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Home My WebLink About0087 THOREAU DRIVE - Health $'1 Thoreau No........2 Fl��.` ................... THE COMMONWEALTH OF MASSACHUSETTS S EOARD. . _ ....� HEALTH ... OF....... ................... Apphra#ion for :41-4p iial Works Cnowitrurtion Vrrmft Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal SysteVi at � - -- ----------- :. ,��: -.... f _ _.ocati Address Lot No. . �----=-•................ L-i�. ... .... Q Owner t�iddr ss �r '. Installer Address Q Type of BuildingCT Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms-- ------------ -------- __-_Expansion Attic ( ) Garbage Grinder ( ) per, Other—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. � Depth in1eJ��Seepage Pit No.._�C�__..�.__ Diameter____.___.�g__---- D p below ---------- Total leaching area------------------sq. it. 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-----------..--.--.--._. �Zq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -----------•--------------------- -- ------ - 0 Description of Soil----- �� ----- ---------------- ------------------ ---------------------- x �., -------- ,,.. 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 Article XI of the State Sanitary Code—The undersi ed further agrees not to place the system in operation until a Certificate of Compliance has been .ssued by th boar of health. Signed --------------------------------------------------- ----------------------------•--- Date Application Approved By------ - -------- - •-•--•• -- ---- - r�-- -�---- ......... � 9? Date Application Disapproved for the following reasons---------------------------------------- ---------------------------------------•----•----•----•------------•-- ----••-----••---••-•••-•-••--•---•-•--••---•-•-----------------•-•_.....--------•-•----•-•••-•-••-•- �� Date Permit No......................................................... Issued...... ` r l-- D ----------------------• Date No....... ....... ........ .... .... ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH . ..... _6 ............ ....... .. ........... ....OF. Appliration -for Digpoiial Workii Tonstrurtion Pumit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal Sys t,T a� ......................... ----- ... .... ...... ......................... ...... ...................................................................... No. ..................... ... ......... ................................. ...... . .............................................. 7 Owner e Address Installer Address ttl Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms___________________________________-------Expansion Attic Garbage Grinder .-I PIA Other—Type of Building --------- No. of persons---------------------------- Showers Cafeteria P4Other fixtures ------------------------------------------------------------------------------------------------------------------------------------_------------_ Design Flow............................................gallons per person per day. Total daily flow------------------------------ -------------gallons. WSeptic Tank—Liquid capacity............gallons Length----------------- Width.......___-__.. Diameter._-.-...---.__-_ Depth._.__.--_.._-- Disposal Trench—No---------------------- Width._._..._..;_....._.. Total Length_-_____-__-_----_--. Total leaching area--------------------sq. f t. Seepage Pit No...(2.... ---CDiameter---------�oi------ Depth below inle,16.....;A.......... Total leaching area..................sq. f t. Other Distribution box Dosing tank Percolation Test Results Performed by-------------------------------------------------------------------------- Date---------------------------------------- Test Pit No. I----------------minutesperinch Depth of Test Pit_----_-_____-_____.. Depth to ground water-..--------------------- L14 Test Pit No. 2................minutes per inch Depth of Test Pit_._-______._____-_-- Depth to ground water__.-.--_-_------_-__- .--------------------------- ......................................................................................................................... ........................ ............................ -----—------ ---------------------------------------------- 0 Description of Soil-.---- ........... ........ ------------------- ----------------------- ---- . .... ...... .... .......................... U ------ ---40- -------------- -- - ----- ------ _1<4 � ------------------------------------I------------ ------- ------------I------- 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 Article XI of the State Sanitary Code—The undersifihed further agrees not to place the system in operation until a Certificate of Compliances been .ss,uec.I by t�(e boarp of health. Signed . ................... .............................................................. ................................ Date Application Approved By----- ----------------- 1-1 -7 .. .. ............................ .... ... 7_ Date Application Disapproved for the following reasons:------------------------------------- ----------------------------------------------------------------------- ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... ............OF.............. ...... V"'Wrtifirate of TI-Imphaurr THlr, ,IS E TkF j, That the Individual Sewage Disposal System constructed or Repaired by A --—" 6 �,� ............. ........................................................................... ......... . ....... .......... .... . at........ ......... ..... ................ -—------ -- ------ .... ......... ............................................................................ has been installed in accordance with the provisions of A ricRe XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit .......... dated-7.—.2-2......7...(7--..... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................................................................... Inspector.--'-q ---/...... -IV----------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD 9F HEA4LTH No...... . .. .............0 F........02.. ................. %rivolAfAV Vamit rtm to ts>efreby rant ...... ------- ........_........................................................... P k.c -................................erm, ic to C or Re, In Indi I S g e D 1 s'tp")o a y—sqfn— o/n , �a/ vi qa ewa 0 o ... ..... 71-10.1- -------------------------------------------------------------------- at N ... ---e.......................t1Z.4.!......... ... Street as shown on the application for Disposal Works ConstructionfPle-rRt ---_ Dated_. ---—---�;.......... --- ------- ... ... / - __Al-.1 e I......_ I �, '` DATE...... ....................................... Board o f Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS PLOT PLAN SNOWING LOCATION OF BUILDING 1N CENTERVILLE BARN STABLE MASS. FOR ALAN E. SMALL INC. SCALE ' I °= 60' DATE JULY 10,1975 CHARLES IV SA✓ERY INC REG C E 8 L S 712 MAIN ST H r'ANNIS , MASS 44 4s Ioo' 8I 5, 332. s.F 60 0 0 82 9 15'+ Lp EEGar, } 35 �00. 88 No R � Au DRIVL I herby certify that the �' uilding exists on the 7round as sl:own on this nlzn and is in accerddni-F ,#Hh the z:!iing re T Ire wts of the Town of Barnstable. ; R'.gistErtd Land Surveyef THIS LOT IS NOT LOCATED IN A FEDERALLY DESIGNATED FLOOD PLAIN ZONE. aka•, _� Ate. . �7 li PLOT PLAN SNOWING LOCATION OF BUILDING } N CENTERVILLE BARN STABLE MASS, I FOR I ALAN E. SMALL INC. SCALE I "= 60' DATE JULY 10,1975 1 CHARLES N SAlERY INC REG C E Eik L S 712 MAIN ST H iANN;S . MASS I i i 44 45 1 1 0 0' BI 15, 332. s.F I — S2 8 0 0 .0 { 9 N ! _ 15+ tu• a I Dwelling Gar. zI,- -.T 35 j0o• SS ' p� U DRIVE I � I I • I herby certify that the ullding i xists on the Around as shown on this nl�n and Is In xcorad%� with the miing red Irements o.* the Town of Barn5table. R,,SISMA Land Surveyor THIS LOT IS NOT LOCATED IN A FEDERALLY DESIGNATED FLOOD PLAIN ZONE.