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Home My WebLink About0142 OLD STAGE ROAD - Health (2) . 42 OLD STAGE RD Centerville A= 209 - 068 5MEA►D KEEPING YOU ORGANIZED No. 12534 2-153LOR q'am"'RY MIN.RECYCLED INITIATIVE CONTENT 10% Certificd Fiber Sourcing POST-CONSUMER www.sfipropram.orp SFWIM MADE IN USA GET ORGANIZED AT SMEAD,COM LOCAYION SEWAGE PERMIT NO. VILLAGE C =•�.i INSTALLEA'S NAME & f 'ADDRESS R U I L D E R 0R OWNER DATE PERMIT I S S U E D D<AT E COMPLIANCE ISSUED �b"` ti F A i - '� Fps...30...........00................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Dbnp ial Warkg C omitrurtiutt rantit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: 142 Old Stage Rd Centerville .........--•-----------------------•----•------------------•--------------------•-----------.._... ..---------------------•------•--•----••-•-••---------------••---.......---------•--------..--•--- Location-Address or Lot No. John-.Covering. -------------------------•---••-----......-------•--•---------------...........-----•-•-•--•••... Owner Address a ---W._E......Robinson___Septic___Sery ce_______________ P_._O.___Box 1 089 Centerville MA Installer Address Type of Building 4 Size Lot............................Sq. feet Dwelling— No. of Bedrooms--------------------------------------------Expansion Attic (. ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther 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. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water......------.......----. (X4 Test Pit No. 2----------------minutes per inch Depth of Test Pit...-----....--...... Depth to ground water..--.................... fY ---------------------------------------------------------------•-...----------••......-----•......--......................................................... 0 Description of Soil------------------sand......---------------------------------------------------.----•-------------------...---------------- x V ---------•--.......--•----•---••----------••--•----------------------------------------------------------•--•--------------•------------•-•-------------------------------•..........--------•---•--•-•. VW ......................I __ N to e o Re irs or Alterations—Answer when applicable Pump & fill cesspool -- install-a ,�0 gal seticank, & D-box to existing precast leachpit. •-------------------------------•---------------------------------------------------• ••---•------------------........----------------------------------.....-------•-------------------•••............. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b en ' ued by the board of health. Signed ....� �...... .. ........... ,�.......................................� .. . ......... Dace Application.Approved By ------ ... -... -�-:.t 3.-..j. ..-.��-'".. Date Application Disapproved for the following reasons- --------------------------------------------------------------------............................................................... ... .......................... ..... ..........................._......... ........ _.... .......... .._...................... .... ... ............ q Dare Permit No. ! J` . -- -------------- Issued --------------- Dace 67 3o.Qo blo_ THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH TOWN OF°BARNSTABLE 1 , pphrtt#Halt for Bi_np t ial Workii Tows#rur#tnn 1hrutit Application is hereby made for a Permit to Construct ( ) or Repair ( x) an Individual Sewage Disposal PP Y P System at: 142 Old Stage Rd Centerville .....-•-•.............•----....-•----........---------•-•---•-----------------------•--...-----_.. ..--------•--------•-----•.....------......----••-•----•..........---------•-------•-•----•--••-•. Location-Address or Lot No. _ETok�zl•_LAv_j?!r ija..--•--------------•--------......-----.................. ........................•......................................................................... Owner Address a ...W.,.E....Robinso�n..Sent .-c...Service.....•--••---•- R.0......Box....1.009._Centervi.11e...MA................ Installer Address d Type of Building Size Lot.. .......................Sq. feet Dwelling— No. of Be�1'oonis-_----------4_____________________________Expansion Attic ( ) Garbage Grinder ( ) f aOther—Type of Building\_________________________ No. of persons-.._--_--_-_-_______--__._._ Showers ( ) — Cafeteria ( ) dOther fixtures ---------- -------------------------------------------------------------------------- ---------•--------------------••-•••-----•--•-----••-..------ W Design Flow.........................................\gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length---------------- Width---------------- Diameter................ Depth................ Disposal Trench—No. .................... Width;--____._.___ Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by---------- --------•-------•--•---................................. Date......................................- �� Test Pit No. l................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........................ ----------------------------------------------------------- •------------------------------------ .--- ------•-•---•-•---.-.......... •-------------------------- ODescription of Soil.................... and-••••-•--------------•-------••-----••--•---•-----------.------....------------•----•-•-•-•......---••--•---•-•-•---•••--. x W .....................-------------•-....._.......------------------------------------------------•-----•...•-••----------------------•-----••--•--••---...------..........-•-----•----...... . UN t of Repairs or Alterations—Answer when applicable rump & fill Cesspool & install..a t11W gal setic tank, & D-box to existing precast leachpit. -•--------------------------------------------------•-------------------- ----------•-•--•-------...