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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH earnsrag1j, APPROVED
Conservation Department
TOWN OF BARNSTABLE
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App iratinn for Uiupnial arks Tonutrnr#innnn
Dato
Application is hereby made for a Permit to Construct ( ) or RepairX) an Individual Sewage Disposal
System at: X
30 Joan Road Centerville
Location-Address or Lot No.
JamesDaly- --• ............................................................ ............................................. - .....-•••-----------•---......... •------
Owner Address
J,,,P,.Macomber Jr.
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling XXNo. of Bedrooms.............2.............................Expansion Attic ( ) Garbage Grinder ( )
�a Other—Type T e of Building No. of persons ...................... Showers
yP g ---------------•-----------• P ( ) — Cafeteria ( )
Otherfixtures ..---•--•-------------------------•---•--------------------•---•--------------------------------........•-••........•... --•-_-•-••-
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....................--..
L14 Test Pit No. 2................minutes per inch Depth of.Test Pit...:................ Depth to ground water.....................--.
P4 •----•••-----••••---••---•-----•-•-•...•••----•--••-••-•---•---••-•-•-•----.......••----------•••---......................................:..................
ODescription of Soil......-......................................._-...... .............•........................................................................................
U ..............................................-•-•--•--•••......•-•-------.Sand & Gravel
W
z ---------------------------------------------•••-•---•--•------•--•----------------••••••-------------•------••-----------------------•----••-••----•••••--••••--••••-••-•--•----•-•---•-...._.........
U Nature of Repairs or Alterations—Answer when applicable................................................................................................
1.-.I.Q00---ga11on....UJIK.._.I-100Q--•-gallon leach---pi.t
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 Complian has be is ed by the bo d health.
Signed ---- d✓ -V ....... ---_------------------------ .......811-9-/9 2.--...---
Date
Application Approved By ........... �� ........ ................................... $.'. �P..-.Y.-`
Application Disapproved for the following reasons: ........................... --'-' "------............--------------........--"---''-"--. ....-----... to ....--..
....................................
q Date
PermitNo. ---------9�.........� ...................... Issued --- ------------------------------------------------------------
Date
J S U.111Y
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
AppliratIlan for Disposal Works Tonkrwtinn [r`rmit
Application is hereby made for a Permit to Construct ( ) or Repair ( XX an Individual Sewage Disposal
System at: X
30 Joan. Road Centerville
Location-Address or Lot No.
James Dalv
Owner Address
aJ .P.... comber Jr. -----------------------•----------------- ••--••--•---•------•••._..._..-----•-------•--------.._....-•--•--•-----------••---........._
Installer Address
dType of Building Size Lot----------------------------Sq. feet
Dwelling XXNo. of Bedrooms.............2.............................Expansion Attic ( ) Garbage Grinder ( )
04 a Other—Type of Building No. of persons............................ Showers — Cafeteria
P4 - 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........................
(Ll Test Pit No. 2................minutes per inch Depth of Test Pit---................. Depth to ground water........................
a •---------•-------------------•--------------------•-----•...--•-------------••------------•--•-----........................................................
0 Description of Soil...............................................................................----------------------------------------------------------------------•-------•----•----
Sand & Gravel
V ---------------------•------------------------------•-••----------------------------•-------•---•--------------------------•----------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable-----------------------------------------------------------------------------------------------
1_-_1000__-clallon--tank---1--1000--crallon leach pit.
---------------------------
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 the board of health.
Signed
Date
Application Approved BY ----------- - ^, -- -----
Date
Application Disapproved for the following reasons: ------------1------------------------------------------------------
---------------------------------------------- -- --------------------- ------------------------------------------------------..........................................................
------------- --------------
Da
-- ------ - ------
---------lre
Permit No. ,�.---` 6 ---------------- Issued --------------.....................................................
Date
I THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE - •rt`(gertifirate of (gontplianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired Z{XX )
J.P.Macomber Jr .
Installer
at ............3-0`Joan Road Centerville
..............----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------_-----------
--
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. ---- ...... dated ------------------------------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE...........................................=-r ................................. ---------- Inspector --------------------- - - .-----------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
yob-- TOWN OF BARNSTABLE 30.00
No....................... FEE.....-----------........
Diop o sal. Narks Tons rirtiun jkrmit
J.P.Macomber Jr.
Permission is hereby granted. -------------------•--------------------------------------------------------------------------
----------------------
----
to Construct ( ) or Repair (XX) an divide Se rage Dis oral. y tem
3U Joan oa ` Cmat rviSilse
atNo............................................................................................................------------------------------•-----------•---•--•---------------•---•----------.-
Works
Street
Vl
as shown on the application for Disposal orks Construction Permit No..x_a ____:____ Dated_____________:::___...:._:__~.:_.`
DATE_ Q ..........................•..... Board of Health
FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS