HomeMy WebLinkAbout0038 SEA MARSH ROAD - Health 38 Sea Marsh Road
Centerville
A= 227— 132 �
S M E A D
No.H163OR
UPC 10259
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TOWN OF BARNSTABLE
LOCATION 40-4��a 5554 W„0&4 SEWAGE #
\VILLAGE ASSESSOR'S MAP & LOT
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INSTALLER'S NAME & PHONE NO.8aV&.Vr% COn�S77
SEPTIC TANK CAPACITY
BLEACHING FACILITY:(type) L9 (size) �,I—
,ENO. OF BEDROOMS .PRIVATE WELL O UBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: Zer " s 7
VARIANCE GRANTED: Yes No
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ASSESSORS MAP NO:
PARCEL NO:
No.�._...�` F�s_....... ...................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...................... ....................O F........--.--............................-----------......---------------.................
ApplirFatiun for Dispaii al Works Cnunutrurtiun jhrmit
Application is hereby made for a Permit to Construct X) or Repair ( ) an Individual. Sewage Disposal
System at:
................. .....................ot IvAevc ru-x04r ---------------------------------
�" --_,Location-Addr ss ,or Lot Nq
Ow er Address
� ------------------------- -----------------------------------
Installer Address
Q Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms-__----/-----•__.__---._.-•...............Expansion Attic ( ) Garbage Grinder (K)
per, Other—Type of Building i____•.................... No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other. fixtures ......................................................
w Design Flow.......... . ..•_._•-.._.--•-_-_-.-._. gallons per person per day. Total daily flow............................................gallons.
9 Septic Tank—Liquid capacity A 5�!....gallons Length................ Width................ Diameter................ Depth................
Disposal Trench— T . _. 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 Result Performed by...................................................---- . ---------- Date...............................v----.
Test Pit No. 1...d!_......minutes per inch Depth of Test Pit.........6_AT-? Depth to ground water---:5.aJ?..........
44 Test Pit No. 2................minutes per inch Depth of Test Pit------/..1......... Depth to ground water........................
jA. - .....................................
_._......
Description of Soil d-' .........
-... 6 11 - =... ar• ......................... -- -......------------------
x
w
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 iiTL iE 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
Date.
Application Approved By......61L,V%Z,- -- -•--- .................. -
Date
Application Disapproved for the f olt g reasons:................................................................................................................
------------•------------------------------------------••----------------•...•----------••___---------------------------•------------•-------•-----------------•.•--•-----••----•---------•------------
Date
PermitNo....... .......................................... Issued........................................................
Date
No................_....... .............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.................. - ..................OF............................I..........-----------------------------_..........._......•.
Appliratiun for Uiopoual Works Tonstrurtion Famit
Application is hereby made for a Permit to Construct X) or Repair ( ) an Individual Sewage Disposal
System at:
..:...._, 3 -------------------- �L rLh
-, .OT Lot No. .,
Location-Address
Y>% !�i:'s v..: y�il :? r._r .�_. �c .. F-
....... . t.............. ...._...._..._......._..._ _... .__._...
_ - Ow.er Address
aQ_ --- ' ` -•--__................ .....•--------•-••---••--•----....._..•--.._........._.._.....•••--------•••----._.._..-••------
Instal;er Address
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms.....'T...................................Expansion Attic ( ) Garbage Grinder (X )
`4 Other—T e of Buildin No. of persons____________________________ Showers — Cafeteria
a Other fixtures ------------------------------•• -
W Design Flow_______ _ _____________________________gallons per person per day. Total daily flow............................................gallons.
W Septic Tank—Liquid capacit}_�_��__gallons Length................ Width................ Diameter________________ Depth................
Disposal Trench—,No_ .................... Width.................... Total Length.................... Total leaching area______________-_____sq. ft.
Seepage Pit No..___�_------
_ _ Diameter_._c_______________ Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box Dosing tank ( )
aPercolation Test Result Performed bY.......................................................................... Date----------._______•-------:---n/.......
Test Pit No. 1__rb........minutes per inch Depth of Test Pit-------- Depth to ground water_.15,Y........
(i Test Pit No. 2................minutes per inch Depth of Test Pit-----I_I.......... Depth to ground water........................
O Description of Soil------
W
V •••••-•••••--••---•--••-•----•---•--------••-•--•-•••--•---•---•-•••--•-------••••-------------•----•....----•••----------------------•----•-----•--•-------------------•--•--•------------.....----•---
W
----•••-------------- ---------------------------------•........-----------------------------------------------------------------------------------------------------------------------------------••--
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 T_T-1 41 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...................................................................................... ----••-•-••--------------•------
ff -� Date
Application Approved B Y 1..�, e! - = •-••••-•--`"------•------•........................................ ................ -- —
PP PP Y••- 1
Date
Application Disapproved for the f oll w• g reasons:...................................................
......................................................-.................................................................................................................. ...............................
Date
PermitNo........ -------------------------------------------- Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
-- BOARD OF HEALTH
...............( .........OF........4& .....i...................................
C9rdif iratr of Toutpliatirr
THIS IS-- O 67ERTIEY, That the Individual ewage Disposal System constructed ) or Repaired ( }
by--------------
L � t ;
Installer
V.
has been installed in accordance with the provisions of T� = " of e State Sanitary ode s crib m the
application for Disposal Works Construction Permit No. r �j ---
PP P �•-�----�•�-•-�---•------- dated--- --'=-----`e'----------�•�--•-------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..................../a--.... ...... ..................... Inspector.................. --D-------------------------------------------------
A3d�-7' THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.'.�.:.............OF... l _. :.�...
NO3...... .9 FEE....................:..
DioposaLIVorkii wo olr ' n rrmit
. � ..:.ems .��-1�..
Permission s hereby granted------.�. -••------•---------------------------------------•-•---------
tc Con truct or Repair ( � ) a ndivldual S.wagF Disposal System -
�rr }} �!
................................ - --...........................................
Street ? .7
as shown on the application for Disposal Works Construction Permit No)1_4_.'_____ Dated___ ___.......
.............. .f?G._ .... ---------------------------------------••-
Lb f--�-- e� '"Board of Health
DATE............... ••----/ -- `�_I.---- ----/------------------------
FORMES HOBBS & WARREN- INC., PUBLISHERS
\, � *
Bresnahan,Alice&Pinero,Julie
38 Sea Marsh Rd �
CONTRACT Customer Name_ Centerville,MA 02632 Customer Signature_
SKETCH Contract Date 508-775-9247 Sales Representative Signature -- --�.
ATTACHMENT Customer Phone_ Contract Price 415
1 2 3 4 6 B 7 B B 10 11 12 13 ,4 15 IB 17 18 19 20 21 22I 23 24 25 28 27 2B 20 30 31 32 33 34 35 W 37 30 39- 40 4, 42 43 44 45 48 4] 48 4B 50 51 52 S7 54 SS 58 57 se 59 W
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24
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33
34
35
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NOTES Qo 3k Chou��s r (xa ra d c�ootS Each box equals one foot unless otherwise noted.This sketch is a good faith
representation of the work to be done,it is understood that all dimensions
derived from this sketch are approximate,and that all locations of outlets,light
fixtures,plugs,lacks and/or switches are subject to change if necessary.
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