby made for a Permit to Construct ( ) or Repair ( kj-'an Individual Sewage Disposal Syst at: _ .... , ...,� --------.� .-....................•--•-- -- ---•------------------............---•--. ocatio ddres or Lot No. z' A , ,V.� ----------- .................................................. Address Installer Address Type of Building Size Lot............................Sq. feet ,� Dwelling�No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1---------------_minutes per inch Depth of Test Pit.................... Depth to ground water--___-_____-_-__-__-___. r.%4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 0 Description of Soil....... .. .............•.............--•-•----------••--------------------------------•--------------•-------------.......................... UW -•-•-•••••-•.....----•-------•-----------•------••-----------------•----••-------••-••---•--•-•-•----------- Nature of R airs or Aj f ions—A war wh ap e..._�... . __. -----------------J=---�....../-'�----------- ------ ------------------•------------------------------------------------------------.-.-----. Agreement: The undersigned agreed to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i TiLE p }of the State Sanitary Code—The undersigned further agrees not to place the system in -operation until a Certificate of Compliance has bee issued by bo d of alth. Signed. .. ... = � : --•-- ••-•-- --........ Date Application Approved By._.__._... ..__ ----- Date Application Disapproved for the following reasons------------------------•----•----•-------•--------------------•-............................................... ----------------•-•-••--•--•--•-•------•--•••----------•-•------••----•---•-•---------.......•-----....•.--•------------•-•--•--•-•------•••------•---•-••-------------•------•-----••-•---•-----••---•- �r Date Permit No.....�7--.Z—.17-T......................... Issued....................................................... Date THE COMMONWEALTH OF. MASSACHUSETTS BOARD 9F HEALTH - - .... ',• .:... OF..........� :. ................................ Appliration for M-4paii al Workii Tnuotrndinat rumit Application is hereby made for a Permit to Construct ( ) or Repair ( ') an Individual Sewage Disposal System at J� s....x f�............................ r..r. �.....aP ....... ................................................................. Location Address^ r �+ or Lot No. ....1�F1, �yr�_ `r tt?I.� fq � !'. .............. ........._.........._..........__.........__......_.............._.._.........._.._..._....__ Owner -Address . �, .. . _.. - r ...............................................•----•-----......---•--------•-•- Installer Address d Type of Garbage Grinder ( ) Building - Size Lot............................Sq. feet U I•-, Dwelling�- o. of Bedrooms............................................Expansion Attic ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria P-I Other fixtures ---------------------------------------•---... ------•--------•-•--------- -••--•------ d 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 ( ) IDosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ ,a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ L14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------...... •----••---•-•-•--------•-----•-----•--......---•----•---•---•--•--•--_-•••. ......................................................... Descriptionof Soil-------1 ^l ---------------------------•----•-•---•---•------------------------------------------------------------------------------•------------- x U ...................................-------•--•-------•----•---•----•-•---•---•---•--------------•.....------•-•--•--•--•----•-•-•--------•-----•---•---•--•--•--•--•--••--•••--•----•-•-•••-•-----•--••. W -------------- - ------------------ ^ ;�< r z f' U Nature of Repairs or Altar tions—.Answer when ap le r ��._... ._._.__._.__p ___ t. . 4410..................................................... Agreement: The undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance with the provisions of iT,'.7, ;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 s �r� Signed.. f�%`s ^` ' , a c� `' •s` `Y Date Application Approved BY .__. ?. -- -------•--•-------- -----•------• _....._.3..-..X.V ... Date Application Disapproved for the following reasons:-•-•-----•----••----•--•--...--•--------•-•---------------•-------•-•-•-----------------•--•-•----•--.........-- ----------------------•-•-••-•-••----------•-•--•--••..........--................................-...................................................................................................... Date PermitNo.—F.Z.--/79......................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH, .............. ........................OF..... .."._ ...r� - ........ ................... %-Errtif iratr of Tuntplianre =� � THiStI, 9OaERT FY�11 That lteyIn vidual Sewage Disposal System constructed ( ) or Repaired (, } '" b ------•--- il. w.,y sR+w s!k• - ., •-E'nstaller - --- F'--------•--•.....................L at__'_ `f�.... 'j !-•- ......... r............' ^'% w. . .. , .................................................. has been installed in accordance with the provisions of TIL i:E 5 of The State Sanitary Code as described. in the,.--- application for Disposal Works Construction Permit No......................................... dated-------------------------------___:- :_________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YH.E SYSTEM WILL FUNCTION SATISFACTORY. DATE...............I.— :...a.7-•-- •-•-•--•----------•--•----- Inspector...---J.,..r_� -------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................ ......_._........ _ No... _�-..1...7�S FEE.....=.................. orkii Tamnitrnrtw'n prrmit Permission is hereby granted-- =----- -----------�"�.... -'-•---=�-- '..... X., to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systemat No j J �. _ Street as shown on the application for Disposal Works Construction Permit NoV.-/67 Dated.....-1*,�__^•_.9-..�I.".12 y� --------- - �J--sue-.- V oard of Health 1 DATE.------ ..................................... FORA 1255 HOBBS & WARREN. INC., PUBLISHERS -