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Home My WebLink About0057 THOREAU DRIVE - Health 57 THOREAU DR. , CENTERVILLE A= 191-229 r No. 42101/3 ORA Q o ESSELTE 1 Q% (a O O O C n II - - � _� _ �. � 3i ,`�� s Y 1�1 - aC) _0 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Xpli iratiou for Diripniai Work,5 C omitrurtivit ramit Application is hereby made for a Permit to Construct ( ) or Repair ( C-�f an Individual Sewage Disposal System at: .......... �c�v ,,K1� •L ceat'o�-Address or Lot No. -- � � � •- ............cA. �e..................................................................... �r wncr ` Addres av1 ?r1li�! `--------------------------------------------- -- Installer Address UType of Building Size Lot............................Sq. feet �. Dwelling— No. of Bedrooms------ ___________________________._-Expansion Attic ( ) Garbage Grinder 44 Other—Type of Building ____________________________ No. of persons------------------.......... Showers ( ) — Cafeteria ( ) QOther fixtures ------------•---•--------------•---•--------------------------------------------------- ............................................................ Design Flow.............................................gallons per person per day. Total daily flow....................................._------gallons. WSeptic Tank—Liquid capacity WPp.galions 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. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water------:.............. ._. (1 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water_-.____.________.______- J 9 ------------------------ ............................................................................................................................. 0 Description of Soil.............S-G=�3- ............................................... x U --------------------------•--------•---------------••----------•-------•---------------------••------ ------------------------------------------------ ................................................. --- ---- -- V 1)ature of Repairs or Alterations—Answer when applicab _ _ _____1-2GC<<ns�_.____ � _ k�j _....--c�,�.. �`. -fi r a......W. 7 —r--4.----.o- -------5-Nu Zr\T,-.e- ' Agreement: I `j► d_e_ 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 under igned further agrees not to place the system in operation until a Certificate of Compli has bee y the board of health. f Signed ......... .... .. --------------------------- ...�'.�16.l.9d Dace Application Approved B Dace Application.Disapproved for the following rearonr: ...... ....... ......_..................................._ ...... ..._.. .............. ------------------------_.....---....:-------...---- ------------------- ----------....-----....-------------------------------------.....---............:..-......_-------------------------------- ........................................ Dat Permit No. Issued Daze TOWN OF BARNSTABLE LOCATION SBC`Ct�.�� SEWAGE # ��- &a? VILLAGE C:!�kV I I�' c ASSESSOR'S MAP&LOT I -�C INSTALLER'S NAME&PHONE NO. _>cUTi ,M SEPTIC TANK CAPACITY J000 G-eL 4) �6 LEACHING FACILITY: (type) <1 V-S (size)I !A 1 R- NO.OF BEDROOMS BUILDER OR OWNER Q U PERMITDATE: 1 S COMPLIANCE DATE: Separation Distance Between the: `'' Maximum Adjusted Groundwater Table and Bottom of Leaching Facility vQ `� JQ Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) /11� - Feet Edge of Wetland and Leaching Facility(If any wetlands exist ffll , within 300 feet of leaching facility) V Feet Furdi'shed by —:S�cio-k4 � 4 15� a� A A-6 W?�'t -144 S O , r , THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTA.BLE TSI.S � CETom, That the Individual Sewage Disposal System constructed ( ) or Repaired J/by ---------- ...-..__._. �"`�'�'^ ...-- - --------------------- - --- -- - - - .----------------------- ------ -. _ - -. 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. -.-"'.- .. - j/.- dated .-----7..t-.l THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE---------------------------------------- ---- --- � Inspector -- k��-----------.------ -_ .. ..._........-_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Q' TOWN OF BARNSTABLE FEE---- % ........ Permission is hereby granted -----XPA....m ..��---- '-------------------•---------------------------------------•---................ to Construct ( ) or Repair ( V) an Individual Sewage Disposal System at No...................... .......t...V;SX71:.C^ C).c.A....._... .................................1 ----------------------------•••...........-- Street as shown on the application for Disposal Works Construction Permit Nop.�_]_._.1��JCk�J.- _ Dated.._..__�.'.,_��.:�.�.•..-. Boarr of Health DATE ...............