HomeMy WebLinkAbout0028 CENTERBROOK LANE - Health 28 CENTERBRROK RD.
CENTERVILLE
A = 172 247
No. 4210 1/3 ORA
10°I°` `
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No. Fee$5 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Yes
ZippYication for Digoal *pgtem Cou5truction i3ermit
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.
A9AsortsMa%Wcre)Drook Rd. , Centerville Pat Steacy
/77- Z
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 1 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 Sand
Nature of Repairs or Alterations(Answer when applicable) Title-5 leach system consis—
ting of a D—box and 2 precast leach chambers with stone all
around. j-3
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 Bo d of ealth.
Signe Date
Application Approved by -Dateo/
Application Disapproved for the following reaso6z, v,- - - W-1 /
Permit No. Date Issued
No. y Fee $5 O
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
0(ppYication for Mi!gpooaf *pgtem Con!5truction 30ermit
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.
A28orCAja azgNUrook Rd. , Centerville Pat Steacy
/7Z- Z`i
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 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 w+
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 consis—
�� tang of a D-box and 2 precast leach chambers with stone all
around. )'3-;L 5-2-
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 Health.
Signe .I - /1 i�.--5 Date �i '3/-� f ^� f
Application Approved by _� Date 1/1 i`! f !f)
Application Disapproved for the following reasons
i
Permit No. 7iM I Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSE77S
St lacy Certificate of Compliance
1 THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired (X )Upgraded( )
Abandoned( )by Wm. E. Robinson Septic Service
at 28 Centerbrrok Rd. , Centerville has been constructed in accor ance
with the provisions of Title 5 and the for Disposal System Construction Permit No.Zlh /—L in
dated 6"Z 7 —�
Installer Wm, E. Robinson Sr. Designer
The issuance of this permit shal not be construed as a guarantee that the syst ill fu ction s de i ned
Date O� Inspector
---�— ' /--//—(,--------------7--- --_-- — --- -
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Steacy
lizpozaf *pztem Construction permit
Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( )
System located at 28 Centerbrook 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:Constructmust be c mpleted within three years of the date oft ffei
0 (�
Date: Z9 G Approved by
t
11tiJ9R '
OTtCE;This Fora►U To Be Used For the Repair Of Failed
G i , Septic system only_
C�l'II+iC.�'rIERi OF SK8'YCH AHD�PPI.ICA'110I�i FOR A DLSPOSAL
wo_RKS CONSTRUCTION M'(WMF I r DEMNED PLANS)
L William E. Robinson.S%mbyca*lhudwapphcationf.,rdLqmWworim
oovau,>yotioe►peyteasia�sited hY me dated �-' . conmffing the
Query Eked at 28 Centerbrook Rd. , Centerville mews all ofthe
following cnteria:
e.
• i
ledsy�isoomundwave$Wb m ddw�e* Theearenoconume�tort is ctas!f> as CLASS 1 and�pemmadm rateideas a u�or equal io 5 inizwvcs per inch
fe no wibin 100 feet of the proposed septic kti7Memam so privata w db wakin 60*a a them pmpesed 9:pw sysu mis no iumcm in flow=ON in use pH"W
are no variants textmad or neededoom of the f wilt MWbe tovamed less shag five fees above%bee
ma.mmum adjosmd Vowdwam mw elm mi f Agrpg at gmundwmcr table usmg the Fnmptor
facdW when appbcabkl
If the SA-S.will be locmd with 250 Cat of ate;veg=mdwedandsLthe bottan of the pmpmed
kar�iug bcfty wM M be kamA hss dQn fmotem t 141 foes abom the:nr&1dmum add
Smundmur table doadek
Pft=c the
A) Top of Gmomd Smbm t G1S Wwmmiml
of G.W.EMraion ,WT +1k MAX MO G.w_A40mmm �
DIFFERENCE BETWEEN A and 0
SIGNED: ze, DATE:
(Swch PMMMEd Pbn of syg m on back).
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TOWN OF-B`S
LOCATION k, ..g C Lo.�-J &rL.ab Ic(T$ : �:;.�. SEWAGE #`
VILLAGE e nn ' ASSESSOR'S MAP & LOT '�7 Z-Zy
INSTALLER'S NAME'&PHONENO. r� I/1- t r 'Z't5 2r2-�Cr t -": ; :Y;•'
SEPTIC, TANK CAPACITY
LEACHING FACILITY (type) "
NO. OF BEDROOMS ,
BUILDER OR OWNER �2 G
E tj,<.:an> -,;a S - r.• .:,:.. :r.:� 7�:1. - - ^GCS � t t r i�tr^ u
PERMI DATE: — COMPLIANCE..DATE.
