HomeMy WebLinkAbout0036 CROSBY ROAD - Health E= 202s9
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No. 42101/3 ORA
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No. ,.
—t' Fee 5 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer.
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Zip plication for 3Dfgpooa1 *p!tem Conotruction Permit
Application for a Permit to Construct( )Repai r(X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
--�"— Location Address or Lot No. Owner's Name,Address and Tel.No.
Assessor3s�ap0cetpby Rd. , Ce terville Mark Egdall
2g J2k 12 Brandywine, Wayland MA 01778
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
WM. E. Robinson Septic Service Sweetser Engineering
P O Box 1089, Centerville P O Box 713 S Dennis MA
Type of Building:
Dwelling No.,of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building RP s i cj P n t i a 1 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 100 C v e of S.A.S. 1 X 6 s
Description of Soil; L —
Nature of Repairs or Alterations(Answer when applicable) Title-5 leach system to the—plan s
of Sweetser En inee
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 CodgAnd not to pl a the system in operation until a Certifi-
cate of Compliance has been issued by this Bo d of Health.
Signed` Date (5 ✓�
Application Approved by :9V- Date Il f—n
Application Disapproved for the following reasons
Permit No. 20 D Date Issued d
�, ..
Fee
i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION--TOWN OF BARNSTABLE., MASSACHUSETTS
ZppYication for �Nopooal *pgtern Construction Verinit-
ApplicationAr a Permit to Construct( ),Repair(X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
l�IapTPazepby Rd.a 7'eli � 1
Centerville 2rB
Assessor�s randywine, Waylamd MA 01778
Installer's Name,Address,and Tel.No. / 2 Designer's Name,Address and Tel.No. - `
Wm. E. Robinson Septic Service Sweetser Engineering
P O Box 1089, Centerville P O Box 713 S Dennis MA
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building Res ident- a 1 No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow ,gallons per day. Calculated daily flow gallons..__
Plan Date Number of sheets Revision Date
Title I
Size of Septic Tank Poo ' e,(OA Ty e of S.A.S. 1 'A d0k 36 !
1
Description of Soil
r M
Nature of Repairs or Alterations(Answer when applicable) Tit-1 e—S 1 g:,..,rh STS t p m to that w l A n!3
of Sweetser Encrinedking, dated 10-18-01 #5239-00
Date"last petted:
e j t
Agreement:l ,�
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
^' F in accordance with the provisions of Title 5 of the EnvironmentaZCon,R not to pla a the system in operation until'a Certifi= ,y
cate of Compliance has been issued by this Board of Health. *�
Signed Date b 0,4
Application Approved by Date It -/5 01
Application Disapproved for the following reasons
Permit No. 900 Date Issued /
——-———-————————————————— —————————————
THE COMMONWEALTH OF MASSACHUSETTS w
BARNSTABLE, MASSACHUSETTS
Egddll Certificate of Compliance `
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( X)Upgraded,( )
Abandoned( )by Wm E Robinson Septic r Sarvi na
at 36 CrosbyRd. Centerville has been construc ed i accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer Wm. E. Robinson Sr. Designer Sweetser Engineering .
The issuance ofs permit shall not be construed as a guarantee that the sy to will function as de igned.
*. Date I J �1�i 110 U 1 Inspector °W� � . �Un�
i
----------------------------------------
No. d 00 Fee$5 O
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS
Ecjdall lwiopogar 6potem Construction 3permit
Permission is hereby granted to Construct( )Repair( X)Upgrade( )Abandon( )
System located at 36 Crosby Rd. , Centerville
,a
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes hiyfier,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: < < h Approved by "7 '
TOWN OF BARNSTABLE
I-OC!An,TON G SEWAGE #0I _.
VILLAGE ASSESSOR'S MAP & LOT mil. a.