------------------------------------------•-----------------------. ............................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is ued by the board of health. Signed ....zec"'..j ( ---------------------------------------------------------- 3...............- .... P� Dare Q Application.Approved BY �--�� ...:.. -----£-E� ........------...--------...._.._------....................................... -..3 Dace Application Disapproved for the following reasons- -----------------------------------,.-------......-------------------------------------------------------------------------------- ................................... ................................ ....... ..._.. ................................. ---------------------------------------- Due Permit No. ..:........ .2------- /------------------- Issued 1-3.................. --- 3-"---- ........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C�ei tifirate of Qlomplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( x ) by ........W--E- -Robins.on- .Sept.ic----Se.rvi.e-----------------------------------------------------------_---------------- ----------....------------------------------- at ---------142 Old Stage Rd Centerville ..... ........... ............................................... ... .......... ................ .. .. ............................ has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .......... dated'....._.._......._._..................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B CONS4 .ED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. '' ----------- p Insector DATE .................................................: , —__—_—_,_,_,_.___,_._, Lovering THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEE..3.0 00 ........No...Cf .� ....'....... Permission is hereby granted.... Robins® -- e- ............................................... to Construct ( ) or Repair (x ) an Individual Sewage Disposal System at No....1.4•2 Old Stage Rd Centerville_.. ------- --------------------- -------------------------------------=---------------------- . Street < as shown on the application for Disposal Works Construction Permit No.��-��/..-- Dated__- �_3_-�f'✓...........PID � ••---------------------------•----------•---------- Board of Health DATE................�� .............................. FORM 36508 HOBBS&WARREN.INC..PUBLISHERS TOWN OF BARNSTABLE LOCATION/ LJa2Z Old S I dC" lql�_l SEWAGE # / VIL`AGE ASSESSOR'S MAP & LOT S INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY &0 dff' + - 1660 LEACHING PACILITY:(type) S (size) NO. OF BE WELL OR PUBLIC WATER_ BUILDER OR OWNER DATE PERMIT ISSUED: 3 `/3 DATE COMPLIANCE ISSUED: �2_1_ VARIANCE GRANTED: Yes No l 'R � 1 Na 1� V M i 'Tj AFFIDAVIT C0 4�18yL CK") I, Carol Chandler-Rourke, of Centerville, in Massachusetts,MAKE OATH AND,SAY THAT: 1. I am.the owner of the property at 142 Old Stage Road, Centerville, MA 02632 2. 142 Old Stage Road, Centerville, MA 02632 is a 5 bedroom house. r COMMONWEALTH OF MASSACHUSETTS COUNTY OF MASSACHUSETTS SUBSCRIBED AND SWORN-BEFORE ME on the da of April, 2018 Y p CRISTINA BROWN Notary Public COMMONWEALTH OF MASSACHUSETIreal) My Commission Expires On Signature Optober 19,2023 NOTARY PUBLIC My Commission expires I i No...hll • •••-•- I VV F:Rs... .A.0......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE LTH .... ... -- -O F.-......ISS:d. .s..-1 .1 /4'..... ........... Appli.ration -for Uiipuiitt1 Works Totuitr7an � u rrniit Application is hereby made for a Permit to Construct ( ) or Repair ( Individual Sewage Disposal System at: I r d / ............... .........---------- ................................... Locatiof,';,A td;dre/ssy � C r L9t No.d-a-Wd1'.•--•-- - -----------•---•------------• ............................... �„� ----•--/---`-------7!__J4Ty-�a. - Owner - dess _.......-------•--•-•--....-•---••-•---•.-.-•-•-•._...-------------- --•---------•--- --•------------- ' Installer Address d Type of Building Size Lot_..........................Sq. feet U Dwelling—No. of Bedrooms________________________________ _Expansion Attic ( ) Garbage Grinder' ( ) pa•, Other—Type of Building ___________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) A'' Other fixtures W Design Flow--------------------------------------------gallons per person per day. Total daily flow____________.._______-________--------------gallons. L4 Septic Tank—Liquid capacity------------gallons Length---------------- Width---------------- Diameter---------------- Depth---------------- W Disposal Trench—No_____________________ Width-------------------- Total Length.................... Total leaching area-. ---------_--------sq. ft. x Seepage Pit No..................... Diameter.....:.............. Depth below inlet____________________ Total leaching area-------.___.___--_sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by----------- ------------------------•------------•-----•---•••••--•--•---• Date--------------------------------------. Test Pit No. L_______________minutes per inch Depth of Test Pit-------------------- Depth to ground water_--__-____________.__.- G%, Test Pit No. 2..............._minutes per inch Depth of Test Pit____________________ Depth to ground water_____-_-____________-__- •--._.._..-•-----------------------------------------•-•-•--•--•-•----••-------------•-••-•-••••••••........................................................ 