Separation pistance Between the
Maximuit Adjusted Groundwater Table to e Bottom of Leaching Facifiity Feet
Pivate Water Supply Well and`Leac g Facility (If any wells east:
on site or Witt n:2W feet<of leac ng.factli'ty') ,Feet trT ,
Edge of Wetland and`LeachOg.F cihty(If any wetlands:exist.'
within':3(b feet of leactun - acuity),:: Feet
Furnished by
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07' �� t
TOWN OF.BARNSTABLE
L,C ATION _.,. iSEWAGE #`
VII I ACC E a a, "ASSESSOR'S Ib1.AP &LOT
LNSTAIILER'S NAME.&.PHONE NO.
SEPIX TANK CAPACITY.
LEACHING FACILrrY: (type) ' �`�"4 P1"°� Z.G (size) 1`,;L J tl
NO. OF,BEDROOMS _
BUILDER OR O`VNER, 'G
PERMI��DATE: " ` G COMPLIANCE DATE:
Separation I?istance Betwee/cility
Max'rnmm.Adibsted GroundwJe Bottom of Leaching Facility `=1Feet
Private water Supply Well a Facility (If any wells exist
on site or within 200 feet acility) Feet
Edge of Wetland and Leachif any-wetlands exist
within 300 feet.of leachin Feet
Furnished by
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�wf�-................OF..............�✓�:!'✓1 1�1! !. ............................
, pliftr ation for Disposal Works Tonstrnrtinn ramit
Application is hereby made for a Permit to Construct k_�) or Repair ( ) an Individual Sewage Disposal
System at: -
Location•Ad a . ............................./GGC . t. oj
..
Owner Address
" 4s......
Install'er C r l i
Address Type of Building Size Lot__/ i
U �f,SC10._....Sq. feet
)
U Dwelling—No. of Bedrooms___..................................Expansion Attic ( Garbage Grinder U
`4 Other—Type T e of Building ............... No. of ersons.....................__.___. Showers — Cafeteria
Q, YP g ------------- P ( ) ( )
Other fi esi----•--•----•---•----------•-
W Design Flow.......................�...._._._.....•..gallons per person per day. Total daily flow---------- .................gallons.
WSeptic Tank—Liquid capacity/)QOA.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................ q. ft.
Z Other Distribution box ( ) Dosin� tank-- ( ) M v
'-' Percolation Test Results Performed by. .� ✓ _ . ...�?I`�.!`...................... --__•_- Date... . .__._� ..
04 Test Pit No. 1.._. __.. ...minutes per inch Depth Test P�......::?�._._.. h to ground water._ooLeO -`
Gz, Test Pit No. 2................minutes per inch Depth of Test Pit..._.........___._.. Depth to ground water-_.-_______-_____.--__-.
04 -- ----
------------------------
•----------------
•---------------
O Description of Soil--- j � ' �`
x ---•----••••-----••---•----... jI� ----. ��ur
U
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 o0, 5 of the State nitary Code—The undersigned further agrees not to place the system in
e tion until of Compl' e has been issued b he board of
plication Approved By..................... •--- ------. :..'
Date
Application Disapproved for the following reasons:........j....................................................
............................. •-•-----------
.......---•....................•-•-----------------------._...--•---------•----------•.......-------•--...-----•--.•...........---••----•--•---•..........•. -------•-- ...............................
—7 Date
Permit No........� �- ---------------- Issued-----------
- - .
Date
�- -
A ,
lyi
THE COMMONWEALTH OF MASSACHUSETTS
,.� BOAR® OF I-IEALTt-I
App iratinn for Disposal Works Tonstrnr#inn Prrmit
Application is hereby made for a Permit to Construct kk) or Repair ( ) an Individual Sewage Disposal
System at: /
3 Cy
........ .....•-• •.--•• ••-----• .. -2.
•-• Location-Ad r t
'
p Owner m Address
`,1 "�' ........ .c '----------------------- -•-•- -•-• 1' `. .........
.. -------•----- ----•---
Installer Address
d Type of Building Size Lot_1S.1.• •--0-�- ......Sq. feet
U Dwelling—No. of Bedrooms----------- ........_.....................Expansion Attic ( Garbage Grinder/ld
04 Other—T e of Building No. of persons.............. Showers
QI YP g ---------------•-----------• P ( ) Cafeteria ( )
p" Other fi e ....
d -•---------------------------------------•--------I-----------------------------------------------
T.
W Design Flow.................:..____.:_.................gallons per person per day. Total daily flow......... . ___...............gallons.
WSeptic Tank—Liquid capacity .....:.gallons Length................ Width................ Diameter---------------- Depth---_............
xDisposal 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 ( ) Dosi �a ;n ��l Percolation Test Results Performed by_ .. / _. .,_._ f...................... ....... Date__ ___ . _ -.
W
Test Pit No. 1.�f....minutes per inch Depth- Test PP......_/�L_... D th to ground
(s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
77
D Description of Soil.. 1. �7 ►.. / -- --- ---- ----------------------•----------------------•---•--•-------•-----
U
W
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 T IT LE 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 oAl.t hf
, . 7/
igned ... ----•• ----••. -•-••...........
a
Application Approved B ..__2...a_...:.:
Date
Application Disapproved for the following reasons---------------------------------------------------------------------------------------- =......
...........................•-•---•-----------------••----•------------------------------........-----------••-•-••----•---•••-•--••...-----•----•--•-•---•---•---•--•-•----•-------•-•......•----•.....
Date
PermitNo......................................................... Issued........................................................ :
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......................................... ............................
Cgrruftiair of (gompliatta
THIS IS TO CEE.ZLFY, That the Individual Sewage..l7'isposal System constructed (.kl or Repairedby ( )
............... ... `:�: !i C.�.� �,�'�'"t._... -----••. .......--•-----------•---....---------....... f
Installer
has been installed in accordance with the provisions of T ,TLC 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No Sy�.._-1..........._...... dated................................................
THE .ISSUANCE. OF.THIS CERTIFICATE SHALL NOT BE CON TRUE® AS A GUARANTEE THAT THE
SYSTEM WILL PUIRCTION SATISFACTORY.
DATE...................A..' 1.6.... --•------------------•-------- Inspector............ ---------. .....-- .-- ............•..........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
' .. 2:'7 IV0Y ..�C ... o .....-...t..............................F...........:_....-.
.........................
FEE........................
Disposal orb (gnn#rnr�ion rrm'
Permission hereby granted--------------------------. �"..-------------------------......_....------.....
to Construct o 1.r Repair ( ) an Individual,Sewage Disposal System /
atNo.-•--•-•-•-••-•-••-•.._....--•-•--•--•----• L.33'C'"-...._.. 7 '" ......_.o�>•.___..Street_
as shown''on the application for Disposal Works Construction Permit-N-o�.. ��.._...__ Dated- / ..........................
.....
j Board of Health
DATE.............. •---•-
} FORM 1255 A. M. SULKIN, INC.. BOSTON -
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OR
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F � LEGEND F�kv
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,EXI$:TING 4POT 'ELEVATION ` E�
XSTING{ C.ONTO4JR _�.� 0 CERTIFIED PLOT PLAN.
t ;,_. a
s FINdSkIED 'SPOT" ELEVAT1 ON ' S
®
#SHEDCON,TOVR -�--- I
° IIbI'b z'fhe .,tlocaton .of`•any exi`s tng"u�nder� a ound sewerage,
we11 ,. or .other`utilities shown' on#t~is�plan�lis appxox rt, T rT 1 N ,�s �, ��gS
�!
mate°'only as-, determined fromrecordst and�or tverbal \ ■ LA bi
' � nformatiori. The contractor is responsible far, the
cation of• the existing locataons �n the 'field. gCALE, '`l` DATE
0Gf fWG/NEERN OR�E
CLIENT„ I- CERTIFY ,THAT THE PROPOSED
JOB NO; +,.. ;
EGI$TERE REOt3TERED v' BUILDING SHOWN ON THIS PLAN
r ° '� C IVIL LAND''.:;, cis ,r ; CONFORMS'TO THE, ZONING LAWS'
DR BY�f
Y Et 0 ,1E R RV ,; •., OF 9ARN.$TABLE MA ► ,
MAI N'STREET"'„ CN:BY�° '7?
