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HomeMy WebLinkAbout0350 SOUTH MAIN STREET - Health �350 S outh Main Street, Centerville A = 165 - 029 I No. 42101/3 ORA a ESSELTE 10% O O O i No......------ - •- Fxs......�.d.......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE V/ Appliratiun for Diripwial Vurk,i Towitrnrtiun Prrutit Application is hereby made for a Permit to Coristruct or Repair ( ) an Individual Sewage Disposal System at: CPNT Location-Address _ I or Lot No. E_ ....... Owner Address Installer Address �5 Type of Building Size Lot...... .................Sq. U Dwelling—No. of Bedrooms.___-__---------------------------------Expansion Attic ( ) Garbage Grinder (TV�Cy aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------------------------------------.-----...-----------....-----......__...------------•--'•-•-•---....-•-•••......--••-•----•--•-- W Design Flow............ -----------------------gallons per person per day. Total daily flow-.-._--__-__.J�--.-��----_____.___^gallons WSeptic Tank—Liquid capacity_�S gallons Length_lQ _ Width_ ^.> _ _ Diameter---------------- Depth..!.__-_& x Disposal Trench—No. .................... Width.................... Total Length_.____----..___•___- Total leaching area....................sq. ft. 3 Seepage Pit No ?._........ Diameter......12.°------- Depth below inlet_5E_51........ Total leaching area.. >..0...sq. ft. Z Other Distribution box (YE35 Dosing aik ( �JQ _ `` _ aPercolation Test Results Performed by....... `�.j4)C ....l�G-...... Date---- .1 �_ _ _..._ .... a Test Pit No. I----"--"'------minutes per inch Depth of Test Pit------ ......... Depth to ground water--- 44 Test Pit No. 2...4 Z..._minutes per inch Depth of Test Pit------`.O--------- Depth to ground water........................ pi ................................... -'-••---•••-......••-- •••'•••-•--•.......•---••----.............--••-----••••--•-••.._..._........._...... Description of Soil..... .... -10.....M-a—.6_._ 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compiia ce been issued by the board of health. Signed .. ............................... Application Approved By .... ................ ............. .... :. .8.----- -- --- -- -'-- ------- .. --------------------------------- --..-......--. .................. Dace Application Disapproved for the following reaso r: ...............................:..... .. .. . . . . ....................... . ........ . . .. ... . .. ................... .. . - -------- - --------------- ---- ------------------------- - - - - -- Dace Permit No. ..... ------ --- --------- Issued ......... .. ... . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certifira E of (gantylia TCP THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( x ) or Repaired ( ) by ------------------------------------------------------------ --------.......-------------------------------------------- --------------.-----.__---------------------- ------------.-------------------------------------- ------------------------------------------------------------------------- has been ed nce h the he applicationlforlDispo alaWorkstConst provisions Perm TITLE 5 ofl e State Environmental Code� described in THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BEtCONSTRUEA AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....- - - � - _...._---------------------------- Inspector �^ ./'.:...�'�. l.f'...I-�..' .. ------------------ --------------------------------------- --------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.---....��.......::. FEE._:!.-1 2. Permissionis hereby granted..............................................----------------------------------•---------------------•----------•---•-••-•-............----- to Construct or Repair ( ) an Individual Sewage Disposal System at No....?.-`Z5-<a....... ..---� ---�?T -----�...- 6-7- 42.d.1- k_�C '�-- Street as shown on the pplicatio for Disposal Works Construction Permit No ,---.Dated...... .-.c. .. ...... ...... ....... C J v Board-of ealth ty DATE......q---= _.-1.. .......... FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS No...! F�$....... .......... THE COMMONWEALTH OF MASSACHUSETTS i BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiou for Uivj-Voottl Workii Tomitriirtiou Permit Application is hereby made for a Permit to Construct (K ) or Repair ( ) an Individual Sewage Disposal System at: I /� ---_..._. ..................•---. ----•- ---.--_...� .