HomeMy WebLinkAbout0064 VICTORIA STREET - Health 64 vI ctorto, st
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SUSTAINABIF
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No......93.:?/ F>;s... ....30.00
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
� TOWN OF BARNSTABLE
,} Appli tt tutt for Diripwial Works Tomitrurtiun Famit
Application is hereby'inade for a Permit to Construct ( ) or Repair �X ) an Individual Sewage Disposal
System at:
64 Victoria Street Centerville
-----------------------------••---•--...---.........----•-•----------------------------...•-•----- -------••-----••--••-----••••....--••--•••-••....-••...._....--•.................---...---•-_....
O'Sullian Location-Address or Lot No.
W J.P.Macomber Jr. O,.ncr Address
1.4
� ListalIer Address
VType of Building 3 Size Lot............................Sq. feet
Dwelling—X No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ............................... . .
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
C' Septic Tank—Liquid capacity............gallons Length-_------------ Width---------------- Diameter....------------ Depth................
Disposal Trench--No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft.
3 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........................
fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
1:4 --••----••-•----•--------------•-------•-------------.........--•-•............-•--•---•---......•-•.........................................................
0 D scri do o Soil...._ .... ...................•--••---•--••---....-•-----•---•---------------------------•--------
W hand g travel
v ...............•---------••----•---•--.....--------------------•---•-•---------...................................
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V Nature of Repairs or Altera io s—A wer when p kale Adding 1-1000 ga l'Yori Teaciiri
to an existing 1�0J ga ionn ' �n 1��J0 gall"on le �� pZ :' "" ""'"'""""""'
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 Compli nce has e 1 iss ed bIthoard of health.
Signed ._ . .. Lf r ...................... -----h/1Q./93..........
Date
Application Approved By ... ... .777)
^ eZ/.°...g5
Application Disapproved for the fol owing reasons: ....... .................................................
........... ......... .. .................................................... ............................ . .. ..._............... ----- . ............................
q ( Dare
PermitNo. .............0 3...-.X7.Lj.................... Issued ....................................................................
Date
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.....r......+.nee.... .......r •- ..-...... r..�-...., Ws.e - "Yv,.
I3=�: �l - $ 30 00
o.--•--......------•-•-•- � ; �- -�=Fps..............................
THE COMMONWEALTH OF MASSACHUSETTS
' BOARD OF HEALTH _ 6 5—
�� •��5 TOWN OF BARNSTABLE `/`YYZ``�"" I �7 C�
Apphratiou for Ui►ipooal orkl -Cnogtotrnrtion rrmit
Application is hereby made for a Permit to Construct ( ) or Repair �X ) an Individual Sewage Disposal
System at:
64 Victoria Street Centerville
..-............................................................................................... .-----•--------------------•--••••----••--••-•••-----..........---....----•-..............-••-....
01 Sulli •an Location-Address or Lot No.
......................--.......................................................................... --------------•--.....-----------•-----•••-------................................................
W J.P.Macomber Jr. O�.•ner Address
,.� ..----- ...--•-•-•--•--•--••••------------•------••-------•------------•--•-••......
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 ( )
d 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.
3 Seepage Pit No------------_----_- Diameter.................... Depth below inlet.-"................. Total leaching area..................sq, ft.
Z Other Distribution box ( ) Dosing tank ( )
1.4 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........................
O ------------------------•----•-----------•••--...•---------•-.....--•.....-----•._........_.._..............••-•-......•--.....•--•--------.........---•-----
DMacNiogI o&Soil...e" •.................
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is �� -- ------•--- - - --.....-----
x ---'------------ ..... . .. .. Acldin i-5"Ooo
U Nature of Repairs or Alte a i s—A wer wLlien applaicable , _ f'a�lori __Ieac_hi..... pit
to an existing anon anx na l���J" " sian lici 1I..
... ---------•----------------..........................................
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 has been, issued by t e board of health.
r
Signed .... / ��L..... ...-' -' .-..!tom' ..._........-' .6/iQ/93...
Dare
Application Approved By .................. (.. .......: :_---� , ,.r. .
.. ' .' ..........................>.......
