HomeMy WebLinkAbout0140 ANSEL HOWLAND ROAD - Health 140 Ansel Howland Rd.
A= 171 -262
Centerville
I
S M E A D
No.2-153LOR
UPC 12534
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No. / Fee t)aes
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
2pplitatlon for Misposal 6pstem Const union Permit
Application for a Permit to Construct( ) Repair W Upgrade( ) Abandon( ) ❑Complete System individual Components
Location Address or Lot No. 1006 O�wjer's,N ne,Address,and Tel.No.
f$II'cP.1/ 'n (� 6 ft crtQ �T
Assessor's Map/Parcel J/2 �G as b�..�(��
Installer's Name,Address,and Tel.No.61:19-+7 Designer's Name Addfe4s,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title / f
Size of Septic Tank Xi ST���g L�Type of S.A.S. eKi Sr�'tn�,
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and mamte a of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmen ode not to place the system in operation until a Certificate of
Compliance has been issued by this Board of ealth
Sign d Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. Date Issued
.-,-...r- .,. -^ ..._„�. ,n,.,�..,,,,,..sa,,.,,��.s�-.� �/-,y•�.+ ..:.z,,...;,,,t�i�r�'---"--,vr:•9�*.:,Y^w+:.crrili,:�+;p-•:R�"x �'+*,.-+�s+w.a+i.-i.,..w...-:•�---•-.,.=,�:.•y. :cr.�..--...,•-w.,�.e+•-..--� ��--� ...�.y�:..�
No. CJ' Fee /UVes
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
application for ]Disposal *pstem (Eanstruttion permit
Application for a Permit to Construct( ) Repair(f Upgrade( ) Abandon( ) ❑Complete System J.k ndividual Components
Location Address or Lot No.f W)416'ej H-L,) qtj Owner's Name,Address,and Tel�.,jN��o�.
Assessor's Map/Parcel//l ,241�'c -L'T
Installer's Name,Address,And Tel.No. , A Designer's Name,Addrels,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
ti Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank CX i S�ii1 1�5C �thType of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) ] p �')�j0 �o 'Ll/C'j 14 /,-Ikl
Date last inspected:
Agreement: Jf
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental- odC- e d not to place thesystem in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed—, _ , Date
Application Approved by Date l /I k r 7
Application Disapproved by Date
for the following reasons
r
Permit No. (J [ — Date Issued I i /
a ._ -- _ -.-__.— -• _ _- - _. r. - -------- ----------- ------- ----- - _---
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
(Certificate of (Contp fiante
4 .
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed-(. ) Repaired( Upgraded( )
Abandoned( )by ar
at < been constructed in accordance
r rr
with the provviisions/of Title,5 and the for Disposal Syste o s c' �rfnit No.2dl � "��b dated 11fA?
Installer /�' � ,, � �.,� ���• /r'n-� Designer ',11/1A...
#bedrooms r��,`} Approved design flow , gpd
The issuance of this permit shall
no
't#be construed as a guarantee that the system�i'l`l'f'unction as designed
Date_ °,d,! 1i Inspector
No. C)1 Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION:-BARNSTABLE,MASSACHUSETTS
30isposal bpstem Construction Permit
Permission is hereby granted to Construct( ) Repair( � Upgrade( ) /Abandon( )
System located at /4y Ap C.n „ al/i�v-,� ,l /: Al ��5
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit
Date I / r, / 7 Approved by // 1 ��
�' Fss.... .._
OMMONWEALTH
40 (� THE
H BOARD OF FHEALTH TS
...............0F....3U. JI '64_1111�............................
Allpftrttttuu for Eltupuual Marks Tomitrudivit 1hrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
t �A�are�s C �or Lod
f?!' ... ..................................
..........-------------...----•--•--- Y ..............................................
Owner Address
.....................•••... ..........
Installer Address ��
U Type of Building Size Lot.. 57,_t14.Sq. feet
Dwelling—No. of Bedrooms.__..._..... ........................Expansion Attic (W Garbage Grinder (/Yd
`4 Other—T e of Building No. of persons............................ Showers — Cafeteria
QOther fixtures .......--••-••. •-•---••----....-•-•-••--•••-••-----•.---------•-----••--•••••-•-••----------••-----------•---------•----•••---•---------•---•-------
W DesignFlow....V..'2��........... ...........gallons per person per day. Total daily flow_.........
g P P P Y Y 3--�----�-------------gallons.
WSeptic Tank—Liquid capacity. hgallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No. .............. Width.................... Total Length.................... Total leaching area....................sq. ft.
CPSeepage Pit No.._ j. 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•-___________--_---_-__.
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a,
0 Description of Soil........................................................................................................................................................................
U
UW -•-•-•-----•.............•-•----------------•------•----------••---•--------•------------•-----••----------•-•---------------------•••-•---•--•--•---••-•-•-•------•-•••--•---------•---•-•----.........
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 HTITL. 5 of the State Sanitary Code—The undersigned further agrees not to Ace the
Signed-- -• . •. -- -----• --- --•....................................• s tem in
operation until a Certificate of Compliance has bee u by the bo rd f health.
. • �...-....
Application Approved BY----------... -----------------•---_- .... �.. 2_e--_--
Date
Application Disapproved for the following reasons_______________________________________________ ..............................
