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Home My WebLink About0015 WEQUAQUET AVENUE - Health /// S M E A D No.2-153LY UPC 12934 smead.com • Made in USA �{tECYC(,!b SUSTAINAM FORESTRY INITMVE Certified RberSeerchig �uw.r.efiwoerenwre No.�._�i_^. Fns.....$....2.0 -.0.0. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .................To.wn.------......OF.....Barnstable ApplirFa#inn for Dispnsaal Works Tnnitrur#inn ramit Application is hereby made for a Permit to Construct ( ) or Repair k.Xj an Individual Sewage Disposal System at: 15 Wecruacfuet..Ave. Centerville . ............ ....•••-••••---------•-•••------••......•••-•_... ...---•----------------....-----•-----...------•.............--•--•-••--•......---••-•--•-•....--- Location-Address or Lot No. �1 a .............................................................................. .................................................................................................. Owner Address aJ.-.P_-.Maq.Qmjber............................................................... ....----••------------------------------------.................---------........------•.....•--•-- Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—X No. of Bedrooms..................3........................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type T e of Building ............... No. of ersons.................---.------. Showers p., yp g ------------- p ( ) — 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 ( ) aPercolation Test Results Performed by.......................................................................... Date..------------------------------------. Test Pit No. 1----------------minutes per inch Depth of Test Pit...........--....... Depth to ground water..-----.--------- GTq Test Pit No. 2................minutes per inch Depth of Test Pit--.--.......--...... Depth to ground water..------..--........---. 9 ••-•-•........................................••---•---------------.-------------------•-------------•-... •------------------------------ •------------------ ODescription of Soil..............................................................................................................................--------------------------------- x Sand & Gravel V ---•--•---------------------------------------------•------•--------------...........-•••....•-•-----------------------......----------------------------------------•---------•-----------••----.------ W V Nature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------- -------------------------------------------•-------------------------. 1--10 0 0.•.g a l l on...l e a ch. l-t------•----------------------------------------........--__---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of I T j. . p of the State Sanitary Code— The undersigned furtherrees not to place the system in operation until a Certificate of Compliance has be issued y t dbDo.ad of heal .Signe .._. A f�VV ................ ...... 1_ 7/$ ..... late Application Approved By---------- ^�`�---------------•------------------ ............. Date?" Application Disapproved for the following reasons---- ----------•-----------------------------------------------------------------•---------------------.......... ......---•----•-----•--------------------------------------------•--------•-......------....------------.•-------------------------------------------------...•-••-------------------------------------- Date PermitNo.-- .......................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................Tj_Ojqn............OF...... .......... Appliration for Disposal Works Tonstrurtion "rrmit V Application is hereby made for a Permit to Construct or Repair kXk an Individual Sewage Disposal System at: .15...Nec�.u.;.L'ILLat... -------------- ------------------------------------------------------------------------------------------------- Location-Address or Lot No. 4R—arte'exi----—-------------------------------------------------------------------------- .................................................................................................. Owner Address •.42 0- 2 .............................t................................. .................................................................................................. Installer Address U Type of Building Size Lot............................Sq. feet Dwelling--XNo. of Bedrooms................._.......................Expansion Attic Garbage Grinder 04 Other—Type of Building ............................ No. of persons.._..................__..._. Showers Cafeteria 914 Other fixtures ....................................................................................................................................................... 9�W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width..._............ Diameter......----_-____ Depth_._.........._.. Disposal Trench—No..................... Width....._.............. Total Length.........._......... Total leaching area--------------_----sq. f t. Seepage Pit No..................... Diameter.._................. Depth below inlet.................... Total leaching area..................sq. f t. 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---------------------- GZ4 Test Pit No. 2................minutes per inch Depth of Test Pit................_... Depth to ground water........................ P4 ..........................................................................................................................................*------------------ 0 Description of Soil........................................................................................................................................................................ �4 ............................................................................Sand...st...0-ramp-L........................................................................................ U W Z ----------------------------------------------------------------------................................................................................................................................. 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 TT 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 by the board of health. Signed...... ...... Date ApplicationApproved By.............. ........... .. .... ........................................................... ............ t Application Disapproved for the following reasons:................................................................................................................ ........................................................................................................................................................................................................ Date Permit No..... ... IssuedL.......................... -------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............T. ................OF.........Ba.r.n.S+_ .nLV............................................. (9rdifirate of Toutpliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired kX) by--------j—P-3,14ac-sm x---------------------------------------------------------------------------------------------------------------------------------------------------------- Installer at.........1-5... ... has been installed in accordance with the provisions of TITIE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.__....._ ------- dated-----------------------_----------------------- THE ISSUANCE OF THIS CERTIFICATE SHAI �T BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................. ................................. Inspector...................... fi .............................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - M NO....fg.....3—ae7 ....... Town.............0 F.........B a.r An s.t 11.b.1.t....�......................................... IFEE-1...2-�Q.i.Q 0... Disposal Works Tonstrudiatt "pautit Permission is hereby granted........3L.R-Ka con,b.e.r.................................................................................................... to Construct 5 W( ) or Repair '�X)� an Individual Sewage Disposal System e at No.. ............qu4.qjA�t..Aw CenbervillLa. ................................................................ ...............I...................................................................... Street as shown on the application for Disposal Works Construction Permit No...,q� __3��& Dated.......................................... - ---- ------- DATE..................... .......I.................. ................................... lic�;_H_ealth------------------------------------------ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS - r TOWN OF BARNSTABLE LOCATION S Vej—�� OkLie— SEWAGE VILLAGEI.f.��C,V V I. 6 ASSESSOR'S MAP & LOT -, t 7 - 333Fs 1 INSTALLER'S NAME & PHONE NQ-T Go- P - y\� G IMbe[ d. SbN 5 SEPTIC TANK CAPACITY _ LEACHING FACILITY:(type) (size)_lC�UD q4/<o�lS NO. OF BEDROOMS ?J PRIVATE WELL OR(PUlB'LIC WATEOPVJ BUILDER OR OWNER W) 1ZS . 1� Gy DATE PERMIT ISSUED: - 7� DATE COMPLIANCE ISSUED_= 7 - VARIANCE GRANTED: Yes r � �- 9