HomeMy WebLinkAbout0415 MAIN STREET (CENT.) - Health 415 Main Street (Cent.)
Centerville
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ASSESSOR'S MAP NO. ').o j PARCEL
LOCATION SEWAGE PERMIT NO.
VILLAGE
I N S T A LLER'S NAME ADDRESS
B U I L D E R OR OWNER
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DATE PERMIT ISSUED
0ATE COMPLIANCE ISSUED
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
........ ...T.ow.n................OF............Bar.ns.t.abl.e-------------------...............-----------
Application is hereby made for a Permit to Construct ( ) or Repair (X� an Individual Sewage Disposal
System at:
415 Main Street Centerville
.................................................................................................. --•---••----....--------•----••--•••-••-•-•-•...•--------•-•••-•--••.....................•-••-•---
Location-Address or Lot No.
Edward White
Owner Address
a J.P_Macomber
Installer Address
dType of Building Size Lot............................Sq. feet
U DwellingX-X No. of Bedrooms--------------------------------- _Expansion Attic ( ) Garbage Grinder ( )
Other—T e 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.......................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-----------------.___---
G% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
-----------------------------------•----•----------•------••----•--•--------------------------------.........................................................
0 Description of Soil........................................................................................................................................................................
WI....--•----------------••-----------------•----•----•-----------............sar d-•-•--•-------.....-------------•--•---------...--------•---.----------------.....----------.....---..........--
W
x ---•-•-----•-----------------•------•------------- ••--------------------------------••--------•-------••------------------......----•-•-----------•---------•------------------•-----•---•-------------
U Nature of Repairs or Alterations—Answer when applicable............1_-_1.q_00...9a1.].Qxt___t_3nk.................................
...-................................................................................................................1-1.Q_Q_Q.-gal.l.wi...Ie cb.--Pit.....----.........
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITL is 5 of the State Sanitary Code— The un ersigned further agrees not to place the system in
operation until a Certificate of Compliance has b n issued th oard f health.
Signed. . ' '' r ` -------------- .....51.3.�88....-•----
\� Date
Application Approved By..............j� ------.�D. ----�..........................
Date
Application Disapproved for the following reasons---------------------------------------------------------------------------------•--------------------.......•---
' •-••-•--•------------------•-•---------------•-•-••------- •----------•----------------•-•----------•----•------------------------------•--------•-•-•----•--•---••---- ..................-----------
Q'�/ Date
PermitNo............Q..11.---J-92..................... Issued.......................................................
No. • �• 7•---
FE$.... I$.....2 0.00
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town................op............Bars tale
e---------------------------------------------
Appliration for Disposal Works Toustrnrtinn Vrrmit
Application is hereby made for a Permit to Construct ( ) or Repair (XX an Individual Sewage Disposal
System at:
415 Main Street; Centerville
..................-.............................................................................. ....................................................- ..........................................
Edward j j rle Address or Lot No.
-------------•-------------•----•---•--•---•-•---...................._•--------......._--------... ..........--........................................................................................
Owner Address
W J.P.Macomber
Installer Address
PQ
d Type of Building Size Lot............................Sq. feet
U DwellingXIANo. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
04 Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
al 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 ( )
0-1 Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................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........................
w •---------------------------------------•-------------•-•--•--•-•---•---------...........-•--•-•----....................................i...................
ODescription of Soil......................................................................•---•--•---------------------------------------------------------------•-•---------••-•---------.
x Sand
V -----------------•------------
W -- •-----------------------------------•---------------...----------------...---------•-------------------•------.
U Nature of Repairs or Alterations—Answer when applicable............ '- a �� an
I-=1 Q fS0-ga ll ori...i-eacri'--p i-t-e---------------
----------------------------•------------------------------------•-----------•-------------------•---...------------------------------------------------------------------------............-----
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 b the and o health. l
5 3 $U
Signedr. .:. __...
\� Date
Application Approved By...............
zcr^d• d�• `...... .---•-------------•------ --------------------
Date
Application Disapproved for the following reasons-----------------------------•---------------------------------•-----------------------------••..................
.................•----•------•----•---------•--•--....-------•-•-•--------•------------•----•---------------------------•--•------•---------------------------•---------------------------------..__.._.
Date
PermitNo............ 4 = f -----------------•--- Issued.......................................................
Date
r THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town Barnstable
..........................................OF.....................................................................................
Trrtifiratr of Tomplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (X*
bJ.P.Macomber - -----------------•••---•-•---------------------•-•-•------------------------•-•----•------
Y -••-- -•- -•---•--•---...
415 Main Street Centerville Installer
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.......?.�__-___t_.9_._7---------- da.ted________________________________________________
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE........................9• J... —.51..................... Inspector...........-- ,�D.....................................................
THE COMMONWEALTH OF MASSACHUSETTS 0 C57
BOARD OF HEALTH 7� J
........Town. . . able
I ......................OF...........-Barns-�----------- t
-- .---.................................................. $ 20.00
No.--- '+.j7... FEE.......................
Disposal orkg Tonotrnrtinn rrntit
J.P.Macom er
Permissionis hereby granted..............................................................................................................................................
to Construct4(15)Ah&paAtr, n j�Z era e Disposal System
atNo...............................................................................................................................................................................................
Street aa II
as shown on the application for Disposal Works Construction Permit No..�p__J.2—_ Dated...........................I...............
•---------------------------------• .a-....................................................
I 1 C Board of FIealth
DATE................... �-_�---------/- ..................................
FORM 1255 HOSES & WARREN. INC., PUBLISHERS