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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
....................... Town......0F..Barnstable....
ApplirFa#ion for Disposal Works Tnntrnrtion ramit �
Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal
System at:
...]..1.__.SJ:i_ea t e_..RQash........................................:.............. ..............................•----------------•-•---------------------.........------.........---
Location-Address or Lot No.
•,Carr j2g-ton_,]:ark .-•-•Centerville
... -----....-•--..... Centerville
• -- - -----•-----
Owner Address
a --Joseph--.P.-..Macomber_-•&---Son••Inc.---••.-•••••. •••..-Centerville
-- ......._ •
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder
per, Other—Type of Building ____________________________ No.' of persons............................ Showers ( ) — Cafeteria ( )
Q' 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 ( ) Dosinglank,( )
Percolation Test Results Performed by-_: fit_: _: �.`�___ .___..61_' ._____________ Date........................................
Test Pit No. 1................minutes per inch Deptl of Test Pit.................... Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
................................•...._.....__.....-••••-----•-.._...•--••--• .. ._.... _.... ..........
O Description of Soil____'__sand...&... ............... _
--••
W ----• ••--••••-•-•-•••-•••-•-•----••--•••----•--•-•-•.............•-•-•--• F-
............................. -••--••••--•-
VNature of Repairs or Alterations—Answer when applicable....1-1000_..gallon__tank________________________________________
----------------------------------------------------•-•----•-------------------..__.......-----•-•--------......----------------------------•--------------------------------•-•---••-•._._....•-•_.....
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT I.;,;. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has en issued by the rd f ealth.
J
J
Date
Application Approved By....... . ...
.......................
-•--
Date
Application Disapproved for the following reasons--------------------------------------------------------------------------------•--••---••• •-•••----....-•----
- -------------------•----------------------------------------------------...-----•---=-----•--------------•-•-•-•----••-----••••-•--•-••-••-•-•-•-•••----•••---••-------•••--•••--------•--•---•--•..._.
Date
Permit No.......................................................... Issued-----l�-. ..`... _
Date
No.... Fizim ........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.. ;Town......�,:.OF..OF.Barnstable
.................. ...I............. .........................................................................................
Appliratilan for DW, posal Works Tonstrurtion ramit
Application is hereby made for a Permit to Construct or Repair (X) an Individual Sewage Disposal
System at:
..........................
- -----------....... -------------------------------------------- ------------------------------------
Location-Address or Lot No.
................................................. .......Centerville............................................................
Owner Address
c4`8on Inc . Centerville
------------------------------------ ............. .......
Installer,7.......".............. Address
Type of Building I Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms.................................4_�..........Expansion Attic Garbage Grinder
PL4 Other—Type of Building ............................ No. of persons......................_.--_. Showers Cafeteria
Otherfixtures ..................................•7...................................................................................................................
Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
1:4 Septic Tank—Liquid-capacity............gallons Length................ Width._.............. Diameter-_-__._......... Depth............._..
Disposal Trench—No..................... Width_................... Total Length.--_.........._..__. Total leaching area....................sq. f t.
Seepage Pit No..................... Diameter.................... Depth below inlet............_..___.. Total leaching area..................sq. f t.
Z Other Distribution box ( ) Dosing a ( )
Percolation Test Results Performed by.. _It._
Wk, 4 ~o............. Date..........._.....__.._...._......_......
De-ptlf of a;
Test Pit No. 1----------------minutes per inch Test Pit..................._ Depth to ground water.......-_--._........-_.
44 Test Pit No. 2................minutes per inch Depth of Test Pit.............------. Depth to ground water........................
........................................................................... ...............Ye_�....................
0 ......1'1 . ..( ----------- --------*......
Description of Soil........Sand...&_--Gravel--------- f .L/ ......... .......
---------7......... on
.............................. ..... .......................
U ............................................................ .......A.... ..............
ZW a .-Now.................................................. .....................
..........................._ ...I ... ........................*
U Nature of Repairs,or Alterations—Answer when applicable...LJ-000...ga,11-on...tank........................................
.......................................................................................................................................................................................................
Agreement: S,
V;e4PA X-10 ...
The undersigned agrees to install the afore'described Individual Sewage Disposal System in accordance with
the provisions of TIT'—' 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 thd,board/of laealth.
l I h I ) � P
& , �,/ �d-Im
4�I'a
JV.................................................. .....I.....................
Siviled .... ....
Date
Application Approved By....... -.001------------------------- ........... i.1.......
Date
Ap'P'lication. Disapproved for the following reasons:................. ....................................... ....................................
............................................................................................................................................................................ ..................
Date
`'",Permit No....................................................... IssuedL........................................................
Pate
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town OF Barnstable
........................................... .. .....................................................................................
p (In fifirate of Tomplialtrr
THIS IS T 'I d VC -ITIFY, That the Individual Sewage Disposal System constructed or Repaired X)
f
by......Joseph P. Macomber & Son Inc . . ...............
T1........................................................
Installer
. 11 Sheafe Road Centerville Clarkat. 4 ..........................
has been installed in accordance with the provisions of T_ E' 5 of The State Sanitary Code as described in the
e_
application for Dispokal Works Construction Permit No.9`4�;.XI............. dated------9� r.w?Ff_...............
THE ISSUANCE1�,OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
11
SYSTEM WILL FUNCTION SATISFACTORY.
DATE............................................................................... Inspector.........................................I..............................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TPc M.......OF..PWqtable
.........No.......... X91... .
. FEE.M.0.0........
Disposal 3 1 1
—Xarkg (Inostrwtivat. rantit
Permission is hereby granted.j4�Opj F. Macombet & Son Xfic.
!V�i...........................................................................................................................
to Con cb� afr R-eiDai& (Xd antIndivTjj Sewage Disposal System
itl Is e ROa ,, en ery e Ciark
atNo...............................................................................................................................................;-----------------
as shov�n on the application for Disposal Works Construction r Str*eet Dated.... ............
...................
—per
Board of Health
DATE--- ..........................................
67. V
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
LO'=C..AT10 SEWAGE PERMIT NO.
VILLAGE
C�c�y4erL�
INS TA LLER'S NAME &__ADDRESS
e U I L D E R OR OWNER�
DATE PERMIT I S S U E D
DATE COMPLIANCE ISSUED
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