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Home My WebLink About0832 SOUTH MAIN STREET - Health (2) 832 So. Main Street, Centerville 9= 185-056 F No. 42101/3 ORA ESSELTE , 10% v a 0 0 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Apli iration for Uivjipnittl Modw Towitrnr#iun ramit Application is hereby made for a Permit to Construct ( ) or Repair (1-<an Individual Sewage Disposal System at: v XUAlk -------.... -----Location-Address or Lot No. -•---••-_•--•--------------•--'-------.... caner Address W ------........---•--•. In a ler Address UType of Building 35 ,E P�� Size Lot___________________________Sq. feet ., Dwelling— No. of Bedrooms........ -•______________-.--Expansion Attic ( ) Garbage Grinder (e;it� aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) A4Other fixtures -------------------------------------------------------------•---•----------------•----...........••••----••---•-•-•-•--••---•••-••-.............--•• W Design Flow------------______/1_t1....................gallons per person per day. Total daily flow_.----____-/.!i!'0-_-_____-_----____--__gallons. WSeptic Tank—Liquid capa6tv..lV0__gal1ons 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 ( ) `1 Percolation Test Results Performed by.......................................................................... Date........................................ 1 Test Pit No. I................minutes per inch Depth of Test Pit-----------------_._ Depth to ground water........................ f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ..----•------------------•--------•-------••-----....--•----•-------------•••-••••••----------'--••----------•-----••--....--•.............................. 0 Description of Soil........................................................................................................................................................................ x x -------------------------•--- - ----------------- U Nature ad Repairs or Alterations—Answer when applicable.__ ds7r rvl I___.--4---� �-._--- .......... Voa.lte.................................................................................................................................. Agreement: koG 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 o erat n gdll a Certifica of Compliance has been issued by the INard of health. Signed _ ---- ---------- ......... .:./.. �... � ..... Applica ' n Approved By ........ \/ �J ................. I*-- -?-��---------------------------- te Application Disapproved for the following reasons: ........................ ....... ... . . . .......................... ....... ................ ....... .......... . . . . ................................ ................. . . . ............................................ . ---------------------------------------- Date PermitNo. ....... .... ..'. .. ----------------------... Issued ............ - �.......... Date -- —'~-------- ------------------------- — y-- —_ - ` a ,vv THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE , Appliration for Disposal Wnrlw Tonstrurtiun Prrntit Application is hereby made for a Permit to Construct ( ) or Repair (k�an Individual Sewage Disposal System at: ��.r ay:E&/-!_/)k ------------------------------•------------------'---------------------•--•--•----•--.....-----'-- ......... Location-i\ddress —or Lot No. !'� I�.1' Al _S >?,1---------------------------------------- -------•--'--•-•---•-•'----...----••---•--.......... Owner Address ............................-------------------------------------------------- ---�"r,^�,J ,� t"�� .......... � .............. Installer Address Type of Building � � -�o �,�,� Size Lot............................Sq. feet Dwelling—No. of Bedrooms........ .-- `........_-------------Expansion Attic ( ) Garbage Grinder (KICs) Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------------ - - w Design Flow.................//.n...................gallons per person per day. Total daily flow..........Y.'(.............._._._..gallon. WSeptic Tank—Liquid capa6ty_10!2 ..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........................................ 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........................ a ---••------•------------------------------•--........_...---•-----•--••••-•------------...-•-..........-'--•---'•------..._..••-----••---............-•-•-•- 0 Description of Soil....................................................................................................................................................................... x U w UNature of Repairs or Alterations—Answer when applicable.-_ -------- . . -:rC ---------- 1 Agreement: 4,.r 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 ........1�1..4 ►, J.. ..t.. [. t ..� �. ' //...... Application Approved BY ......... Date Lr�-----------------------------------------------------------� � . . Date Application Disapproved for the following reasons- ----------------------------- ---------------------------------------------------------------------------------------------------- ............ . .................................................... . ........................................... . ... . .......................... . ........................................ c Date Permit No J... ..'. .��a Issued .............. -.-..I .-..`�.�I............ Date ------------------------------------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Tertifirate of Tomplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( 1l) by --------------------------------------------------------.............----------- CINI.�61) ..._-------------------............------------------------------------------------------------- Insrdler at .--------------------------------------------------------r..3.2----— ------Aq - ... " -G K1 ;✓1.��.t� - _....... 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. ._?iv-.----73&/.......... dated ----------------............................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..................................... '...........r- ----------------------------- Inspector �...: -.._.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ,00 No.-----y----...� FEE.--��•--.......... Disposal Works Tonotru.rtilan "rrmit Permission is hereby granted...................18... �..�C-LS�`/nj ------------------------.-----------.....----------------------------............... to Construct ( ) or Repair (tl) an Individual Sewage Disposal System . atNo...••---•••-•••-•••-------•-•------•-••-•••-----••--••----•---•..? e••---='n-... !-Ca! t t :t� .................................... Street .r_ ._.. -?__ s ......._^ .. C .... as shown on the application for Disposal Works Construction Permit No..,�W~7��: Dated___...r �...� . -........................................... UBoard of Health DATE.........../�..... j --------------------------------- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS S SOWN OF BARNSTABLE 3, ;.0(:1 ON (3 H Ip_, S T-A C SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. 