HomeMy WebLinkAbout0011 BUCKSKIN PATH - Health 11 BUCKSKIN PATH
CENTERVILLE
A= 170 -021
S M E A DR
KEEPING YOU ORGANIZED'
No. 12534
2-153LOR
SUSTAINABLE FORESTRY MIN.RECYCLED
INITIATIVE CONTENTIO°%
cenlfied Fiber Sourcing FOSTCONSUMER
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SFl-01290
MADE IN USA
GET ORGANIZED AT SMEAD.COM
TOWN OF BARNSTABLE
LOCATION // a ��5�in! Pad SEWAGE# a(:A i "d:5 1
VILLAGE CPNhfs?1 dA0 ASSESSOR'S MAP&PARCEL f 7® Qa_J
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY r TO a _1 p )p,,0
LEACHING FACILITY:(type) 3 (4cJ) 1410 &&4 (size) ID J
NO.OF BEDROOMS y
OWNER I
PERMIT DATE: a I i 21 COMPLIANCE DATE: 2
Separation Distance Between the:
A!0 G.W•of "(ice-C
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 0 Jperr Te%�— 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 Z A •T�f g,,aA nr
z
No. / Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
— �
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ftplitation for Misposal 6pstem Construction jhrmit
Application for a Permit to Construct( ) Repair(14pgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Add csss7or Lot No.i `A5�k�IP44"4 Owner's Name,Address,and Tel.No.
A ss esssorrss Ma !Parcel J`7 1 j�
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
� /-> ►3r(��J�Jc SOg-t1t?O--7isS d�ot� l�,�c:e��
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 #5-5— gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank f5W /0 Type of S.A.S. 6'►l /S tolih 1/ 5 lw
Description of Soil
f >
Nature of Repairs or Alterations(Answer when applicable)_1V6AZW 4 /S-00 4�`161V r e,AA/,- ./6„.4 eiVd
'i�16N N-to C&Ly beis W iF6 N`Sk-Ve T5 tihvCr� err✓ �/U.✓/
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 Certificate of
Compliance has been issued by this Board of Health.
S e Date
Application Approved by Date
Application Disapproved by Date
for the following reasons -
Permit No. C?��`1 � � Date Issued l
No 3 I Feelet5 0
i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yell i'
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
application,for is' osaY 6pstetn Construction Permit ,{
IApplication for a Permit to Construct( ) Repair`( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components +'
Location Addrq ss or Lot No.t Ir�, _Owner's Name,Address,and Tel.No. a
Assessor's Map/Parcel 1-f
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building f P R;t No.of Persons Showers( ) Cafeteria(I;r,-)
Other Fixtures ,s '
Design Flow(min.required) gpd Design flow provided f,7, gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank /5W />//0 Type of S.A.S. '} ;S'Q0 (,1d/ h /5 / �5/0/00
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) G/� k /5'Oo 4411,J
3 Sa0 �)IrJN W-10 d"'u6pf5 wrF6 d/z5�r 45 lybci�✓ cyN �l�tµ/
� 4
f
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 Certificate of
Compliance has been issued by this Board of Health.
S e Date 0—" 70
Application Approved by Date j
Application Disapproved by Date
for the following reasons
Permit No. r1 / Q Date Issued t9 t d
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS .44
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
Abandoned( )by Q.A J;x'cw,-4TNL
at / fj yc k51 ,1, 774,4 G eer'.y wa.,111C has been constructed in accordance l
with the pr,'ovisions of Title 5 and the for Disposal System Construction Permit Nu VJ-`C 3 / dated
Installer���/�/- �7,yp�,,�.✓ �tiL. Designer ] �ayir/ GSG^�
�r
#bedrooms !ll r Approved design flow. WV,() gpd
The issuance of this permit shall not be construed as a guarantee that the system will ffCm•ti jn as designed.
Date / 2 L Z y Inspector { (/ j'
d J / Fee THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Disposal 6pstem Construction Permit
Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( )
System located at /f///N */f
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 ust -e completed within three years of the date of this permit.
Date l 1 I Approv�d
Town of Barnstable
Regulatory Services
Thomas F.Geiler,Director
"U'ffABL = Public Health Division
6 Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
Office: 508-8624644 Fax: 508-790-6304
Date.: 3 2 Sewage Permit# A8.1-1•-O 5 Assessor's Map/Parcel 70 021
Installer&Designer Certification Form
Designer: � J�D Installer:
Address: G>�'I
�� C��c'�� Address:
On 2.111,2-f was issued a permit to install a
(date) (installer)
septic system at dA ,y dvs ?4,�h Cat eeV,1Je based on a design drawn by
a (address)
1Q'V��- 1"'1� dated —1 0 9l
(designer)
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation oft he
distribution box and/or septic tank. Stripout (if required) was inspected and the soils
} were 16und satisfactory.
I certify that'the.septic system referenced above was installed with major changes (i.e.
greater than 10'.-lateral relocation of the SAS or any vertical relocation of any component
of the•septic system).'but in accordance with State &Local R�- `-tions. Plan revision or
certified as-built by'designer to follow. Stripout(if rp -cted and the soils
were.found satisfactory. w ��A OFMgs
�;�(Ins=alletls DAVIDSignature) r
No... Fizz....... ...-00.....
THE COMMONWEALTH.OF MASSACHUSETTS
BOAR® OF HEALTH
................T_own.---------.....OF......Barnstable......