--•----•--------•••-----••......-•---•---•----...-------•----------...-•--•------....---••------- Location-Address i S or Lot No. . � J >� `r4 «• >_•r2cas�1-' 7 ..-�_ tL} ' -t�\ h\_ila t\a 1 `' ........ ----•- Owner Address W __�_�_ �C/ �.... ----------------------------------------- ........................................................•-------•------•---••...........---A,,—,,,-..... Y r Installer Address / �s Type of Building Size Lot.............................Sq.-feet Dwelling— No.of Bedrooms----------5-----------------------------Expansion Attic ( ) Garbage Grinder (Kk� aOther—Type, of :Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Other fixtures --------------------------- ------------------------- W Design Flow.._._....5.�.........:................gallons per person per day. Total daily flow.___......._J`� 0...__.__..__._gallons.,� WSeptic Tank—Liquid capacitv_�`a —gallons Length_ID: -,_ Width-5.�.. ___. Diameter._..—_ -- Depth:�-_-6.. x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......7.-.-_.___ Diameter...... Depth below inlet-�!_,.'.� p .......... Total leaching area..-4 (D...sq. ft. Z Other Distribution box (y1 Dosing tank (�)'D _ a Percolation Test Results Performed by------- t .c _+ �y _..W.-...... Date---- _ ........ Test Pit No. 1---L�.-__-minutes per inch Depth of Test Pit-____-�U___...._.. Depth to ground water_-_ L14 Test Pit No. 2.._G-.Z--_-_minutes per inch Depth of Test Pit---_.-�K--------- Depth to ground water........................ --------- ----------•-••--• ...................................... 0 Description of Soil...... _.?_...0 CJAv��_ _........-�....1� 1__(e...._____ __ U ----------------------------------------------- •--------------------------------------------------------------------------------------------------- •-------------- --.-------------- .----------•---- W U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -•------------------------------------------------------------------------------------------------•---------••-••-••-----------------•--••••---•--••••--•-•----•-••••••••-•••-•••••-••...---........---- Agreement: or 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 Compliancehha bbeep issued bythe board of health. \ Signed .. ........iL.J_.. ` h3.)o .wll ;: :?-, ` -- "© rn. � Dace Application Approved By .._ ...:........._.........._ ------. - -- � .................Dace.................. Application Disapproved for the following reason--------✓---------.--,--------------------------------------------..._------ . ... ................................. ........__.........y......... . ...... .... ----- -- / 1r Permit No. .. /..:..t�.7............... : --,> Issued .... -.�• ,. �e � � L�a�re �S I N DATA - 5l�! 6�A�sAc�E' Gl?IIJUpZ, ,, '.,?AIL-( .FLoW G xllo :Sz :6pfl • , .5�'PT'I C �"AN�. 55o also;fa 92� . Pc A�.J CANS l 7 lSoo`lac . Wn-cOF 21SSQ AI-; iI M 31 P_ 2�6G . s AIIJ Sq- 51�EVV4U- J A;?�A oTToM ToTAL t)a5l6N _ TOTAL. VA►LY P Lov = 550 d-PD .11 OL T�E¢Ga(.ATI ON: I BATE .t 4'1rNZMtN S 1K OF AfA RECHARD P-MR BAXTER NM 24048 ti0 2973 Ti*r ��a lq� L 1=G= 40 TF.=4e 2 `t" l IIJY 2', °'ST �u✓ INV• G�Lo 38.E GAL r7 lutl box g7y 38.1 �NI; ;l. 3 f - 7 7 T wl SAl p r ll'''' WA49EP . - M: At1_ Srtuclvzv StT TON(: S ET: 64L -6e Zo l �1 C Zrl-R® PLnr PLa N _-PNE1.oPF 'P2aFi Ls- 86 � -----�-tp' ��..=moo �G�11..�� (►I DAB f MAZ. (3�lgg5 pne�pos�-�' � pLAN I CE2T17y Tl-,tr TIfiE 'awt✓�.uNL — � ERO.IC,E Show N NirzEoN coM�pLY S wlTt-4 '1�� 51�EU�JE l-c5`T' 2, A TDWN o f 13W2 Nsra� 5 T' L-o T ItllltJ TN£ �1oau 1't oli 1. L' C• G `3I a Q lglN FLAN l5 NCr- A�il� otJ tiN 1t15 vti4EUT' p 55lorJdi LAub Suev�/ozS Sut2V��f alJp TNT OFFSeT's 44OULX> ► or �E uSc oE�IGI0E-ELL T-0 C-5'rABLI�N EQ . _ S CT>EfzvlLLa MA . �O'P . T / l.i u�5 14PPLtcANTs F 15 2 Axr),JEW-- - - � zo►J6 �C 7y/io/ia / MAP I&S Pc.L 29 1 N QA r FR & � '►�N1(r Q I A(r 00 Li oF- \� a 0 i 9"I pie s � yZs+ :i SDvrg MAIO avwry QhPEMR J SULUVAN RIC1iAH0 � NO; 28733 BAXTER V Z: 9 TOWN OF BARNSTABLE v T:OCATION J" /'f^w -sr - SEWAGE,# VILLAGE Gs°St ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. �-S�e.I«y ota�' 7/ 41/et :.SEPTIC TANK CAPACITY /• — LEACHING FACILITY: (type) / (size) '.NO.OF BEDROOMS , S BUII,DE4-0 OWNER .�_" n rM e r PERMTTDAy` T 9' • 97 COMPLIANCE DATE: Z&— —�/`9 7 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) Feet :.':Edge of Wetland and Leaching Facility(If any wetlands.exist within 300 feet of leachi lity) Feet Furnished by — - o 30 cp9 YO4 " .s •