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Home My WebLink About0183 MAIN STREET (CENT.) - Health 183 Main Street Centerville A= 209 —042 i UPC 12534 ' HAiTINOI,UN THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a. Apphration for Disposal Works Tonstrudion rams# Application is hereby made for a Permit to Construct ( ) or Repair ( •L)-ah Individual Sewage Disposal System at: .........�-- W��,� s I ��v5e.............................._.._--- -Location-Address or Lot No. Owner A d ............. Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms___..3_ ___________________________________Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons____________________________ Showers Cafeteria aOther fixtures .----•...................••-•--- .... W Design Flow........�5 .......................gallons per person per day. Total daily flow_.._.�3_ ......................gallons. WSeptic Tank—Liquid capacity.._____.....gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..... Diameter._.J__O_.___.___ Depth below inlet.....16........... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 1.4 Percolation Test Results Performed by__________________________________________________________________________ Date........................................ ,.� Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ------------------------------------------------------------------------------- ......_-----------------••-•••••....... 0 Description of Soil..........................:...................•--.._...---......-•-----.....------•-•--------•--•----•-•--..._...---•--•---•--••--•-•-----........_.................._.. W VNature of Repairs or Alterations—Answer when applicable........"..V•-____.ovk_'_c._..._6l<_(9.....19.�� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI'U 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 ,, rd of Ith. GGc� Signed .................. •-•--.._..--•-•---••--- =. .:..Q...-l- Date Application Approved By............... ... ............................... ............cl---•' . Date Application Disapproved for the following reasons--------------------•------------•--------------------------•---••-------•-•-----•-•-•--•--••----••---•........_. ................•-•--••-•---.._.....------•--._.....---------••---------------------------....-------------••-------•---••---••-----•--•--•---•--...------•-••-•••••-•-•-----•------......-•-•-••-•-•--- Date Permit No------- --- --=------ Lf-6,C)-_--------------- Issued......................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _ o 77V wA r.......OF......N�s ?±Y2et -Ewa-�-�- — n�� Applirntiun fur Disposal Works Tonstrurtiion 11rrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ca-�;n Individual Sewage Disposal J .. System at: 1 ( -Z �_ c�1�. ,5 T .....-•---- r tti-l.. �(L U , .............:.:............-.............. Location-•Address ••. ................. ............or Lot No. .._...... !.l �ri-P✓T.........�.. '. .......................... ............ ..— le ..!! Q-a...._..,..._... ...........••. _...... . Owner Address a _ ...... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms._. ...........:.......................Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) p' Other fixtures .............................................. ...............................`.. . =. W Design Flow.............�<.. ..............................gallons per person per day. Total daily flow..... . .....................gallons. W - Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No-----I------------- Diameter...1_0..._..... Depth below inlet.....1............ Total leaching area..................sq. ft. - z PercolationDistribution Dosing tank Test Results ) Performed by .....)................................................... Date....----- _...... a - ,P P Test Pit No. L...............mmutes er inch Depth of Test Pit.................... Depth to ground water........................ ri, Test Pit No. 2...............:minutes per inch Depth of Test Pit.................... Depth to ground water...................... x O _ Description of Soil...............•---.....--•....... �.h ----------------------- --------------------•-- ---...... .. ----••-------- ------------------------------------------------ -•--.. _.....---......_....------------------........ .......-•-. ........... --------------------•--- . ---- ........---- -----•-- U Nature of Repairs or Alterations—Answer when applicable........AV-0.....Q1'!'L=..._.6 .(p...... ✓��-.C.. �'.... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIE 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 y-the b roof n ealth. Signed.��---------- ----- -- --- -- -- ._ .... Date Application Approved By.............. -----••.....� Date Application Disapproved for the following reasons:-----...-•---------------------•.--------------------------................................ .......-•---_ --, . �/' V ...............................•----------•---...................._.........----------••--•••-•--•-•-••.................•--------•••----...........-•----------------....................--....----•---- Date Permit No..--- :............ ii:----�-=��.................... Issued.---------.:..._..------------- ............ Date _ THE COMMONWEALTH OF MASSACHUSETTS y - BOARD OF HEALTH .................O.�N' '.......O F.......�'S.1�1.1 4:rAr t?.,1K.............................. %5rrtifiratt of, Tomplinnrr ' THIS IS TO CERTIFY, That the Individual Sewage,Disposal System constructed ( ) or Repaired by-........................�6-4-_ 3 .... yy..."�;a-.c...............P`................................................................................ ......... - Installer ` at.............. �� ? v`. t(- t�t- - `�� "L r�.....e rt vA has been installed in accordance with the provisions of TITIF. 5 of The State Sanitary 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.........................:J............................-•------....._•--•-_.. Inspector...... .......................................� ................................ 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 0o No.. ?Q- `/� .1 ,. .► -'.......O F ..AV.�SST:�. + ...................................... !.. .s.!..-.. FEE... O........ Disposal Works �unntrnr#ian rrutit - Permission is hereby granted.........4nd L.±�:�:2_.:�r- --{.i..l..,_..... - to Construct ( ) or Repair (lam saC-an Individual;Sewage Dispo System , at-No.:.................1T.`a-.........!^. _emq ....l)NC ......SIX ..-.-•�`- -!' Wit.------••----•--:...---... Street ' as'shown on the application for Disposal Works Construction Permit No -.--::-�5r i-a Dated.....................:.................... ------• ............ •------------ ---------•-•-----•------...................� �.�� Board of Heald DATE.............y-.......7- - . S TOWN OF BARNSTABLE LOCATION ► 1UV S(i SEWAGE #_ - p VILLAGE GmC yLit er,I 1 (LP— ASSESSOR'S MAP & LOT_ INSTALLER'S NAME & PHONE NO._e_,� A rha_ L A ug� 0'TA e SEPTIC TANK CAPACITY LEACHING FACILITY:(type) `Cc tw �. (size) NO. OF BEDROOMS _PRIVATE WELL OR LIC WATE ' BUILDER OR OWNER__- . DATE PERMIT ISSUED: DATE COLIPLIANCE ISSUED:`_� VARIANCE',GRANTED-, 'Yes No t v Neu b-4