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Home My WebLink About0181 ANSEL HOWLAND ROAD - Health E L HOWLANDrRD. VILLE 237 ctFo�o�� 1rie(u�� llll UPC 12543 No. 5.3LOR coo HASTINGS, MN w TOWMOF BARNSTABLE is LOCATION 4-1 4nP,1 400 SEWAGE #,-�'Co� -cam 1' VILLAGE C"fuillc ASSESSOR'S MAP & LOT %7 ---23 '( INSTALLER'S NAME&PHONE NO. fSEPTIC TANK CAPACITY Moo 6(X LEACHING FACILITY: (type) r 5 (size) 21)O!K Z j NO. OF BEDROOMS _ BUILDER OR OWNER PERMITDATE: f_cJ m COMPLIANCE DATE: Separation Distance.Between the: `Maximum Adjusted Groundwater Table.ta the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge:of Wetland and Leaching Facility. (If any-wetlands exist within 300 feet of leaching facility) Feet Furnished.by � � Q T N. t Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for 0iouar 6potem Cow5truction Permit Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 181 Ansel Howland Rd. , CentervillE Tom Creighton Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service P O Box 1089, Centerville Type of Building: Dwelling No.of Bedrooms 2 / 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Sant] Nature of Repairs or Alterations(Answer when applicable) Title-5 leach system consisting of a D—box and 2 concrte chamber with stone all aroun . Date last inspected: Agreement: 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 Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Bg4 of He Signe Date Application Approved by 14K Date 6211 Application Disapproved or the following reasons a Permit No Date Issued Fee , t THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Vs PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE MASSACHUSETTS S 4 "g 01pplication for �Digozal *p.5tem Congtruction Permit Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 181 Ansel Howland Rd. , Centerville Tom Creighton Assessor's Map/Parcel ..;t. Installer's Name,Address,and,Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service P O Box 1089, Centerville Type of Building: ' Dwelling No.,ofBedrooms 2 3 Lot Size sq.ft. Garbage Grinder( ) Other Type QBuilding No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow . gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Sand Nature of Repairs or Alterations(Answer when applicable) Title-5 leach system consisting of a D-box and 2 concrte chamber with stone all arouna. Date last inspected: Agreement: 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 Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of He `S S.igite Date Application Approved by .,� �. Date ) Application Disapproved Porthe following reasons ;i Permit No " 00Date Issued' I THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Creighton Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( X )Upgraded( ) Abandoned( )by Wm. E. Robinsonm Septic Serv-ice at 181 Ansel Howland Rd. , Centerville has ben constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No - dated Installer Wm. E. Robinson Sr. Designer The issuance of this pe sha 1 not be construed as a guarantee that the syst ill function- d-'signed,. Date 75 Z � v Inspector _�fi � T ------,�L------------------------------- No. Fee$5 0 l� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Creighton lwigoaf *pgtem Construction Permit Permission is hereby granted to Construct( )Repair( X)Upgrade( )Abandon( ) Systemlocatedat 181 Ansel HowlaND Rd. , Centerville and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constru ion mu be completed within three years of the date of thi 't. d�/ _ Date: / Approved by • -,d MM NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DLSPOSAL WORKS CONSTRUCTION PERMIT(WTMOUT DESIGNED PLANS) William E. 2 ob ins on,S>weby certify that the application for disposal works construction permit sighed by me dated %` D , , concerning the property located at 181 Ansel Howland Rd. , Centerville meets an ofthe Mowing criteria: • The failed system is connected to a dential dwelling only. There are no commercial or business uses associated with the dwelling. The soil is classified as CLASS and the percolation rate is less than or equal to 5 minutes per inch- There are no wetlands within 00 feet of the proposed septic system • There are no private wells ithin 150 feet of the proposed septic system There is no increase in and/or change in use proposed • There are no requested or tteedtxl. • The bottom of proposed leaching facility will ngt be located less than five feet above the maximum ad' ed groundwater table elevation.: (Adjust the groundwater table using the Frimptor method wit applicablel • If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(1.1)feet above the maximum adjusted groundwater table elevation, Please complete the following / ?►) Top of Ground Surface Elevation(using GIS information) 1 r B) G.W.Elevation +the MAX. High G.W. Adjustment. DIFFERENCE BETWEEN A and B SIGNED :`'(J�/`(a- .