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Home My WebLink About0320 MAIN STREET (CENT.) - Health F320 Main Street Centerville A= 2.08 —047 S M E A D No.2-1531.OR UEsCI 12534 smead.com • Made in USA 3 � 5 ,y *,r ,. Ja vi 4up tuts g iQ N Cyo $y 'IOWId OF BARNSTP BLE ,-- Fir LOrs1"20Pd db N: SE.WAGH V1 L:L.As.fi aJTEiP F/ZLG ASSESSOWS MAP LITS' . LbEI3"S NAME&PHONE No SEP111C TANK.CAPACITY /_576o S_T__ T:.I?�.CI-aLIv�PACILtTY:{>CyJ�) � •�•�rsr� i e�1 _tsiz.�) �ISfS'' .a.,_W.. 1'T�).OT?BEDR�MS�,PRIVATE WELL OR PUBLIC WATER 0�!'�-. DU-ALDER OR OWNER 17i TF,PERMIT ISSUED: irJaI.TC COMPLIANCE ISSUEDD• U'IOU'ANCE GRANTED- c TOWN OF BARNSTABLE LOCATION SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 3� 33 i p THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � 0 - t✓r;i...................oF...... �3e?� b. � 1 e......._.....-------•--........--••------ `✓ Appliration for Dispasu' l World Tnnitrnr inn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (' ) an Individual Sewage Disposal System at: --v...... -•-----------------------------------------•-•---• ---......----------------------........--•---. Location-Address or Lot No.,, o ..................................... .• �........ 4l�a.� .......�: Owner Add i e ................................................ ...........� Installer ddress + UType of Building Size Lot._ ay_Ct��--•--_-•-Sq. feet _____________Ex ansion Attic Garbage Grinder W U Dwelling—No. of Bedrooms--- �Z�______________ p ( ) g aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 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........................ w Test Pit No. 2................minutes per inch Depth of Test Pit_________---____-- Depth to ground water........................ 04 ---•--•-•-•...................•--...................••••-----••••-•••-•--•--.._......._......__...--........................................................ 0 Description of Soil..................................................................................----------------------------------------------------------••......---..........-••_.. x .............................................................................................................................................................C. L U Nature of Repairs or Alterations—Answer when applicable.___V1_9-_---- -----------t4•.._._....... -• .441E..... ....................................................................................._.................................................................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITZU 5 of the State Sanitary Code he undersigned further agrees not to place the system in operation until a Certificate of Compliance has b en ' s by the boar f health. Signed..................... ---•--• --------••---•----••-•••......-•--_.. � .� Date Application Approved By______ _ •- ...................................... •-•-•• Date Application Disapproved for the following reasons-.......................-------------------------------•----------------------------........................... ••...............................................................-••••---••••••-••••---...••-•-••-------•-•-------------------••--•...•••-----------•--•-••-----•••---•-------••---------•----......_. �,�• Date Permit No..... .._ .' -�`�` ...................... Issued_....................................................... Date .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH !. n....................OF..... AL-�.S �.... J e----......---------.......-_........._..._ ApplirFation for Bispos al Works Cna ustrur#ion Prams Application is hereby made for a Permit to Construct ( ) or Repair (V ) an Individual Sewage Disposal System at ..� •✓Lof 1 .......f �?, %y:: (?ftitl ........... ........•-....._......_..--•--•••-•--.....--- -•--•------------•-•-----•-•---•-••------• Location-Address 1 or Lot No., p .........��s�.�13_9-AS� .................................... ='�-------.ZL)i?4....._�'✓1 •„_ Owner Address a � i/, ... G �u G�riVt....F1 . y` C'................................ Installer Address Type of Building Size Lot_. pad---------Sq. feet H..1 Dwelling No. of Bedrooms............. ..............................Expansion Attic ( ) Garbage Grinder (rb) Other—Type e of Building No. of ersons____________________________ Showers — Cafeteria a yP g P ( ) ( ) alOther fixtures ....,. •-----.---•............... ...1..,---•-•------------•---•-----------------------•---------------------------------.-.-......... 