The URL can be used to link to this page

Home My WebLink About0063 PINE CREST ROAD - Health (2) 63 Pine Crest Road Centerville A 247- 125 _002 No. 42101/3 ORA o n Q C� � FssF�.:�E 1010/0 (0 0 a c 0 TOWN OF BARNSTABLE LOC�yTIGN_�i7/ /'rv'�� fit' S7' Ad SEWAGE # �/ "�� VILLAGE Gr-�,G�r/;f�� ASSESSOR'S MAP & LOT)S/7/2 S.602 INSTALLER'S NAME 6i PHONE NO. Aa SEPTIC TANK CAPACITY LEACHING FACILITY-.(type) A7"'- (size) 41" Wo NO. OF BEDROOMS PRIVATE WELL OR UB�WATER ' (BUIL�DERIOR OWNER r�,y',In e��re r . DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No r�� s l \ � I /?b,e��-�s� /`� N ......_•---•............. FRV77 - . ..... . THE COMMONWEALTH OF MASSACHUSETTS ""d ,� "* BOARD �OF HEALTH ` ...---..�"o," ."....................OF..........,A?. ............................................................ App ira#ion for Uiipnsal Works Tnntitrnrtinn ramit Application is hereby made for a Permit to Construct (�_ or �epair ( ) an Individual Sewage Disposal System at: 3 _ C 0 l�1 ................__......- •-•---•--•-----• ----------------Loca on-Address or Lot No. ... /1'l A'1Z� --------------------------- ':K ....- � �:5.:. n f\ t Owner Address a ............�T:....-lr�_-L'1�5'l.. 1/1(�l ":-:-�_C,L...........--•--.....----•------•----•-••....................... Installer Y Address b� U Type of Buildmp/ Size Lot... feet Dwelling(—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ............................ . W Design Flow................ per person�per�day. Total daily�flow.._.......33_�....._._....__......gallons. WSeptic Tank—Liquid ca.pacity:16-.O..gallons Length..6_._...._ Width...¢_f P .. Diameter................ Depth. .. �.__. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------I__-________- Diameter...__._.q........ Depth below inlet........ ?_....... Total leaching area.. ....sq. ft. Z Other Distribution box Dosing tank ( ) Percolation Test Results Performed QA)(TW ` NY. Date... _ Test Pit No. 1.Lz ......minutes per inch Depth of Test Pit........0........ Depth to ground water.__._... 13_. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P ........... . . ........................................f O Description of Soil.....a••-Zl...............................................-�� L....------. ---- � M tb' S�........ x . ................•-••••••-•••.........-•--•••. V ------------------------------ ------------------------ __...... _------ ------------------------------------------------------------------------------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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b i ued by the board of health. L Sign ---• ,-....................�_---- ............................................ _.l1_...------•----�....._-.... Application Approved lication A BY•-•-•-••••_ 8x!a� ---------------------•••-- at , ate Application Disapproved for the following reasons__________________________________________________ -•--•------•........................••-_.D ••--..._______ --...........................................................--------....--------------------------•---•-•--•••.......••••-••••-•-•••••••••-•-•-••-•••-•-•----•-•--•••••••••............•••-•--------- Date Permit No------gig---------Y..L.................. Issued..-------t� �� Gf-, .......... _ dL„7 b Date t" ry t��s No ..•...�.. . THE COMMONWEALTH OF MASSACHUSETTS w� BOARD OF HEALTH ------� .. ..................OF........... - 5 Z-C -- ... Appliration for Diipustal Vjark,6 Tontrurtion ramit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: v,� J M , •� L_cT , L c ��l l �-- -• --- --- 1 � -- � L�: LJ. (��I`N►�D�S j��l ........ Alf,�.� Address................................. C t or Lot No. ........ -({'(.. I L Imo. ��1�.. r.....L 6, t- 40. w r a��u15 • - -- ...•- - ...................•------------------- :.....5 �l .....-- Owner Address . Installer Address r\ 6� `9 Type of Building/ Size Lot_...&-.V.,_.__---.--�-J-....Sq. edt, Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( T aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fia tt-Ires . Design Flow................ _......._._._.....•__gallons per person per day. Total daily flow_.._......3...V...... _...._..... to S. W - WSeptic Tank—Liquid capacity..kRP—gallons Length.'..�'....___ Width.... _�' ... Diameter................ Depth._ ........ xDisposal Trench—No..................... Width................... Total Length._................_. Total leaching area____-___---------.--sq. ft. Seepage Pit No........I............ Diameter.........Y....... Depth below inlet......... Total leaching area... U...sq. ft. Z Other Distribution box Dosing tank ( ) aPercolation Test Results Performed by....'