HYANNIS� MASS: . SHEET �t; t
F A E SURVEYOR
O REG. LAND;
.- .. ..;f a_-�... ca-. ., .... s ..f:,1if r:'r";%a._yrst�2,.i 'ki.+r-.f,.x.}:✓i.., 4n'�k a,.,.TS.rsta.t��,,�;3.e ... ..,.. »-w.�.t .... .,-x... -. .. ..,....�.�,•^.r
a0 FT. M/N. N0 THE SEPT/C TANK OR
L,�f+CN/iYG P/T ARE MORE "TNAN /2"S.ELOW
r'RAOE• A 24'D/AM ETER CONCR.F7'F: COWER
/D:FT• M/N. SWALL &,F"BROUGHT TO 4MADW-�'4,V EXTRA YI
CONCRETE 4'PYC P/PE t,rEAVy CAST /RO/Y COV40R S/;.QL.L 13.E VS�1� I
wlm. P/TCH
� .J�,p COWERS %f�'PFR FT /F/N L7R/VEy1/Ay hl
a 2 MiN. CONCRETE ~ ,
GkAOE COVER Q CLEAN .SANG i- t
40
z LAYER
ofrey J DIST. • WASHED -S=,YE
/q+Peet T'T. S.EPT/C TA/VK .. . .0 .o o .'v .
• P • • •EP'rECT/YC' • 4 - �2
• • • • • DEPTN • •• • v.. WASHED STONE t
• - e . v D P PRECAST SEEPAGE
r�.t-�.�/�p y o •o • • • • • • • • e o ' -P/T OR 4Vu/V.
IMNL.'ICT CL2YAT7oNS
i 6 FT D1AM
1"YERT AT S/J/�.i�/NG C'z ,� FT b F7. P1,4M. 0 CSEE TABLL4TlON>
lNLE7 .SEPT/C T.4I►!/C � R FT ��—
OUTLET SEPTIC TA/VK �t.� F�
._AIGEr-P1STR/40l?/ON BOX G( FT. SECTl01W OF G�OuND N�tTERTAELE MG �Z� • q ,�s �F'
Dt/TLETDJSTRfB!!T/ON BOX mil•� FT.
`� /NLET: ,ACNJJVfs PIT 6!60 .�T SEI�AGE O/• PthSr4 d. Sf�ST�Nl -rA4W.AT1A/V
L G'HI/VG �f T o aJEl+r�/oAt A 3 FT,
-SCALE �.i m / -0 /Yr
jo
!?FS16dV CRITER/�t Dl�f tS/aN FT.
iV L/�dB�R OF SE�RoOMS 21
GARBAGED/,SPOSAL UNIT hfJ//= SO/I- LOG s®/.co 'TEST
T0ZAI- Fd.OK/ 22o 0.4L14AY SOIL TEST A/ SOIL 72FS7-*Z
UMSER QF LEACX/Nl+ P/TS f^gLEY. 5 z.,�j ELE'K DATE"OR- .SOIL TEST �12 S�rf�
A
S/OEd,0ACH/NG PER P/T S41. PT.. ' RESULTS JR/ITNESSED
v— �
49077"01W LA4CNIAta PER P/T ?�,S SQ. F'T. Sfr a!r�Y PEIeCOLAT/0I9� mA7,E At/ G�SS !y//V•I/NCN ;
'' ? Fmveco A-'/ON R.4TF 2 ` �' M1N:�lNCH
TOTAL L.EAC'N/NG AREA ; SQ. FT.
R-SaITYELEACNIN6*4REA ?-&T SQ. FT.
+rsROStRT
3 BRVCE 11.. 02 .. p� J �C."g3.15 �ZCv/S :%7
2 � - ELDREG I I j/�
Sj�f�o ` RSE ..�c51 � - L5E�j A ONGEW A✓i J �l s N1
�. -
GISTP/BS 7te? M:atN .9 , h i3, MA S_ i
Po�FS ENS\
IONAV I t�i T6�R �/COElrV!�'ER€Go
ifOGilgOtlND
-
VOt A' T ION SEWAGE PE IMIT No.
a
VILLAGE
C eo-c 1-1//Af,
I N S T A LLER'S NAME A ADDRESS
•zJ_ .�7r�sccs/ dh
BUILDER R 0 TIER
("reen/ / r
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED c�S
hron t o /70
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SF i
6
30