INSTALLER'S NAME&PHONE NO. a 7 -2 5'— Y 71 4
SEPTIC TANK CAPACITY Bch m�
LEACHING FACILITY: (type)//;t U .Z.t-r L.G„ (size)//°—,3 6 O
NO. OF BEDROOMS 3
BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE/
Separation Distance Between the:
Maximum Adjusted Groundwater Table to 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
C
or���i
LO A I ` SEWAGE PERM1 NO.
6y- �9
VILLAGE
INSTA LLER'S NA E a& ADDRESS
LG
t
I � a U I L D E R OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
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ice'� .s L� ,��
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TOWN OF BARNSTABLE
LOCATION Y Wd SEWAGE #®/
VILLAGE ���h-i, ASSESSOR'S MAP & LOT �.
INSTALLER'S NAME&PHONE NO. 576 /Z S d 9 71 Z,
SEPTIC TANK CAPACITY fa m-d
LEACHING FACILITY: (type)'/s ot-U e- (size)/%-,5 4
NO. OF BEDROOMS 3
BUILDER OR OWNER
PERMITDATE: //>/SS-0 COMPLIANCE DATE/
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet 1
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
9
1
7� M
ll 1�2�4 L,�-
i
TOWN OF BARNSTABLE
`LOCATION 3�0 ,01 P, SEWAGE #
'VILLAGE Ctcr►itiefVAL ASSESSOR'S MAP & LOT �9 halo
INSTALLER'S NAME&PHONE NO._
SEPTIC TANK CAPACITY UW GAI
LEACHING FACILITY: (type) 1T (VX to (size)
NO. OF BEDROOMS
BUILDER.OROWNER SrcVc Z�SIAW
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to 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
S
Furnished by e �`. "=nSO Oh • �oi
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No....... 7qfL Fss..-r�...............
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® E HEALTH
�-- �Ym----------------OF......... ��°°_.�� ----------------------
Appliration for Disposal Works Toustrurtiun Prrutit
Application is hereby made for a Permit to Construct r Repair ( ) an Individual Sewage Disposal
Systemaq:�. .. . .... .. r1. .......................................
.Lop .ion-Address o. w
•................. .�- �� ! ._..._.... ¢ ' _.��r l-��'--•-n---•-..n..1 L.5 ...........................
...� low n �� ���...-•-----•----.•_•_.---Address
.................................................
Installer Address
Type of Building Size Lot.'__ _ � .....Sq. feet
Dwelling—No. of Bedrooms.....................
................�....._......___.___.Expansion Attic ( ) Garbage Grinder (^V
Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures .--.
Design Flow.................. ...... ...............gallons per person�er day. Total daily flow......�,._.�,� ..............gallons.
Septic Tank—Liquid capacity/,90�_gallons Length.._ --1_- ____ Width................ Diameter---------------- Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area............ sq, ft.
Seepage Pit No.......L------------ Diameter.../�.�__-___ Depth below inlet................... Total leaching area.�'Z q. ft.
Z Other Distribution box ( (�}� Dosing tank
Percolation Test Results Performed by............ ... !y_ _ I.��._...... Date.._l_._..
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........................
------------ ---- - ......................................•••. -
O Description of Soil 'a ° qs-�---�--�°. -----------------------------------
V -------------------------------- -----------------------------------
W -------------------------------------------- -------1- --------...---... ...... . ...............................................
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 TML U 5 of the State Sanitary Code— The un ersigned further agrees not to place the system in
operation until a Ce ificate of Compliance has bwxu
th o rd of health.
+ Signed.... --•-----••-•-•--•-. l =
Application Approved BY - �. '"-..------•---------------•--•------- ----•--612�..� `'---------
Date
Application Disapproved for the following reasons-..............................................................................................................
r
--- - ------ -- - ------------------
Date
Permit No.--.... t _'._ --------------------- Issued........... ---•---• .
Date
t
No........................ F>�s.����..).........
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® F HEALTH
..............._OF........o...� . ..�..f.'..��' �r: :.-_4(�' .......................