- DATE: -- [Sketch proposed plan of system on badcl. q:health foldcr.cen i V Ea �J I TOWN OF BARNSTABLE � 'LOCATION 1 !'A 4ocO 0 I(L SEWAGE # (SO VILLAGE U c ASSESSOR'S MAP & LOT 7/` 3 7 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY D Grp LEACHING FACILITY: (type) r (size) 7 001 k 7- NO.OF BEDROOMS ` BUILDER OR OWNER PERMITDATE:, 'rJ ______'COMPLIANCE DATE: Separation Distance Between the:. Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility n Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by rp � ,c -1 s� l O No.... 9a 111r�„ + v Fxs.. u..`.�......... THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH ........OF........ ......... Appliration for Disposal Works Tnntitrnrtiun thrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal SySMtat, _.� . --- ----------------------------------- --"'-4 ........... ... Loc on-Ad ess or Lot No ... ........................ .. ....... ....................................... ......... ...... ..... ... ...-- ....................................... 0 fn ----------Address a -•••-------- . .. .._... .. -- - ------------------------------------------- Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms._�.................................Expansion Attic (40 Garbage Grinder (04 /L� '4 Other—T e of Building No. of persons............................ Showers — Cafeteria a' Ot e fixture, W Design Flow..... _................ allons per person per day. Total daily flow........ WSeptic Tank—Liquid'capacity. Length.... ........... Width.......--•---... Diameter. Depth xDisposal Trench—-No o.s..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.lwk�_.. Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest 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........................ ------------------------------•-----•------------------•------------------------------•--.------......................................................... 0 Description of Soil............................................................................................................................---•-----------------------------------•--•- x W •------------------------------------------•-----------------------------•........•-•--•---------•-------•••••---------•-•••-•••----•-------••-••--••-•-•-•-•--•---••-•--•----••--••--•---••-----•-•--- UNature 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 iILTILS 5 of the State Sanitary Code—The undersigned,,Mrther agrees not to plac the system in operation until a Certificate of Compliance has been ' by the b d iealth. l Signed -------- -- ---- ate Application Approved By------------ ---- '�' _ � �{ ....................... Date Application Disapproved for the following reasons:.............................................................................................................. -----------------•--......--•--------.......---.....-----•---------------•--------------........---......•---•••••-••••••••-------------••--••----•-•----------•--•-----••-----••-••••--•--•-•-......... Date PermitNo......................................................... Issued....................................................... Date 1 IOCAT SEWAGE PERMIT NO. VILLAGE I N S T A LLER'S NAME i ADDRESS R06ERT B. OUR CO., INC. NOATN NARYY4CR. MASS. 02645 i U 1 LV E R OR OWNER DATE PERMIT ISSUED 9-a_ga DATE COMPLIANCE ISSUED 9 -�0 -8z ��-` _ � 9 � �� ' 4 Ak No-----(5 FxR...3S............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................ ........................OF................11................... ............................................ Appliratiou for Disposal Iforkii Tonstrurtion ramit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ................................................................................................ ................................................................................................. Location-Address or Lot No. ............................................................................................... ............................................................................................... Owner . Address .................................................................................................. .................................................................................................. Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder PL4 Other—Type of Building ............................ No. of persons.......................... Showers Cafeteria �P-4 N Other fixtures .......................................................................................... .......................................................... Design Flow............................................gallons per person per day. Total daily flow.