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Home My WebLink About0021 WESTMINSTER ROAD - Health 21 Westminster Road Centerville A= 168 - 075 UPC 12534 � NO wnrwa�r APPROVED THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Applirbeat n for Diripwml Workq Tontitrnrtion rrrmit Application is hereby made for a Permit to Construct ( ) or Repair Individual Sewage Disposal System.at* -- • ... - At'L -: dr s or Lot No. cr Addres a /--------- --------G ---.............................................. 7Z�- Gf Installer Tr, Address UType of Building .� �/ Size Lot............................Sq. feet rl4., Dwelling—No. of Bedrooms--------------------------------------------Expansion A tic ( ) Garbage Grinder ( ) 04 Other—Type of Building ---------------------------- No. of persons------------------------------ Showers ( ) — Cafeteria ( ) 04 Other fixtures -------------------------------------- ----------- -- --- ----•- ................................................... •-•--•-----------• -- ....... W Design Flow........... ` gallons per person g�r day. TotalValflow.... ...........................gallons. Septic Tank—Liglt"d-Va y/ .gallons Length__.-IS---------- 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. I................minutes per inch Depth of Test Pit---------_.......... Depth to ground water........................ LT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 --•-------•................•------••-------------------------------•-----------------------••-•.............................................................. 0 Description of Soil........................................................................................................................................................................ x U ------------------------------- ------------------------------------------------------ -.---------------- ------------ --------•-------------------------------------------------------- ••----------.. W ----••-•--••-- ------------------------•----------•-•-•-•-•-------------------------------------•-----------... 1 hV U N ture of Repairs r A teratio s S nswer w en a plicabl � ._ ..._ _..�_... ...(.o..... .....:.................... ..................... emu. - ./. .... .... h� f .� x------------ -----------------•--•-....... 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 undersi ned further agrees not to place the system in operation until a Certificate of Compliance h e iss ealth. Signed .. . `�.............. ... .......... .............................. ........................................ Dace q Application Approved By ....... .... ......................................... ................... ............. 6;".. .-..-F..� Application Disapproved for reasons: .................................... . ................:......................................................................... ........................................ ..................................................................... . ............................----.--- ........................... ........................................ Cy Dace PermitNo. .....g. ...- g�.�.....✓............... Issued ........................U----....................................... are I/, Ci /� ) � f j /{ (I'Q CJ s No r FEB ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH S� l S` TOWN OF BARNSTABLE Applirttti>alt fir Ditj-p'uiu1 W,arli,6 Cnowitrur#"tun frrutif Application is hereby made for a Permit to Construct ( ) or Repair �, an Individual Sewage Disposal System at• ' /.... /.�....�.�® �� , --------------------------- Vid (�/' ../�.[tiol(�--1/ Ir-�1�(_ .............................................Addres ro m! t L.)_`--t_........Address Installer UType of Building ._.. 3 ��/Size Lot............................Sq. feet .-I Dwelling— No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ___________________________• No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures --------------------------------- -------- -----•------------------------------------- ---------------------------_... ........---•-------•-------- Design Flow............�............... gallons per person pr day. Total daily flow....3 7................. ...._. .. .._. .._...gallons. WSeptic Tank 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a ,.� 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........................ 1:4 ............-------------------------•--•--•--•------------•----...------.........-•---•------................-•---••---•----........-----.................-- 0 Description of Soil..................................................................... -••-------------...-----------••--------......----................................................ x w ----------------------------------------------------------------------------------------------------------------- .............................. - .................... U Nature of Repairs r Alterations—Answer when a plicable,l/_)---SY t_f�-.-___---(�xl�...•100U_.•-�/CC///'rC�_- p -- --. ------ ! r......- h7I .......y ....f S�/ //?_! ..... :7i�J./ _ ..............( -- C/!_ / - /ea , ..............• 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 Certific e of Compliance has.-been issuedby-the,�oard/of/health. // Signed ...1 J.......a/ .... _/..`\ l/........................... .... .........................1'7 . . v a �•�,, ..K�.�� .-.� .✓�".-..1��..-.. ..y ......... ...................................................................................... Dale Application Approved By ........... /Dare Application Disapproved for the following reasons: ................... ............................................................ ............................... ........ . .................................... ....... ................... ...... 17 Permit No. -----.. Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Camplianre THIS IS TO CERTIFY, That'the Individual Sewage Disposal System constructed ( ) or Repaired y .................................................................... .. J I xnllcr _................_........................................_............-.................................. at ............................................................l.........l.�i` ,.� � .y` -'J.�:..... �....(..............._... _....... 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. ..... ..y,.:.. _y_.9_---- dated _. ............................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ........: ..... .....J..l.....`../...L/.------ --------------------- Inspector . -----------_�. '..�.- '..:--- .....---- .....------------------..------.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH cc77 TOWN OF BARNSTABLE Disposal SabiTunptrttd�y Prrmit Permission is hereby granted.................. to Construct ( ) or Repair e-- an Individual Sewage Disposal System• �} at No. -ra € //f ��'?1�7.`2.�l!j......................` :-�-�-�---- ................................. Street as shown on the application for Disposal Works Construction Permit No.__7�_)_Y? ..................................... i =— --------------•--------------•-----•------••- /Board of Health DATE......................- r ---•------- FORM 36508 HOBBS B WARREN.INC..PUBLISHERS fi • cp. TOWN OF BARNSTABLE LOCA. I ON SEWAGE # VILLAGE ke — ASSESSOR'S MAP LOT INSTALLER'S NAME & PHONE NO.46ef SEPTIC TANK CAPACITY PY15 7'127 MOO LEACHING FACILITY:(t ) /'t NO. OF BEDROOMS \ P A, SELL OR PU LI WATER BUILDER OR OWNEGC �� DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: �� VARIANCE GRANTED: Yes No c, 3 d e 1� ,