Appliration for Uiipus al Works Tonstrurtion ranfit
Application is hereby made for a Permit to Construct r_�or Repair ( ) an Individual Sewage Disposal
System aj• -�-"' ,� ► '
ti
......-. ....... .... . �S_�-�. ........ .... ........- -l:..I�:.."r,�>--,� .------------------------........--------
dirt Lo lion•Addres
• ........... 1 t.:.. -• .......r....................... ao! _. !....�......•-- ---------•....................
s Owne �— Address
a .......!�-,��.� �,_ `................................ .'.:..-... -•--••..............••--------•--------•-...------..................--•---.......--
Installer Address
Type of Building •-- Size Lot..._:._f;_._.__t_!__.___-----Sq. feet
Dwelling—No. of Bedrooms..................115I -----•--------___-_.-Expansion Attic ( ) Garbage Grinder
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
QI Other fixtures ..._
Design Flow................. gallons per erson�er . Total daily flow____-- ''
g ..�--•:�---------------g P P ..�.--.� Y .......................gallons.
WSeptic Tank—Liquid capacity//9,0,0.gallons Length__- ._t_'.---• Width................ Diameter-------- Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area............ sq. ft.
Seepage Pit No..._._I............ Diameter../7'____._. Depth below inlet.......... Total Total leaching area����+ -sq. ft.
Z Other Distribution box (C.� Dosing to )
~' Percolation Test Results Performed by------------
-?. r' �............ ......L1 :.e / __.....__.. Date... yl .___
.minutes per inch Depth of Test Pit._/ ../....... Depth to ground water.._.a Test Pit No. 1...�, --
(� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
D Description of Soil-------- J-' �_ P. . . P.7 .... ..�.� :-.� ---------------------------
U -- .......- •-----.e------•-
x ---•---------------------- -----------•------ ..... -- . -�= . . .'".`fir ---------� 1
1 " ----------•------•--------------------------------------------
V Nature of Repairs or Alterations—Answer when applicable........................................................................................0...__.
---------------------------------------•-----------------------------------........--•---------•-------------------------------•-•------------•--------.......................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code—The un ersigned further agrees not to place the system in
operation until a Certificate of Compliance has beer >s ued by theord of health.
Signed. �f /.....Da e '
Application Approved By...... �. _.- . `!_------
Date
Application Disapproved for the following reasons:--- .........................
............................•-.--••--•-------•-•--------•-•-•----•-----•---.._.........-••----•----•-----.-----•----------------•-•-------••--------•---...-•••---•-•-•...-------------••------•••---••-.
Date
Permit No.-•-•9A-T 9a1---------•-----..... Issued------- .....D�
Date----------•-------•-------•----
THE COMMONWEALTH OF MASSACHUSETTS
BARD F HEALTH
a
....................O F....:.. ... ...��..., ...:................................•
(Irrtifirttte of Tuutpliattrr
THIS IS TO C TIFY, Th t the Indivi al Sewage Disposal System constructed (for Repaired ( )
byi e-... '`' - ---------------• ---....---•--•--------------------------------------------------------------
P Z
l �. i
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.....' ='^-__..... . ............ da.ted_...__t__:f._'.....,1. .._.._._._._....•...
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE C NSTRUED AS A G RANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.------.....�.`_. j .................. -------- Inspector---- ------------ --- t.... . .....-- ------ .................
TH MMONWEALTH OF MASSACHUSETTS
BOARD HEALTH
No............ FEE......................
..
Mu11usnt1 or u Tuty3trudivit rutit
_Permission is hereby granted..... - -._. .... -
to Construct or Repair ( ) an Individual Se�age Di System
.......7A
at No.. f••.----•-- •..... `" --------r.....•....
...............-•------------------------------•-----••-•-•-
Street
as shown on the application for Disposal Works Construction Permit No_'.'^'�.�____ Dated...........................................
Board of Health
DATE................................................................................
FORM 1255 A. M. SULKIN, INC., BOSTON
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