-',........................................gallons. ,:4 Septic Tank—Liquid capacity............gallons Length................ Width.__.._..__..._.. Diameter---__-__-------- Depth................ Disposal Trench—No:-------------_---- Width.................... Total Length.................... Total 16aching area....................sq. f t. Seepage Pit No..................... Diameter......_..___.__.._.. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.....:.................................................................... Date......................................... 1.4 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..___._____........._... .............................................................................................................................................................. 0 Description of Soil......................................................................................................................................................................... �4 *--------*-------------*----------------------------*------------------------------------------------------------------------------- ----------------------------------*----------"----------------- ........................................................................................................................................................................................................ 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'TT:IZ- 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.............. 'AV....... a te .................. Date Application Disapproved for the following reasons:............................................................................................................ ...........................................................................................................................................................................................I............. Date PermitNo....................................................... Issued----------------------------.......-------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF............................................................................... (Irdifirate of Tompliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by............... f ----.........-•--------•-•---•------------ ------------------------......----...---....7........................................................ Istaller C / .................................................. .. ............. ..... at..................6 -7 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.._._. ............ dated-...---_--.---.-.--___--.-__--_.-_____---__-_--. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................................. 0 - ,.............. Inspector........AAA�........................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.................................................................................... FEE..................... Billposal rks (L"111notrurtion "prrutit Permission is ereby granted------ .....41......0. .......................................................................................... to Construct (p or Repair ( ) an InVdual Sewage Disposal- System .' atNo.......... ...........e! �4------ ....... -------------------------------------------- Street as shown on the application for Disposal Works Construction Permit No.................... Dated.._.________.._............_.............. -------------------------------------------------- DATE....................................... i?................ dar�WHealth FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ' NO GAQ-5A6E �jR.11.1TSt✓2' . DA%L..( FLOW a 110X 3 = 3506.P� SEPTIC, TANK = 330xl5e>% =-}9yG.P. o u 5c- 1 o 0o GAL.. ' . Go}o �Pir 5►pSVVALI_ AV-Sh, = 150 S.F. V aam- BOTTOM AREA= 5O 6.F. -T GT A L- C E�I GN T --,2 5 &.P D .• �IDl�'C1p1:I �— 'ToT AL_ DA I t-Y F%-OW = 330 G,P,o Pa V-COL.ATIC)k RATE: 1''IN ZAIN AI�SEL L{jb WHAA6 ,��• ALA �r .A. QAXTER No.24(M 4.� T65T Q�1L `�.G TOP FWV=�;CPZ;• I f.G-60 r -� INS. OIL. 5$,� �v's�411+t�•• . Bb�C 56PTtC- �I _ . Z .f : _. . : t o0o IN�f, S$•6 TANK .. PIT --___ ._.... iNY.._.__INY;_. ..._.._.;___.____..�. _.. . .........._ Z (o WASNGD j .. 1.. LSTONE .. .} ' .: .. . i•� ;....�_{._i .; I .-- . S Q CG2TIr-tG0 PLbT PLAN it PRot=i LE Ab �Z NO SGALE SCALE. � I� 40, pATV-- � ' 14�sL EJn rlJA.TL-e;.,. . j�' ; . CERTIFY THAT 'TNrc 1'oVaDAT100* SOWN PLAN REFE�� GE NER.Eo►.I GOMPI-`�5 1nlITN'CHE. Slot-lt-1� AND SI=T5AGK 26QU1R.ENC�ENY� OF-tN� _ "fo W N O F 'f3A ')TASLG LOGp,T -V11lTNltJ NE GL_oo� PL.A.It,I .. �. ..;. .... . �.�V • 1�� -�-3 Pfo �� AATE� Id lea. ; R.EG 13Z r--v-r.D I.,AN IO 5 u RN EYb26 'T%Al!! PL&Nl 115 f Crr Bko56D GVd AM vSTE2VILLE N1A55. tu5TR.uMENT Suevr--Y 4-TNE oFFSE75 Suoul,� NoT C36 V56DT0 LC-T kLAO SSA L4. �