0 Description of Soil---------------------------------------------------------------------------------------------- -------------------------------------------- ---------------------------- x U ---------------------------------------------------------------------•---------------------------------------------------------------------------------------------------------------------------------- ----------------------- -------------------------------------------------------------------------------- ------------------------------------------- ----------- --------- -- V Nature of Repairs or Alterations—Answer when applicable---/ -47o-_- AZ__ -�� -�*___ e 4 _.._- CKr/. -3 ------------------------------------------ it Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issuedby.>he boar f Ith. 4, Signed..................... ---••----- -•--•-••-•-------•---------------------- �__�_ Date ApplicationApproved By---••--•--------------------••-----•-•••••••••••••••-••••-•-------•----•-------•-•-•--•••-•------ -------------------•-------------------- Date Application Disapproved for the following reasons:------------------------------------------------------------------------------------------------------------•_--• .................•-•-••-•••-•--•••-••••--•••••---•--••--------------------•-••••••••••--•----...•••••••••----------•------•------____--•-------•-•-•-----------_---- •-----------•--•---•--------------- Date Permit No......................................................... Issued•••- � Date b X THE COMMONWEALTH. OF MASSACHUSETTS BOARD OF HEALTH-1 '` .`. Appliratiaan for Ui!ipaaoartl lVarkii Tomitrnrtion jJrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( Individual Sewaa Disposal System at: �!C,�c� ----------------------- _t�y�_1,,"_`'2s.�_-?_ .' s. :---•----------- Locatio -Address or Lot No. -- W Owner Address S i --- •---- � yjjtaller � Address --------------------- Type Type of Building t . Size Lot____________________'.._._.Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ---------------------------- No. of persons----_----------_----------- Showers ( ) — Cafeteria ( ) Other fixtures -•----------••-----------------------•--- - -----------•---------------------------•---------------- W Design Flow............................................gallons per person per day. Total daily flow--_---._.-___--_-_------------------------_gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width-----------..... Diameter---------------- Depth--'---i:--------. x Disposal Trench—No- -------------------- Width-------------------- Total Length-------------------- Total leaching area ------------------ q. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area---_._.--.----... z Other Distribution box ( ) Dosing tank ( ) ° Percolation Test Results Performed by------ ---------------------- ............................................ Date........................................ F. ,-1 j Test Pit No. 1................minutes per inch Depth of Test Pit.................._. Depth to ground water-_---------------_---- f3, Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water--------------------_-- „ --------•---•----•--------------•-•--••-----•-••--•------------------------•----•-•-•---._.....-----•-------------------------------------------------------- i 0 Description of Soil----------------------------------------------------------------•---------------...-----------------..•.....---------._...---------------------------------------------- W V Nature of Repairs or Alterations—Answer when applicable.- --41-G ,3,/-------�57..7,0 s•�-_t`-_- ; -_----... -----------------------------•-•------•------------------------------------ 4' N'!c.. =1�-!„�.�+� --------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificated of Compliance has been issued by e boar f lth. Signed-- '��"�. . .. �! Date ApplicationApproved By--•-------------•---••-••-••-----------•----•-•--••--•-•-•---•---------•-----•-•••--•••--•-•---•• ....................................... ..._., Date Application Disapproved for the following reasons:................................................................................................................ ..............--................................................. Date `= Permit No.•-•--••-••--•- .............................. Issued........................................................ r Date r + THE Cd11MM"0-N_- EALTH OF MASSACHUSETTS - 130'y4RD OF HEALTH .. I :.. .........OF............... ... ... ....................................... _...Cnrrtifira aQ omplinnraP THIS IS O CERTIFY, That the Ind-----------------------------------------------ividual Sewage Disposal System constructed (.W-4:�) or Repaired by....... ..........................I....................... ------------------ - n 411eat d V( Yi .." ��1 � t -� ,/-------- ---�6�ha been installed in acco � with the rovisions of At -of The State Sanitary ad s p y Code a described in the application for Disposal Works Construction Permit No.................. -------- dated-/w.I..- 'TKE. ISSUANCE OF THIS CERTIFICATE`SHALL NOT BE CONST ED AS GUARNTEE THAT THE SYSTEM-V+IILL, FUNCTION SATISFACTORY DATE [0.�7 t._ InspecVi tor 1�4tr r -- . --- ... r ' • .r 6 THE COMMONWEALTH OF MASSACHUSETTS w BOARD OF HEALTH .. /�jj ...............OF............ No. [--7 FEE-X ....... Binpviia nark Qlaanstrn ion `Vrrmit Permission is hereby granted i�+` "----------------------------------•-----•------- . .._...... to Con ruct ( ) o Repair ( Fran ndividual ewa 1 System r at No._. .. - ---• - ..�. --y-/--f - - r et- -- ---- - -- L/ _..' as shown on the application fo Disposal Works Construction Per No..... _ ated__..�I�- -�— 7`�•- f sY t .. ................ w - w DATE__T � «- / - t Boo ard _.._ .tea.... . 4 . .-+IV ' Y.� -' FORM 1255 Hoe SS & WARREN. ING.'PUBLISHERS r e LOCATION : 5EWo,CtE PERMIT UO. WSTQLLER 5 U&ME AD_DRESS BUILDER 5 IJ / VAF— ADDRESS DNTE PERtvI,IT ISSUED DATE COMPLI &&ICE ISSUED : Z-(I- c .. ...�.� �� R- _ i �� v - .. l 2