712 SEPTIC TANK CAPACITY l o6 o G ST LEACHING FACILITY:(type) P R&CAsT' (size) Coo 64A NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER P W 5- BUILDER OR OWNER Il o 10 6 5e,J DATE PERMIT ISSUED:_ DATE .COM. PLIANCE ISSUED: ;7_ p;z VARIANCE GRANTED: Yes No �= 1 yaw �S -A3 s - THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH --•-•-. . ......................OF.......................................................................................... ApplirFatioaa for Diipuiai Works C on.6trurtivaa Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (V4 an Individual Sewage Disposal System at: , G .................. 6�e o lion-Address or Lot No. caner -_--•-••-••--••-•-•-------------Address tl_�YI �. .iY!�..................................... ...•-•__--- ••-•-•......---•••----•••-••--•--••••_..... Installe Address Type of Building Size Lot............................Sq. feet U Dwelling�/No. of Bedrooms____________ ______________________________Expansion Attic ( ) Garbage Grinder ( ) P4 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 Pat No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by--••••---••-•••-••-••••••-•..............••••--•-••-•••••-••-••......-•••• Date........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-__.--_.__---------__--. GT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ODescription of Soil....S�0 ----•-•----•-•---•---------------------••.......................................-- --.-••--• ...................................... x U UW -------------------=------------------------------------------------------••---••-••-•••-•••--•--•---•••--••-••---------------------•--•-••-••.L....-----•----------•---••---•-•--•••••-•-••.....•••- Nature of Repairs or Alterations—Answer when applicable___-__ d0 .._! /_.._ T G_.Tk•_----. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TTTILE 5 of the State Sanitary Code—The unders•Nneddrther agrees not to place the system in operation until a Certificate of Compliance has been issu d by the boalt ..Signed------•----•-----• - -- -------•------ ----------•--- ........................... Date Application Approved By............... --------9 ` P..__S�•••-- •--...__•-•••-__ Date Application Disapproved for the following reasons:.............................................................................................................. --------------------------•-------------------------------------•---------------------.......--------•---•-•--•-•----••--••••••-••---------•----•---•-•-•-----••--•--••--•----••-•......--••••-•-.._.... p Date Permit No.------- ---•---------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS �— BOARD OF HEALTH ......................... ............OF...........................---...........-------------••------------•--.................. Appliratiutt for Di-spuiial Works Tonfitruriiutt 11anfit Application is hereby made for a Permit to Construct ( ) or Repair (1i�n Individual Sewage Disposal System at• oc n-Addres or Lot 'v o. .... ----------------------------------- --•-•••---------------------------------- ------- -------------------- ............ .------- Owner - Address ar _ S.�r� ..................................... Insta Address Type of Buildin Size Lot............................Sq. feet Dwelling No. of Bedrooms............. .............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ............................... . . Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Cd Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ 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........................................ 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-----.----_-_--.._--_--. 1:4 ........ ------- 1-1----•------------- -.----------- ----•--•--•------------ •---------- DDescription of Soil..... �67 -----•.................•-•---...................------------------------------------------------ ........................................... x U ---------------••---•-•••--•---•••-••--.....---•---••-•-•-------•--•....-•------••---------••••----.....•---------•---•---•-------••-------------••--••---••--•---•-----•-•--•--•-•-••------•---------- W ------------------------------------------------------------------------------------------------------------------------ ---- UNature of Repairs or Alterations—Answer when applicable.__... ad..... ?o�.r..... ---------------------------------------------------------------------------------------------------------•..... ---ra��._._, :: ..�........... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I'I'?E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss y the boar I1 . Signed.................... Date Application Approved By............. �1 �' ." '--................ ...... ate Application Disapproved for the following reasons---------------------------------------------------------------•---------------------------------------.......... ---------------------------------•-•---------------••----•-----------------------------......------....--•-----•.....•--•--......•-•-------•------------------------•-••-•---------•-----•-•----...-•--- Date Permit No....... ?-•------5---& ----------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD y�OF HEALTH �, _........OF.........+ Yrvv .�Cli................................... Trrfif irab of f ampliFaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repairednstaller �} by---------------•r'��-„� .......� ...............-I ----------•-.....----------••--•--............-•---•---•-•--•------------•--.....--------" PCaz ............................................ has been installed in accordance with the provisions of TiTIE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......6_7------ ...... dated_---------------------_-----_--_-____------•-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE...........................7'-", . 7t ..................... Inspector................... _..� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...... ..............OF.......... 4 .1�..:5 ................ �.-.,,ems -. . Disposal Works TFutuAr iurt arAii Permission is hereby granted........PIN4Z'9 ......... ................. ................................................... to Construct ( ) or Repair ) an Individual Sewage Disposal System at No............ c >P- .......... - e - ------ Street as shown on the application for Disposal Works Construction Permit No6r7g.Z_.. Dated.......................................... ..................... - Q► I3bard of Health DATE ��' ...................•----......... �J FORM 1255 HOBBS & WARREN. INC., PUBLISHERS - TOWN OF BARNSTABLE �'' tocATION Fc 32 SEWAGE # 91/— 736 VILLAGE �_ ��e..�=ASSESSOR'S MAP & LOT 13<r-d 4 INSTALLER'S NAME&PHONE NO. 9, d SEPTIC TANK CAPACITY ® h LEACHING FACELI TY: (type) (size) NO.OF BEDROOMS_ BUILDER OR OWNER PERMIT DATE: _COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) ,i�f�l� Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of le hing f c��GS/ Feet Furnished by f - /000 f