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Home My WebLink About0432 MAIN STREET (CENT.) - Health 432 Main Street Centerville A= 208 019 A/ I SMEA®® UPC 1M6 smad com • Made In USA TOWN OF BARNSTABLE LOCATION e�,?a SEWAGE # VILLAGE (.;��"T 5-45V 14. ASSESSOR'S MAP & LOT INSTALLER'S NAME PHONE NO. A & B C M 775-6264 SEPTIC TANK CAPACITY_j,�,�(,1 -4� LEACHING FACILITY:(type)�/0V C,9/ /PACE/ (size) �i AV NO.OF BEDROOMSPRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER p�s, DATE PERMIT ISSUED: /0 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes Not S i pe. 1 ® > w... , No.._ r�. ►].� Fss..-± ®'............._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH �Eo TOWN OF BARNSTABLE Allpfiration for Dig niia1 Workii Cum Application is hereby made for a Permit to Construct ( ) or Repair ( jel'an Individual Sewage Disposal System at: --....Z:: a `-YY)/-a i f-? �..V .................•-............ .......��N- .................................................... .......... ............. ............. ation-&ddress or Lot No. Owner e Address W - -ram___....�=�-------C ..........c�............................................ ................ l�....d..-.. C' �x ...�1t-►P'��'. �4...--------- ,.ap Installer Address Q Type of Building Size Lot..........................__Sq. feet Dwelling—No. of BedroomsA_.....................______..........Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) 0 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. 1________________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........................ a -------•------------•••----•--------------•------------------------------------•.._..-------••••.....-•------••-•-•----•--•------......------.._........._.-. 0 Description of Soil.................................................................................................................. ...................................._................ W U .._..._..--••---••--•---•---•-------------------•---..._...---------•---------------•------------------------------------•---------------•----------•-------------.-..---......-----••---••-------------- W -------•------_... Nature of Repairs tpr Alterations—Answe whe licable. •� ___- ......ht l�__U P W PP - /.6 6® g .45_ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Enviropffftral Code—The undersigned further agrees not to place the system in operation until a Certificate of Comp a h ee issued by t e board of health. Signed .. ------------------ ---- ---- - -./6--�/ --�-�- Date Application Approved By ---- ------) - te Application Disapproved for the following reasons: ............................................................................................................--- -- ------------ ---------------- - -------- --------------------------- ------------------------------------------- ---------------------------- -------------------------------------------------------------- - --------------------------------------- Da[e PermitNo. -----J..-a..--S _ ------------------------- Issued ........................................................----- Date r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Kliipnsal torks Tomitrurfion, .ermit Application is hereby made for a Permit to Construct ( ) or Repair (V'an Individual Sewage Disposal System at: ......"�.� ........................? .� ............................... .......C lah T.44 2 1J:I LSE-------------------•-----.......-•--------- Location-Address or Lot No. ...................cL.................. ....................................................../5.C�4 .......---..•.................•-------.............--- Owner ^, Address (Ai • .a 71� ------ .........BB11.a ..........................•-•-•--........... � teI ... - Installer Address Q Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms..�.�k.....................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons.............--..---....... Showers ( ) — Cafeteria ( ) d 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. I................minutes per inch Depth of Test Pit---.............--.. Depth to ground water—..................... (14 Test Pit No. 2................minutes per inch Depth of Test Pit--.................. Depth to ground water....................--.. M ----•-•------------------------------------------------•-----------••-----------...............-----........................................................ 0 Description of Soil............................................................................... ----------------------------------•---------------------------•-•-.........------------. x tJ UNature of Repairs or Alterations—Answer when applicable'N L �0dg- � aA `;r /1 _� ..-o..- _' I ....-------•-- , d 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`thle board of health. Signed ----/.....1.,. ..... ....M --K . ... /0 -/ `. Date Application Approved By -------------- - -, ... 1. - -n . .- ... r� Dace Application Disapproved for the following rea cons- --------------- -- ----------------------------- ------------ ----------------------------------------------------------------- --------------- - -- -- -----------------q ------.........------........--------....------ --------...---------..............-----------------....------...------.................-.-- ---------------------------------------- Permit No. f .--. :! ........... .... Issued ....... Date....-. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certifirate of Graptianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by............._k.!nt --A...... t` --Cd......................----................---.................................------------......... ---------------------------------------------------------................. ._ Installer at ..... ....' .fA.f. .......� .:............... .. ...................... ---------------------------------------------............................ 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. ..........r� ..-...:5...�..�i dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------- A ....... '.....-- `....-----.................................. Inspector ...... ........ v THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r TOWN OF BARNSTABLE Permission is hereby granted-----. R�..---•C'6.�.a C n---------------••-------------••-----------------......------.......-•--•••...... to Construct ( ) or Repair ( V)>an Individual Sewage Disposal System at No......ZI)?-A.......' n. =_;_a. ........ .............! fa:-t.T '/?.-- -J-4.4 . _77- ............ Street � �//r as shown on the application for Disposal Works Construction Permit No._-,e_�- --'�_7-Dated.......................................... G k_./" Board of Health DATE............... .^� =. .. ..�._-1..�- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS moo - 0WO ext �� IV/Z/ a E vjoA \ w S AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION e�3Oz /'� � ST SEWAGE # - iS ��_ VILLAGE CBr'f e-,<vo ze— ASSESSOR'S MAP & LOT - 0 f�� INSTALLER'S NAME G PHONE NO. A & B CANOD 775-6264 SEPTIC TANK CAPACITY , t,� h'� LEACHING FACILITY:(tgpe)./jcW C,91 (size) NO. OF BEDROOMS _ PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER �/iC��AS DATE PERMIT ISSUED:_ /Q - I Sr 41 1 DATE COMPLIANCE ISSUED; `1 - VARIANCE GRANTED: Yes 0 http://issgl2/intranet/propdata/prebuilt.aspx?mappar=208019&seq=1 4/20/2012