---------------•-----------...---••••••••.......•-
Apptiration for Uispwi ai Vorkg Tomlrurfivat ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( x) an Individual Sewage Disposal
System at:
_11 Buckskin Paths Centerville) MA 02632
Location-Address or Lot No.
Edw. Tynan _ ll Buckskin Path, Centerville MA 02632
.......... .........___ ....- ...- . _. • --•- ----.......
gwner Addr ss
W A & B Cesspool Service 128 Bishops Terrace, Hyannis, MA 02601
Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e 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.
Seepage Pit No--_-----_-------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
14 Percolation Test Results Performed by.......................................................................... Date...........>............................
a
1.4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
ODescription of Soil........................................................................................................................................................................
W
UNature of Repairs or Alterations—Answer when applicable.___inatallatzan...af_-a..1,10-M-gell.on-_gam--Cast
..at me c<kad..leach--htt------------------•------•----•---•---....... ----•--•---•----------------=-----•------------------------------------•-----.....-•----------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has ben issued by the board 0health. `
Signe -- �-•.. - ----------7�2 f 81-
/'
Application Approved By........... J�1 ------------------7/;e 81
��= Datk
Application Disapproved for the following reasons-------------•---------------•-------......--..•....-----------•--- ...........................................
............................•---------•--••-------•---------•••••--....-•--------•----••----••-------•••-•-•--------•-•---••------••------•-•---------•-------•••••-•-••-•--------•--•-•--•------------
Date
Permit No....------81--....................................... Issued..................-71281
Daze -•
of
FRs......$...5.00....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...............T.own...............OF......Farnstable.........
Appliraation for Disposal Works Tonstrurtiun Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal
System at:
11 Buckskin Path,..Centerville, MA •--02632 ...............................................................
Edw. Tynan Location-Address 11 Buckskin Path, Centerville, MA 02632
................--....__•................-•-•----••-•------......---.....--•-••---•-------_-••_. ......... . ---•--------•-•------------ ..._.. ...........---
A. & B Cesspool Serv�ce 128 Bishops Terraee;d��yannis, ;lA 02601
--••-•-•-•••......-•••••-_....
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
C14 Other—Type of Building ............................ No. of persons......................5 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.
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---___-_______----_--.
PLI Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
9 .......-...88i7id'-----
•••--
----•--------------••--•-•••••...-•-------••............---------•••••--•...................................................
•
ODescription of Soil.......................................................................................................................................................................
W
U .....................................•-----•••••••........-•••---••••........•-•••----•-•--•-----••-----••-•••--•--•--••---•----------•---••••--•-••----•--•--••••••---•--•-----•••-•...-•---•..........
w
x ....................................................... ------------•---•--•----•--•••••••-----•-••----••--•--••-------------------••-••-----•--•-•-•-----•----•-•-•-•-•--•-•••-......--•-...._.._------
U Nature of Repairs or Alterations—Answer when applicable._._AJ MU1,14.tion_-of-_A._1,-000._gall Ala._pxg-Cast
._stQne..p ckea.leMb l..pttt-•-••-•-•--•••-•••----••-••-----•-•--._.....••-•.....-•-•-•-••--•••-••--•••-••••----•--•-•---••••••-•--•-•••••••--•--••----•••-•...-•-------•-•.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITL; 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 Ahealth.
Signs. =------------ - �4De
1.81
Application Approved By....•......-��� ���'-�1._.. � ; 1. .
_-•----_-------------- -- 7 1
Application Disapproved for the following reasons:----•---------••------------•-----------------------•---------•-----------•-----•----••----•-•----•-•........---
.-•----------------•---------•--•----••••--------------•-•--•-------•-•---•••-----•--------•-•----••----
Date
Permit No..........$1`--•------•----••....................._ Issued_................... l /81....._..--••--•--•-
Date
i
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.....................T WA.........OF..........�A=;stable..........................................-----..
Trrtifiratr of (CoutpliFattrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System construct d ( ) or Repaired ( $)
by A & B Cesspool Service,. 128 Pishops Terrace, Hyannis, :A 02�01
at
11 Buckskin Path, Centerville YMA . OMJ ' - Edw. Tynan
----••--•----•---••--•--••••-••-••--••................•----...--••............•--...----------•-
has been installed in accordance with the provisions of TIT F 5 of The State Sanitaryo escribed in the
application forDisposal Works Construction Permit No------------- ya9'..._....... dated .. ___. -/
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT TIME
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..............8/11/81................................................. Inspector............ -------------------
V-COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
81- �D Toaan.........OF._...........................................................rstable $ 5.00
..................... ....
0...............T '..._. FEE........................
Disposal Narks TwOnstrurtion rrutit
Permission is hereby granted.............A & B Cessp ool Service
to Construct ( ) or Repair (X) an Individual Sewa e Disposal System
at No..11._Fuckskin Path, Centerville, PM,A 632 - Edw. Tynan
Street / ,-/......_.
as shown on the application for Disposal Works Construction Permit No.. ..___.-:_ Dated........ ........7. ..1
--------
.................................................and of Health
DATE------------------•--�/�7-��1-------•-••---........-------•--
FORM 1255 HOBBS & WARREN,, INC., PUBLISHERS
LOCATION, SEWAGE PERMIT NO.
yC,�S�C0")
VILLAGE
I N S T A LL R'S AME i ADDRESS
ss b/I
BUILDER OR OWNER
dLk)P;�
DA T E PERMIT ISSUED079_��
DkT"E COMPLIANCE ISSUED
m' �C Feb
ee,6400I
1060 9
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