HomeMy WebLinkAbout0028 WEAVER ROAD - Health 28 WEAVER RD, CENTERVILLE
A= 207-085. 002
No. 42101/3 ORA
47 A
ESSELTE
11%
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No...... .. �.7_`-13 Fas.3 0._...........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF •BARNSTABLE
,� lirtttion for U npoottl Vorkn Cnnnntrur#inn Permit
Application is hereby made fora Permit to Construct ( ) or Repair (K ) an Individual Sewage Disposal
System at:
................. . ........�� ►L ... �......---.......••--•-•----.........••-•--•----..........................-••...................
........
Lo lion-Address or Lot o.
-e ,��� ....... ......
Owner /
�- Address ......... :�l. s.......
ce—
.................... w:... ..�..(.......... 7
C5p�taller C b'.4 Address 1Aywv�eS
Type of Building c77 Size Lot............................Sq. feet
Dwelling—No. of Bedrooms....................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............................ No. of persons:........................... Showers ( ) — Cafeteria ( )
Otherfixtures ...................................:......................................................................•---•----...................................
allons per person per day. Total daily flow.... .......................gallons.
Design Flow.......:---�----•-----•-- ---••-•--g P P P Y• Y
Septic Tank--Liquid capacity.�it gallons Length... ... Width.LS........ Diameter................ Depth................
Disposal Trench—No.Z. s !— Width...f.�........ . Total Length__ `....... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
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........................
Descriptionof Soil...:.....................................................................................................................--..............................................
....--•----------------------------•-•---•----------••--•----------•--...---.......----------.................... •--•---.........-----•-••---........••••.............•...
Nature of Repairs or Alterations—Answer when applicable... ' 5. 14- --.•jGIOQ.Sri.: __.. ..= 4- ...
y oL. U.Yl -._.a�e,/�- �.. TPd✓......... .STD' ....[d.! ..._�`�-...�C1.��1 ......
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with .
the provisions of:ITSI] 5 of the State Sanitary Code— The undersigned further agrees noLLQ.DJ ice thj system in
operation until a Certificate of Compliance has been issued b the boar of health ��CT " 0 //�
Signed. ............... ....... _ ...... ...... __ ......-•--•- -
_..�= €..::Szs-
Dt...
Application Approved BY ............ ----•--•-- •..----...
t Date
Application Disapproved for the following reasons:..............................................................................................................-
N
S � Sate
.............................•• -• Issued_........`.
Permit No...........-•---• .................................
Date
F
No................_....... Fss- . ..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF •BARNSTABLE
AVVIiration for Iliopostt1 Worko Tonotrurtiinn Permit
Application is hereby made for a Permit to Construct ( ) or Repair (�4 an Individual Sewage Disposal
Systemat__....._.... ---- •-•-•------------------•---- ----_--_.. .........._................. ........
......... ... Locateo --Address or Lot•No� ........... .................
5� /� Address
�,lo /..��.. /. ..—................ --'`� PZ"�- ... ............... i riin� 2 t% VAS�7
Insta er Address
YP Building `� ............................ i�ywv.t5 M�
Type of Buildin � 5 CG�- Cc� Size Lot Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building .......'. - __.__...._ No. of persons..............:............. Showers ( ) — Cafeteria ( )
Otherfixtures ._•---•-----••. ------•---•--........•••--•=•-•-••---••--.....•--•---------------••--• -•-............._.._......----•---•---•..._..-••-......_.__..
Design Flow.................. ...................gallons per person per day. Total daily flow......... -- .................gallons.
Septic Tank—Liquid capacity............gallons Length.........:...... Width_.............. Diameter................ Depth................
Disposal Trench—No. jT7lMP_. Width.___.._.._.._._. Total Length..'C�_........ Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
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........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Descriptionof Soil.....................................::.:...:..:..::...........................•---.....------------._...---......_.._..._.........-......._..•_•-•-•--......I......-•--•
.---------------•---......----•--•--•--......--------•--....--------......_..---•---------•-••---------------•-----..._...._..---•--••---.............................-•-----......_•-------------•__-••-
....-•..................................•--•-------------•--------------...........----...._............-•---....-----......_..... ........................................................
Nature of Repairs or Alterations—Answer when / ............
�• �=-----•--•--`-- A4..- ® � .........
Agreement:
�
The undersigned agrees to install the aforedescribed Tndividual Sewage Disposal System in accordance with
the provisions of TITl.L 5 of the State Sanitary Code— The undersigned further a ees
operation until a Certificate of Compliance has been issued by the board of�-l-rea•I
Signed................. ...... ........ ✓... _. _.._._. ._..... :- ......
3 �-F
Application Approved BY---••--_---- --_.... .... ..............................: �� ....---...__......._
Date
Application Disapproved for the following reasons::.............•____.___..._..___._......_______------------••--••--••-------•---.._......_...._........._•____-
...................••--•-.....-•---•-----------•._......-•---....----•.......-• -•--•---•-•-...._.._..........-••-•-••--•-•-••••••--••••---•---•---•---•-• ---•••-••-•---•--..........•----••--•--------
S S ?C-/ Issued........ �.___. ._;_,_...-S?ate
.......
Permit No.............------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN of BARNSTABLE
Tertifirate of Tomphunre
THIS IS TO CERTIFY, That the Individual Scwa eeyDis oem corud� eor Repaire� ( j
by--------------------------------------------- .:...............
Installer
/ 1, �� ✓ .1 ....................................................................
has been installed in accordance with the provisions of TITILE_ 5 f The State Sanitary Code as des 'bed ' -the
application for Disposal Works Construction Permit No---- •---•-•----• dated............ .................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFAC RY.
DATE..........'J... ............. Inspecto .... •=-t r!!
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH 00
TOWN of BARNSTABLE
No................�1-.�-. �� FFE........................
�io�oo�t1 urko �onotrnr#ion �eriltit ��
< .
Permission is hereby granted.......................... ..._. ..............._._.........-_--......_ .....
to Construct ( ) or Repair (1-4 an Individual Sewage Disposal System
C ^
at No.... -------------------. )...._.. llz'Ex<c_- �
Street �jS `�V
as shown on the application for Disposal Works Construction Perm/'' No...�.-.i------------- I��ted�...._.. - %t..� '......---C� ---./i- ----•------..............................
i ;41 3
Board of Health
DATE................................................................................