•.................•-------....--•••••-------•-----...---•••-•---•---------._..._.....----•-•-•---•----------•---••----•------•--•-------•------•---...-••-------•-••••••---•----•--- •------•-••---
Date
PermitNo......................................................... Issued.......................................................
Date
No.--R� y�� Fz�s.... J .�....•......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......................OF.....................---.----..._.....---.-----------•--•------------._...................
Appiiratiou for Disposal Works Tonstrurtiou tirrutit
Application is,hereby made for a Permit to Construct ( } or Repair ( ) an Individual Sewage Disposal
System at:
-•.............._...........................--••-------•------....---------•--................... --•--•--••--•--•-----•--•----••--•---•--------•---•-•-.....---•--........................_•----_..
Location-Address or Lot No.
..........................^...................................................................... •........._.•--•'----_....------....•---•-----•-••-•----•----•--................................
Owner Address
W ................... ........._............................... •--•--........_..__........---•--••--•----.......................................................
Installer Address
dType of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms................................ _Expansion Attic ( ) Garbage Grinder ( )
44 Otfier—Type of Building No. of persons............................ Showers — Cafeteria
Otherfixtures --------------------------------------••---•-----•----..-..-._--.----------•-•-----------------------..-------.------..---------•---------------------
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. 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........................
•-----------------------------------------------------------------------------------------------------------------------------------•---•......-••--•......--
Descriptionof Soil.................................------------------------------------------------------------------------------------------------------...............................
x
c.,
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 TiTiE 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...................................................................................... .........................._....
Application Approved By........... + i I...........
Application Disapproved for the following reasons__________________________________________________
-------------•.......................... Date----........_
-----------------------------------•-------------------------------------------------------------..•....-•--............-••----------------------•-----------------------------------------------------
Date
PermitNo--------------------------------------------------------- Issued....................................................... .
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................................I.........OF.....................................................................................
Quprtif irttte of Toutpliattrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
•-
In taller f
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.___+��-4/r',/................ dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.............................................. ............... Inspector.........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF.....................................................................................
Nogf:-2.--+.4/--/---••-- FEE., .$............•.
Diopooal Works Tonstrudiutt pamit
Permission is ereby granted----- .- x....( ---------------•----------------------•----.-.-.--.---•------••--------------.-.-------•--•-
to Constr ct car Repair ( an Indjyidual Sewage Disposal ystem
Street
as shown on the application for Disposal Works Construction Permit No.................fi__ Dated..........................................
---------------------------------------
DATE y oard o Health
% /l�
FORM HOBBS & WARREN. INC.. PUBLISHERS
,l Via; 41( k
AT LOCION c1 SEMIAGE PERMIT NO.
l ol-ft 377 _
VILLAGE
1erlJt —
C� lle. ►�- I �-� �
IN A LLER'S NAME i ADDRESS
(,yP..ster(\ Rb No Narwib.. 432-0!k)
BUILDS OR _OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
Gee ,
43 tip.
'tom
�14,,' ti
r 11
!oX IT
�I SIu(vLr- FAMILY - gf DRooM
wo GAIZaAGI= 6Qjwr)GPL `
DAtI�( FLOW z 110 x 3 = a3oG.Pt?
5EPT1G TAtJK = 330x150%
u51=- I000 GAL.
o15Po5AL PIT USE too CAI_. I 1' •
rZ.2. .q 3
►5o 5.t. X 2.5 375 G.I'R
BOTTO/A AREA= • j0 ,iF. i
&Po- f Z5 F-
-Torra.I_ C>S516N * 425 :_:.. . .., r
TOTAL DA I t.-"{ F%-C>W = 33o G.Po. JO I : rou4ta ►olL 'n L I
-NTH... I
PE2Goj_AT1oN RATE] 1''IN ?-MINIo�LE55 M -- '
/ per
Of
J _ IRtdHARp y� o� ALAN
A i W tip ' I t
B"TER 'JON
No 2404A V ! u 2 ' CIL-
t, �� SroIVALE�6.
ry.
TEST R41jI .• ?7�5��� ToP FNU
CLa so l r _ jNv. 49 •o
loovBOA
INV. I
I
Z' I000 PIN
Y ' TANK i
la GAS.. I ,
0 �j,A�Jpr� LEAG11 . . �
PIT INY.. INV. �
6"vto- WITW 4SZ. At.+
� 1�3�9•��i i
N WASNGD ,
�y P�CKtT� 5T[�N6 +
f LIMZDPAtiiIAS
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PRoFIL6 LoG4z1oN �T�� j
88 i2 N o" 5 GALE - - 5 c_
rr
REF•r=ZSt4 C E--
I, CERTIFY -I NAT ?HE 90' uIJnATIv1A 5"C)ww
H6.R�O►•I GOMPL%?!S WITN-T NF- 37
A►•I D 5 6T 2AGK R.6 Q v►
10W1`4 of pt2ly�j��1► l:Lr AND ►S oar
3 r
LOGp.TED WITNI►J T!•N6• G 000 PL ,6.II•I �Eultrlwll.l-l3 (�+t�L�r��s
DATE
i3AX'T'Eee IJ`(E INC.
R.EG 1 S'T icQ6►'D I.A►.I D S u ZY EYoeS
Tu15 Pl.o.t l ►<� WaT oa AN osT'EevIL.LE • MASS.
Iw,5TR.uM6N-V Sv2VG--Y A�-TNE oFV5ET5 SWOUO
No-r 5C v>c.D-ro Lc -r APPLie-A i r ALAQ