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Home My WebLink About0968 WEST MAIN STREET - Health (2) 968 West Main. Street Centerville r A= 249—053 S M EAD No.H163OR UPC 10259 smead.com • Made In USA .roz). 1'4r asu No._99." 171- Fss........ ....20.00 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH T.o.w.11................0 F..............Barnstable .......................... ........................ ApplirFatiou for BiiipniiFal Works Cnouvtrurfinn ami# Application is hereby made for a Permit to Construct ( ) or Repair XX$ an Individual Sewage Disposal System at: ' d ... 968 West Main S t re e t--=.. -s - -.......-•---------------------------•-------------•-•------•------------------------•••-•.....•-- Location•Address or Lot No. ...............Ha_7.d ...Uah.].DVU—C.K........................................ ..........--...................................................................................... Owner Address a ...............►T-..2--hiacombp-r................................................. .•..••••...•-.-..-••.-.-..••-•.-..--•..•....•......•.-....••••••••....................._.......... Installer Address d .Type of Building Size Lot................-...........Sq. feet U Dwelling No. of Bedrooms-------------------------------- -Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) aOther fixtures ------------------------- ............................................................... 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. , n. 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........................ Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water...----.-------------.-. a -------•-------------------------••--------------------------------------•-----•----•_--•-------------_-:•...---•-•-•----•---......---.........•--•-••-••••. ODescription of Soil....................Ga-nd----&---Gra-v-e3•--•---------------------------------------------------------------------•--•--------•-----------------•------- x U W •----------------------------------•----•------------------------------------------------------•---•--------•-----------......-..-----•------•-•-----••-----•-•----•-•••-•----•-••---•---•••-•-•--••--•- UNature of Repairs or Alterations—Answer when applicable.----------1-, ]-40-0....ga1,l,on---leach.-pit-------------------- ..------•----••------•------••-•••••--•-•-•--------•---•-•=••••••--•---••--•-•••---•••••••••••••••••-•--•••-••-•--•-----•-•••-------•--•-------••••----•--•--------••-•-•----------•-•-.........-•-•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI 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 bw the and f health. Signed--- ..•.. ..........••-•••••--••-•--•--••----- ••••41.-1 /s38.--••••-- Date Application Approved By••-. ............I Date Application Disapproved for the following reasons-------------------------------------------------------•--------------------------------------------------•••-•- ..-•----•-•--..--......•-•••-••--••••-----•-•-•-•••-•------•••-•....--..•...•.............•..-•-----•.•.......-..---•---••-•••------•-----•--••-•-••----------------•----•-------•--- --------...... Date PermitNo........ = L71.......................... Issued-•-------••---••------------••-••---•--••---•------•--- Date No�4� >�7�•--- Fic$........$....2D.AM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............!I+gjt n_............._OF...............Barn_gta.bje•-•--............._........................ ApplirFa#ion for 0hip i al 10orkii Tnnitrnrtinn rumit Application is hereby made for a Permit to Construct ( ) or Repair �Xj an Individual Sewage Disposal System at: ...............9L6.8---lust-. ---- ------•--------------------------------------•---•------------------------------------------------ Location-Address or Lot No. a 1,. Owner Address..............J.1.P_1 raQQV1ii9=*1----------.-------------------------------------- -----------------------------------------------'!,E...........-................................... Installer Address Type of Building Size Lot............................Sq. feet U 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. 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 box ( ) Dosing tank ( ) Percolation Test Results Performed by.....................................................•••......-•'--••----- Date........................................ 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........................ ............................................................................................................................................................. oDescription of Soil-------------------. £;--fG'-avL=t---------------------------------------------------------------------------------------------------------------- x W ..........................................-'-......•-"•"'-------••-•......._.....-"---"-'•-"'•--•'------------------------....-•-.....:.•-•--•-'•-•••'-•-•-"---•-""•--"-'-''•---••-•---•-.--" UNature of Repairs or Alterations—Answer when applicable.----------I.—I.G0fl---egad.-lan----1-eaeh...pit.................... ..------'------------"'-----'------------------•---•----------•--••------------------•--••-'------------'----------------------•------'•---•--'----------------------'-"'--•--•••--•••....._.......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT12 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 b.;the b' ard, f health / ' g '� ' ...44.1.3-1-82......... Date Application Approved By.............. ,3-----. :. ------- --------- Date Date Application Disapproved for the following reasons-------------•-•-•--•--'---------'•--••----------------------................................................... ...................................•-•'.....----------'-------------------•-----------------•-------------••'--•'--'-'--•------•--•'•-"---"---'--•---•----------•-•----•--'-•-----------..'.......... Date - PermitNo.......et......../--7/.......................... Issued-...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town.............OF............Barnstabl. .e . ............. .............. ......... ....... C'rr#ifiratr of f�� mptiFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired kX) by...._3. r----------------------•-----------.-.----------------------------------------------•------•---•-------•------------------•---•-•---------------.---•--------- Installer at.......9.68...West-..Main.-.atreat..ay.annla,NA-* .............................................................................................. has been installed in accordance with the provisions of TIT r 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...._.A�."_._�_,�1............. dated............................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector......................................................................0............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town................OF.........Barnstable ..........-•'-------....................... 20 00 No.'-- j ' r� FEE...$...- 0.. Disposal nrkii Cwianitra uan Trani# Permission is hereby granted...._J.P.Maeotnber to Construct ( ) or Repair �X) aw Individual Sewage Disposal System at No......968_..West..M.ain-St:.r et_._H�rannis,Masa� -------"-'-----'•'--'-.... Street as shown on the application for Disposal Works Construction Permit. o.__�".7�... Dated.......................................... ............................................................. � — ..................•....... Board of Health DATE-----•------------- --- ------ -- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS rA "TOWN OF BARNSTABLE LOCATION ��6 alar SEWAGE # aE- 17/ VILLAGE �/� �,�J ASSESSOR'S MAP & LOT ,U g� . INSTALLER'S NAME & PHONE NO. U, , SEPTIC TANK CAPACITY LEACHING FACILITY:(type) eg- Alas r J�- �� (size) -JAW NO. OF BEDROOMS_PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER ,✓�aQYANZ DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes y No �o Q-7 L i