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HomeMy WebLinkAbout0117 SOUTH MAIN STREET - Health 117 SOUTH MAIN ST., CENTERVILLE A= Slll J� � UPC 12534 No.2-153LOR HASTINGS,MN a v E- . ���■■itotiiititit� tic - OEM � i 3� •ENn�■ IVA `'Jill i _ R•i��.�aats�,s<<�lr ffCL 49 IN 3M_!ftliM Ijl� f�� � � � iAP F1 CC , =CSC*bl"IWAq t''*itdi6'h,Ti —- -- — �j�111�►1�7 rid" �S:, _<" -ems.: i �<o���a awr+�w�r ©i + , ,. C. _ . a � ti } C ear ar, i t ff Y .JL.L121iL bk L es rwml ,.s Ate_' Mtn Z F'= FA7CY�TiilrrrF - �'` J TOWN OF BARNSTABLE LOCATION 'S SEWAGE # VILLAGE ASSESSOR'S MAP & LOT loll INSTALLER'S NAME & PHONE NO. Get-TGu>Ti/ Q-S SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) JL/U f - - �'.,: NO. OF BEDROOMS PRIVATE WELL OR LIC WA� T� BUILDER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes �No j �-jr� f�' 71ttLi v ; '� � �� g" r ` � �" �'s. �� i ��/ 5' 3y� .��a' No.... t1-4I ,3 Fim$.......---5.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diripitial Workii Tomitrnrtinn Permit Application is hereby made for a Permit to Construct ( ) or Repair (r>� an Individual Sewage Disposal System at: .................................................... .. iru�¢ �1' ti -T, CF�i ee J,, i2� ......... ... -----•----------•------ .................... .... Lf� 1d �r Lot No. ��� ....... ............._. ._............------......• -... .--•---..................---•-....... -------------- ----......----•--- Owne —�U Address W 7e—�!/!� TjL�! a ' �./ iU ___ ---• �.....................................................Y..... - 5------.., PQ Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.............�--------------------.---Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building -------------------•--.--__- No. of persons--------.------------------- Showers ( ) — Cafeteria ( ) dOther fixtures -------------------------------------------------• ---....-----•----------•----•-------- ---------.....--------------------------•-----------•--•----- W Design Flow-------------- ----------------gallons per person per day. Total daily flow--------, 0--_-------------------gallons. WSeptic Tank—Liquid capacityA000---gallons Length---------------- Width---------------- Diameter---------------- Depth.............. x Disposal Trench—No. .................... Width.................... Total Length---___-___-�-___. Total leaching area_----____---_-------sq. ft. Seepage Pit No---------/. ------ Diameter---10._.._....... Depth below inlet...---........... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. I................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........................ 9 ------------------------------------------------------------------------------------•----•----••••--......................................................... ODescription of Soil................................................................................................................................... .................................... W x -------------------------- --------------------------------------------------------------------------------- ------------------------------------------ ---------------------------------•---- U Nature of Repairs or Alterations—Answer when�pplicable----/� 1�4-!�.�_--A-.. &X.. -- G ��/ '°v� ...................................................... 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 Piwbbeeiss by e oard of health. Signed ------------------ ---- - -------0;;�� Application Approved By .........lJ ..._� C----a.,,, -� `---..-.-- 7,q J ------------- ------------------------------ ------ Application Disapproved for the following rea.ronr- -------- --------------------------------------------------------------------------------------------------------------------------- ......................... . .................................................................. ....... ..................................... - -- - - - ........................................ Date Permit No. .. g-L/---- &--43................ . Issued ...................... . ........... .......... Dare THE COMMONWEALTH OF MASSACHUSETTS '1 BOARD OF HEALTH TOWN OF BARNSTABLE Ter#ifira e of Compliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( �) by .......................................... G/L G- -------------------- ......................................................... at ................ - `-SQ.....----------------- �' - has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ...q.. . �. _ ..... dated ..._._..........................._..... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR'Utp AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIO SATI EA RY. �� I� _ DATE...... _...... ....------------------ Insper .... _........_...._..._.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � TOWN OF BARNSTABLE No..�.�..4 n.:52 FEE........................ �t��rn�tt1 f� Permission is hereby granted.......................�_t ! L --------- %....:.? ................r�''� to Construct ( ) or Repair an Individual Sewage Disposal System i at No---------------------•-------•--...._../1.7-----`�°- ----•• !h -s"1 .. €n?T lc ►J�c-L ........ street as shown on the application for Disposal Works Construction Permit Dated.......�_-.?�...7•---9_-;_-------- ...................... ----------------------------------------------------- J [� Board of Health DATE----•-•-----------�---•----•--•-----------f----f------------------------•-•-- FORM 36508 HOBBS♦!WARREN,INC.,PUBLISHERS •ter.. No... FEs.....-. o............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Apphration for Uinpwial Workii Tomitrnr#inn Vamit Application is hereby made for a Permit to Construct ( ) or Repair (4) an Individual Sewage Disposal System at: 117 �`G u i -/ ..............•-...........-..........--.....--....------....-••-•------------------•-----.-.....• ............-..................................................................................... �k/� "asJor Lot No. ti T .. �...� Owner Address a lSCl✓l�l!i t ),7 C it!Y�1 %flnl cam` /G •... w y----• L J Installer Address I' Type of Building Size Lot............................Sq. feet .. Dwelling— No. of Bedrooms............. ------------------------------Expansion Attic ( ) Garbage Grinder ( ) CLI Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------- - - W Design Flow................<j....-.-.-..-.----gallons per person per day. Total daily flow..---.------ 0-......................gallons. WSeptic Tank—Liquid capacityZiP0---gallons Length................ Width---------------- Diameter...------------- Depth.............. x Disposal Trench—No. .................... Width-...- Total Length-------------�•----• Total leaching area---------_---------sq. ft. 3 Seepage Pit No.......... ./--__----- Diameter---/Q.... 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-----------------------. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a .............•--------•-•---•-------..-....-•-----•------.--..-•------•••--•----•----.-...----••---.......................................................... 0 Description of Soil-------------------------------------------------------•-••--•--•-----------.....---------------------------------..------------------------------------------------•• W V ....--------•--•••-•...-•------•••---••------------•-•--------------------------•-••-•--••-----•---••••-•---------------------------•-----------•------•-••••------------------..-..-------•-•---------- W U Nature of Repairs or Alterations—Answer whe�applicable_.1 _�- ._ --- .......... !?7I 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 ha bee issue'/ by/die%board of health. j y P Signed P �1- rt//_...../. . (.->r`n -' 1�.....................y. / Dace Application Approved By ......... M -' � x�.:,�•-�= �...-.__ /......................_.---------.. .-------------- ----- Of V [dace Application Disapproved for the following reafons: ' ' .... ..................... '' ' ..... ' ........................"-. .. --'--------- --- - ------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------- ---------------------------------------- Date Permit No. ....q.. .....-...�2..-lP2)------------------------ Issued ....-....._-..._...._...- ' .....-........... .---. ...... Dare