•------••-•--•- FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS No--75-71�)-� Fizim THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH + TOWN OF BARNSTABLE Appliration for Di!3pnial Worlai Touptrnr#inn Permit Application is hereby made for a Permit to Corrstruct ( ) or Repair ( Co�an Individual`Sewage Disposal System at: ......... �1.... �a�tc.v.._..�•-------•--� ��`�------------------------------------------------------------------------------------------••---- ` L c�t'oc -Addressor Lot No. 1 � --------------------------------- ---------`C�C_,s141.�.------------------................................................. n-ncr Addres � 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 ( ) Q' Other fixtures W Design Flow............................................gallons per person per day. Total daily flow-------------------------------------,......gallons. WSeptic Tank—Liquid capacity k!A.galIons 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 ( ) '~ Per olation Test Results Performed b -------••----------•--••---------------•-•--•------•--••.. Date........................................ Test Pit No. I__ ____________minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ fs. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..`_.__..__..___........ P4 ---- -------•---------- -------- ........................................ 0 Description of Soil.............5G`�S�_. (...GcuvC. .....--------•------------------------ U --•------------------------------------•-•-------------------------•-------------------•-----------------------------------------------------------------•----....--------------..-----•-•-----•------ W .............................................................. -------------------------------------------------- -t ------------------------------------•-•-•----•-••---••-•.---•- U �ature of Repairs or Alterations—Answer when applicable._ V--_..__ _.... Agreement: ] f Utid-u' 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 Compli ce has beegisIboard of health.Signed ....... ----------------------------------------- ......� .619 - Dare Application.Approved By . " Due TO Application.Disapproved for the following reasons- --------------------_.-----------------------------------------------------------------------------------------------------.... . ------------------------------------------------------------------------------------ -- ------------------------------------------------------------------- --- ----------------------- ----- ----------------------------------- Da e 7 Permit No. -• .�.. .. -........ Issued- ------- ------------�= - 7,,a� ------- � Dace A � CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I, �C o Cn V tc AV,. , hereby certify that the application for disposal works construction permit signed by me dated t�lS , concerning the property located at c�r C�cw ��_ meets all of the following criteria: • There are no wetlandsmithin 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in,flow and/or change in use proposed • There are no variances requested or needed. SIGNED : a �'� , DATE: � 1 cC J LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. C7, crk No.,� FEE...,,�,,.................. THE COMMONWEALTH OF MASSACHUSETTS BOARDgF I-DEALT _ a_..............OF...................� hsn/� r ......... .----------- ��.� 2Z� , ppliratiun -fur 43iipuiittt lVarkii Towitrurtiun Permit � 2 Application is r-by made for a Permit to Construct ( or Repair ( } an Individual Sewage Disposal System " - ----- ------- ---- V1 _ Locati Address or Lot No: O er .......................•------•----•--------Address Insta ler Address �,d UType of Buildir Size Lot_.----- _....:?-r�____Sq. feet Dwelling—l�'No. of Bedrooms____________________________________________Expansion Attic ( ) Garbage Grinder.... rinder ( ) a4 Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures _. . --------------•-------------•----•----------------------------.. .. Design Flow__ __________________ _ --------- gallons per person per day. Total daily flow.......... W �-------------------•------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 ox ( ) Dosing tank ( ) - G "/ ------------------------------ Date.................................... Percolation Test Results . Performed by__________________________________ Test Pit No. 1----------------minutes per inch Depth of "Pest Pit...---______-_____-- Depth to ground water-------..____..-__.----- 44 Test Pit No. 2................minutes per inch Depth of est Pit.................... Depth to ground water------------------------ P4 --------------------------------- 1 - - - O Description of Soil--------- --------------------------- =: %-e - U ..................................................................................................................4A------------------------------------------------------------------------------ W --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- VNature 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 Article \I of the State Sanitary Code—The undersigned furthe agrees not to place the system in operation until a Certificate of Compliance has been issu b he board alth. Signed ) ............................ --- -_----------------- ............................... Date Application Approved By--------- ' . -------- -------- �... -- -- y ateate Application Disapproved for the following reasons:.................................... ........................................................................... -------------------------------------------•----••-------------------------------------------------------------------------.....----.....------------------.....•--•-•----------•----------------------- Date PermitNo......................................................... Issued.------................................................ Date THE COMMONWEALTH OF MASSACHUSETTS �- BOARD OF HEALTH y._.._....--- OF........... •, .0 Fa�±..'�'r/�' ....-... Applirtttiutt -fur Biipufittl Norks Tonstrurttuu Vrrulft Application is here y made for a Permit to Construct ( b or Repair ( ) an Individual Sewage Disposal System at Location•-Address �/F'_l� or Lot No. /�• v O er Address Installer � Address •,,, '�"" U Type.of Building Size Lot...... �5V_k�---Sq. feet �-I Dwelling—No. of Bedrooms.............--`-________-__-._.-___.__.Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) d Other fixtures . •----------•----------- W Design Flow__p•_...................._.._______.__...gallons per person per day. Total daily flow---------- _ -------------------.._.....gallons. Septic Tank Liquid capacity& 'gallons Length................ Width.--------.--.-.- Diameter_-.--...-_.___ Depth....------------ xDisposal 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 ( ) _ / J) Percolation Test Results Performed by---------------------------------�_ .___._.._._._ a --------------••---- Date---------------------------------------- Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water...----.----..--._.--.-. !� Test Pit No. 2----------------minutes per inch Depth of/I est Pit-------------------- Depth to ground water-----------.------------ - ------------ --------------------------•--- --- -- - " =` .... Description of Soil , '� P - y ---------------_--------- ----------------------- U --------------------------------------------------------------------------------- W . U Nature of Repairs or Alterations—Anser,when applicable..--------------------------------------------------------------------•--------------------_--. �5 Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code— The undersigned furtherf'agrees not to place the system in operation until a:.=C.ertificate of Compliance has been issued byahe board of health.. Signed �'" - _.....:�--�•---� ,' _ PPApprove,.� ,r f Dater _ ...... Application d3• I-a �.-- Application Disapproved for the following reasons:-................................... ----------------------------------------------- te ------------- r--------------------------------------------------------------------------•------------------•-------------------------------------------------------------------------------------------- Date �(�ermit No......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEAL..UH ..........................................OF. ..................................................... �rrtif irtttr of Tomplittttre THIS IS TO. GJ��JIgg� t the Individual Sewage Disposal stem constructed ( ) or Repaired ( ) by-------- Or)A-C �t Ialle at------ - ---- ---------------------------------------------------------------------- ------------------- - has been installed in accordance with the provisiotf's of Article—Ig�,.The State Sanitary Code jdes it i�?t the application for Disposal Works Construction Permit No'ti �'_`________________ dated �J -•----•----------- } THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT TIME SYSTEM WILL FUNCTION SATISFACTORY. DATE /l a` ------ 5....................................... Inspector- ---------•------------ . ----------......................................... a THE COMMONWEALTH OL ( SACHUSETTS >6� • BOARD�HT ,......................................... OF..-................--.......... ;t.... '. No. T' FEE �trriutt Prrmit Permissionis hereb granted-----------------------------------------------------------------------------------------------------------------------------------........... to Construe cp vi i w e Di sal stem ...g .n��: Street Dated.......................................... y as shown qn;the application for Disposal Works Construction Per No' f -•••---••--- , DATE_ oard of Health FORM 1255 HOBBS & WARREN. INC., PUBLISHERS r,� . . , �, �� 7� as �. n' G � -lb - Zo � 3�� J � -� � �� . � 1 ��