__..S"!- . --...V�'�X.'Z'�._y!� �__• Date....S...............Ju----_..--.� Test Pit No. I................minutes per inch Depth of Test Pit---------13....... Depth to ground water.... ..... .� - �, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.______--.------._______ ----------- ----- - •---------- -•-- -.....•............ ......•-••-•- 0 Description of Soil------. -Z -----C-�'l t.... ^Z f 3' /M Cl0 F�,J�` x ------------------------------------------------------------•---......_--•---•-- (� ................................ •-------•-••---•••---••---•-•.....•-•-•-------•-----•--•••--.....-•----....•-------•--•----•--------•--•------•--•-------...•..................................... 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 TITL% 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bepqssiyd by the board of heal Signam,--••--. _.[i._....•• -----••------••--•-•---•----•-•---•-------. ..... ................. �._ t Application Approved By............ -- =' � �• .. . +. .........6:) Date Application Disapproved for the following reasons-----------------------------•---------------------------------•--•--•-•-----•---------•-. .................... ---•--•••---------•----•-...------•---Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH W�..................oF........ :N.S.� ..................... dr %luntifiratr of TontpliFanrle THIS IS T CERTIFY That the Individual Sewage Disposal System constructed ( or Repaired ( ) by........................�.!-:......... ......--•-•--------------------------•---•-•-----•-••------•-----•----•-....--------.......-----------•--•---•-----------.... L.VT P N f. C, /'CC;. y Insfa�leF� C.•1-- -/- --- at---••••....--•--•••------•----•-•.....................................................................................................................-_l- f ) }d i) lL._(.r.(a,_......................................... has been installed in accordance with the provisions of TITIE 5.9LYhe, State Sanitary Coe a described in the _�-•-------- application for Disposal Works Construction Permit No. -_-. ��. .. da.ted------- I�_I-"' &-----... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................. ........................................ Inspector------.......------..... .e . -----------•-----..------------•-----•----- THE COMMONWEALTH OF MASSACHUSETTS' BOARD OF HEALTH .................................oF..................................................................................... t No .. FEE' 11ispos al WorhD Tunstr ivan rranit Permission is hereby granted.............A--1....... U-I--4Z_eC.•-•---•--••------•---•--------•-•----••-•...-•-••-•-•---......-•-•--.....•---.............--- to Construct ( �/or Repair ( ) an Individual Sewage Disposal System at No....................L_Q.j.:.$ . aN.L... =------• ----------- Street ,. as shown on the application for Disposal Works Construction rmit. No`� - -' ated-_..•.....__ --. ••----------. ^------_----- ----•-•• •------•-•--•.........._ Board of Health DATE................................................................................ 4 FORM 1255 HOBBS & WARREN. INC., PUBLISHERS �.ES/G/V 0A17".4 SIrIC-c_.E 'GAMiLy 3 13 DRooM _ .. N c GA IZ6l�GG G�i►.1�C CZ.. DAI L-\f FLov J a t j o x 3 s 330 G.P. D. 40 �� SE C.PTI TANK = 33o x 15070 • 4q5 CG-P.o. USE 4-Z DISPc�SAI PST VSE 1000 G-AL. ol IS"o S.F X 2,$ 3 C3•. P. 0 10 ,, . 605 oM -A?--EA So S.F 4 �" ToTA t_ v C5161`1 = 4�"- C�: P• D. ,,.� tid <c �� r` T'O-rAL. DAILY FLAW = 33o G.P,O. t�RCoL.41 1oiJ RATE i iti Z MAN, oQ LESS .,.,. �A l0 •�t� �P�TH.OF Mgss \. TER c f agRD tU SUL IVAN No:29133 o rM Giti tnflM Nb.24048 •0 Q Y/b Q Lro� �SSiaNA L ENG��. Pl- , �L=45 FG• � a5 � � a• ,L[;Am �• ..KL.� s ,�. 41 �as�o) /3. v -72� o• P•T War-) /AM 7- laz .vim • ' W�4sHC-D :• G'.E.GT/F/EO PG DT pLAi✓ �c3G L.4G.GT/o�Y iz pF 11_E j 13' EL-32. r N40 WArE2 jX�df�uSt� ��r,Qi.J- f�iZ �vl�a!zTi�.l . 7?7/�y�W.l'cil / G�,eri,Cy TH,QT Th'E Awt--?rc.uN6 S'41aw.v. ,yE�Ea v G�i+�PGY.s Wir�/Tiy�'SiOE,c,ii�E.. BAXT�,2 ',c/yE, I've. 4AIo.5�7'l��Gv ,eE4lJ/,�E�I�N�S o.� Th'� ,C�.E�s sr.Pc'D.G�No.SlieYEya,�S Tox%v aF A./2/J5rAA3 L.t�,v� i.S .vaT �3 Ao.-QE vsEv . Ta ES?�l�G%SyLoT-G/NEv� il TOWN OF BARNSTABLE j. LOCATlG.N_Z0j' o2 1p,e'lf t- rp17' SEWAGE VILLAGE �r�r,' �, � ASSESSOR'S MAP & LOT 7 j:Z S.002 INSTALLER'S NAME & PHONE NO. �� SEPTIC TANK CAPACITY LEACHING FACILITY:(type) 0,f 7"_ (size) y/0 NO. OF BEDROOMS =PRIVATE WELL OR UBLIC WATE • BUILDER OR OWNER siSeeno'Q 1� DATE PERMIT ISSUED: 3 - T- DATE COMPLIANCE ISSUED: °� VARIANCE GRANTED: .Yes No ram/ f f It\(Z�c) o