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 Period ed by......................................................................... Date........................................ Test Pit No. I................minutes er�inch Depth of Test Pit.................... Depth to ground water..................... Lzl Test Pit No. 2................minutes per-inch Depth of Test Pit.................... Depth to ground water........................ -------------------------------•------...-•-•----•--•••-------------------•--......-----------........................................................ Descriptionof Soil........................................................................................................................................................................ ----------------- ---------------------•--..._..,.-------•---•-----•--------------------------------------------------------------------------------------- -------•----- U Nature of Repairs or Alterations—Answer when applicable.-.v ___.._` - t '........... .....__..` . •--••---• •-- . .. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 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 y--•-•-•; ., ; �= c Application Approved B r------- Date Application Disapproved for the following reasons:................................................................................................................ .............................................. --------•-•------•---•-----••••-- '� Date Permit No.._._ .1.•-.V.":>-ti Issued ----........ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALnTnH ..........................l...Li. OF...........1 `F� �t?�1,!!�-.................................... TrrtifirFa#r of (1�naza�li�aat�r THIS�IS��TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by..............!:J`. ...... .......................................•-----------------•-•---------•--------------------------.............-------------------•--.......... C Installer a . . at ....... '�.........I.......I........... ._....( has been installed in accordance with the provisions of T-!m1L 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No------- ---�_ l____�>___- dated-.----------_---------- ...................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. � DATE..........................A...;.�_?4 _ _.......--------••--------.... Inspector.............. --- .................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /7 �.. .....� <. ! ............OF......... .................,- ..----( I. ................... No.L?..!..:.. c% FEE ......- Disposal Works Tonstr ion rramt Permission is hereby granted------------ . 2?........................................................................................... to Construct ) or Repair � an Individual Sewage Disposal System at No..--.........�...2-o JAI r,^h.' k,•.........A... n�,j...... . ----- . s -,^� Street as shown on the application for Disposal Works Construction Permit No.�/ _ _ Dated------------------------------------------ .......................... --------------------------------------------•----• DATE---------.............. ' �y ............................ oard of Health FORM 1255 HOBBS & WARREN, INC., PUBLISHERS I ,n 22 08 01:40p Ellis Brothers 508-362-62E>Ei p.2 2. BARNSTABLE "6 A " ' ASSESSOVVS MAP & _ _-- _ ny��yy��gp��q[ J �rl SE-WAGE it VILLAGE e T� _r//A, 1[iSTALLER"S NAME &s PHONE NO__�'lfi� � as �i ',. 4,0EPTIC `TANK CAPACITY /-� � (size 3;.pACI G FACILITY:AWPe i �„_..�... Y. O. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER 'BUILDER OR OWNER 6c.., 'I0A,'TE PERMn ISSUED: DATE COUPLIANCE ISSUED VARIANCE GRANTED: 'des 33 ' P 1) I {\i I y OD c) ZT l o . GHUS�•r'TS OF MAr�5A .. - e ispo �r_.. cn heK�Y granted•' ' yudividu� Sc �.............. • at + cd- ission is r as ��• s«�� N � .. •• _ o perm or R� ��!l .... permit o.. ........... to Construct , , ,...-_. ` s Construct on ,�a of ticattb u, ' ._. sal Vliork rn at N own on the application for Disposal ..... �pRM -D W an 22 08 01:40p Ellis Brothers 508-362-62E 3 p.1 j� 1, FAX LDS AT ELLIS BROTHERS. CONST. CO. -62 362-6237 ik To PHONE # ti ii I� f p �Al ; r Ewe r Fmc k THE COMMONWEALTH OF MASSACHUSETTS �� . BOARD OF HEALT .........low ,✓..........OF. Yam/ .... ............................. �( �l Applirttftlan for Mivnattl Workii (>zianudrnrttnn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( L—r Individual Sewage Disposal System at: � .... �.1,F"1... ...................• --...------------------------------------•-------------------------------------------------------- Lot No. Owner .............................................. 23bess c' ..._._ _t ,r��.�h-.......----------......