Date 7
Application Disapproved for the fol owing reasons: ...................................................................................... ....... ...................... . '
Date
PermitNo. ............. ... ...-. .�.�..................... Issued .......................... . ............................ .....
--
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
(1erttftcttte of Tompliance
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XX )
by ........J...P..Macomb.er....Jr..................... ....................... -'' ' ... ' ' ...... ....... ' ......... . ............................
Invallc,
64 Victoria Street Centerville
at ........ ' ... ................... -----------------------------........ .........................................................
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. ------1.3..I...."_7 ... dated ------._------. .. .
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUEA _.
AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE...................._...% .......,-.. f......../�7 -77 j.... Inspector ..... ------- -----.:. -----..._...---..__.._...-------..------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE NO...��...�...--�:�� FEE.._�...30.-oO.
Disposal Workii Tonotrution "vin it
J.P. acomber Jr.
Permissionis hereby granted.................... ----------•-------•--------------------------------------------------------------------------•-------•-•---.........•-
to Cons�uct iC)t°C7rr} gai�t(YX,�ea�n �neclinv��le1��1��Sle��ge Disposal System
atNo.-•------F----------------------------••------.....-------------"•-- ------------...•------•--'---------'---------......------......------------........... ------ ...........................
Street
as shown on the application for Disposal Works Construction Permit No�3-��. Dated"..........................................
-- --------------------------------•---------------••-
I Bbard of Health
DATE................................................................................
--...----•-----------•--•------------•----------------------•-----_.. v
FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS
a C-;
TOWN OF BARNSTABLE
LOCATION V ��c,Ior cc 4 L� SEWAGE # 7
VILLAGE r(',� /(°,r /i I
—�� L � ASSESSORS MAP & LOT
INSTALLER'S NAME & PHONE NO. �Mk,--ne, 7
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) J7,(� (size)
NO. OF BEDROOMS+ PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR®. OF HEALTH
..._.......................................O F.........................................--------------•---....................._.....__..
Appliration for Bitipm al Works Tonstrnrtinn Vamit
Application is hereby made for a Permit to Construct (V_�or Repair ( ) an Individual Sewage Disposal
System at:
i
ocation-Address or Lot No.
................ ............ ... ... ._............ ••-•••••-•-......................................................................................
a r...O.. Address
-----------•----------•...........................
Installer Address
Type of Building Size Lot.....:......................S . fegt
U Dwelling—No. of Bedrooms...............��........................Expansion Attic ( ) Garbage Grind (`1�.1�1
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeter
Otherfixtures -----------------•------------------•--.......--------.--•--......---••-•--------••----•-•-••----•--------•....----.........-----..._......-•---------
W Design Flow.............. ......................gallons per person yr day. Total daily flow...............3 .<)..........._....gallons.
WSeptic Tank—Liquid capacity.lQQo.gallons Length... Width---Y ...... Diameter................ Depth..... ...
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
.I Seepage Pit No-------1----------- Diameter.. 2!:�_..... Depth below inlet---4.:-C....... Total leachin arep..-�_.?Q. .sq. ft.
Z Other Distribution box (� Dosing to ( ), >> �'e `J �` `t CY`P�'
'-' Percolation Test Results Performed by....... _ ..G.I.I�E e ,..AR........_. Date........L7z 2_4.-.k3__.__.
a
Test Pit.No. 1. ___minutes per inch Depth of Test Pit...
Depth to ground water...
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a _
O Description of Soil---- ...1�17- ?.....� _ --•------------------•-•---------......_.
W
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-------------------------------------------------------------------
-------------
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U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
-----------------------------------------------------------------------•--•-•------.....---••-•-----....--•--•------.------------------------•----------------------------------------•......•--------
Agreement:
T ndersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the ovi ions f l I h
p 5 the State Sanitary C —Thyundersigned further agrees not to place the system in
op ati er,i ca f Compliance has bee sued the board of health.
f ed... :............... .........................................................- ziz ._....
Applit' PProved BY •--• ------ .... ..fir---- --------- ----------•--•----------•---•--------....-•-•-- -� .............