----------------- Installer Address UType of Building Size Lot............................Sq. feet �. Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — 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 ( ) Percolation Test Results Performed by....... --.....-•-••--••--••-••--•-•--...-•--••-••---•-••••-----•......_.. Date--'........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ••... ...... 0 Description of Soil---------------------- - _. .. ... J l�L- ---------------3- U ------------------------------------------------------------------------------------ •.....--•---••--•-----•••••--------•----.......-•----....-----••......---------...........-••---•--------•------ w 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the Wboof health. Signed.._ " � - ... . ......... = .•. Date ApplicationApproved By................................ ......•-••-•-••-••----•--•••........-----...................... Date Application Disapproved for the following reasons:-----•------•--•-----------••---------------•---------------•-----------------..........--=•--•--.._............ ---------------------------•-----....----------------------••----•-•-----.........-•--•-..................-----•--•---.......--•-•---------•-----•---------------•-------•------......---•-•------•.••••. Date PermitNo........................................... .............. Issued....................................................... ....- •- Date ___ THE COMMONWEALTH OF MASSACHUSETTS FEic #... ... BOARD OF HEALT �,/� •tom i��''� .........OF..... .............................. Appliratiun for Biiipnutti Works Towitrurtion fIrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( f)-an Individual Sewage Disposal System at: �� .... 1J1...; ..................... .. ..:. --- -- ............................................... . / a�Jado dress z b 3� �i jt f of No. ....... rty E.4- ..... .[.... .. / 'f+-�.l.. -s!!'_ ".___f........ _. _ ��- /.........jt!,f. f ________________________________________________ n r .l C 1 E i't 1 `hddress........ ... -.. -./-.._Y. _o ._... --...... 1. Installer Address d. Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria (. ) PA 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest 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......................... Pr ------------- O Description.of Soil---------•------------•-�-•--��--�-�-- _-----�---• ��- -------------------------•---.......................................................... ---•----------••-----------------------------.......................................................... x w VNature 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 TITLE 5 of the State Sanitary Code—The undersigned further a rees not to place the system in operation until a Certificate of Compliance ha/bee ssued by the ar health.g toDateApplication Approved BY.................................. •-•-------•--..._......_..._......................- Date Application Disapproved for the following reasons:.......................................................................................... ................. -•-•-----••---••-•--•..................•---..-_..---••-•-----•---••----••-•-•---.._...........--------........_......._...._..--------•-.-------••----...-----•-----------•---••....--------•------_..... Date PermitNo......................................................... Issued..................................... ........ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t _4 s 1�• Trrtif iratr of Tontlrfiatta THIS IS T C VTbIY, That th IIN,*vldual S a is stem constructed ( ) or Repaired ( ) by.................... . ,_. .1 `% "_ _._. - l ..._.. ........ ..._..- - at ------ - -• •---•- ......................--- ..�...- has been installed in accordance with the provisions of TITLE 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 WI IX.. FU CTION SATISFACTORY. v t ............................................................ Inspector.-- ..... ........................................................................ THE COMMONWEALTH OF MASSACHUSETTS •f BOARDW OF HEALTH 1................OFF �yi No�_'�--__.2//....._ ... .. FEE..,* u 1 yYor C ono i Uan ��`prut Y g Permission is hereby ranted__.......1-_$ ...... 11 I �-;t�:_-..,, 7_ ........................ ........ to Cons�� l ) Repair n Ind4 ual wage DisDosal System at N Street as shown on the appli ion for Disposal Works Construction ;Permit No.................... e- _--___---_-------_- .......... ...................... oard of Health DATE : .............................................. FORM 1255 A. M. SULKIN, INC., BOSTON