App tion Disapproved th ollowing reasons---------------------•-••-------------------------------•------------------------------•---...--•--•--...........
...........................................................................•---------.................._.._
------------------
Date
PermitNo......................................................... Issued........................................................
Date
d�
FRIM Q................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...........................................OF.....................--------•--...... ..............-......-.........................
Appliration for Dioposal Works Tonstrurtiou Frrutit
Application is hereby made for a Permit to Construct (/) or Repair ( ) an Individual Sewage Disposal
System at: r
.....•• - •---.-. .. - - - - -
ocation Address --or Lot No.
............. — ._.. .... .........................,
Ow er Address
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms.............�_........................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
PL4 Other fixtures .•--•--••--•--•---•-----•-••-_.... _
Design Flow............�•�? ....................gallons per person per day. Total daily flow............._3 ._<�.........._.......gallons.
W p q p y. _. _ gallons Length__ _,...... Width...�....... Diameter................ Depth....Y.?.....
W Septic Tank—Liquid Li uid ca acit ��+�p__
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No......./----------- Diameter._!%.-_g_...... Depth below inlet...:®........ Total leaching ar ....sq. ft.
Z Other Distribution box ( ) g ( ) C'.� J �' 'Dosing tank / !•
'� Percolation Test Results Performed by....... r ,.__!..!' .___.___._ Date._._____��:_ �__ `_......_..
� 1, .a
a Test Pit No. 1_ _ '____minutes per inch Depth of Test Pit--- _.___ Depth to ground water..X)12 01;:____-
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
O Description of Soil.._cC
x
U •••••••-•-••-•------•••-...•---•........-•--••••-•--•-••-••-•-•-•-•-••--••--•-••-•••••----••••-•--••.....••-•-•••••••••-----•••--••---•-•-•-•••--•--•-•-.......-•••---•••-••---•-••...............•-•••.
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-------------------------------------------•-------------------------------------------...------------------------------------------------------. .....................................................
U Nature of Repairs or Alterations—Answer when applicable._______________________________________________•__---------__-_______--•------•------•-______-.
------------------------------------•-------------......------------------------------•---------------------------------------------------------------------------------------------••.................
Agreement:
TK undersigned agrees to install the aforedescribed'Individual Sewage Disposal System in accordance with
the prov' ions of TITU 5�f the State Sanitary Code— The undersigned further agrees not to place the system in
operati, 'it it a'tifica f Compliance has been issued by the board of health.
F S' ed..
�. 1�1 ✓ ate
Applica on pproved By----- ; ...................
APPIu,ation Disapproved r t f ollowing reasons---------------------•-----------------------•----------•----------------------------------------------..........
----------
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF H, ALTH
a
.........................'.h'✓.............OF.................... .............
Trrtifirav of Toutptianrr
T- IS IS TO CERTIFY, That the Individual Sewage Di s Syste�ons ucted or Repaired ( )
by . ' r*?! ... ------------------------•------•-•......---
" " Installer
has been installed in accordance with the provisions of TJTT7 5 of The State Sanitary Co as described in the
application for Disposal Works Construction Permit N /
PP P j%`fE� dated -I '
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.................•--•...............--•------•--•---------•-------------......_. Inspector................
---------------------------....----•---••-•.......----------.....•.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF' HEALTH
� � �-�./
OF......................................:........:....................................
o FEr'�'`1-1..................
Disposal Works 0onutrudion prrutit
Permission ' hereby grante
to Const ) opair ( Indi dual Sewag i osal System
atN .•••• •--.........•-•-- -•-••---- ..•... •-•--- .
Street
as shown on the application for Disposal Works Construction Permit No_______________ atd`__ _ .___ .._.............
+ oard of Health —
DATE............ •••-••-•••-•................................
FORM 1255 A. M. SULKIN, INC., BOSTON a. -
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l0 CATION
SEWAGE PERMIT NO.
VILLAGE
I N S T A LLER'S NAME i ADDRESS
4 cP
d UILDIE R OR OWNER a�dyS�
DATE PERMIT ISSUED
O OAT E COMPLIANCE ISSUED jqo/
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