HomeMy WebLinkAbout0028 PLEASANT PINES AVE - Health (2) 28 Pleasant Pines
Centerville
A=234-013
I SMF.Adj
No.2-153LOR
UPC 12534
amead.com • Made In USA
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Apphration for Diopo ial Workii Tonitrnrtion Famit
Application is hereby made for a Permit to Construct ( ) or Repair (< an Individual Sewage Disposal
System at:
Location- ress or Lot
..�i4'a .......................................1I ----- ------t-••--......---•-•-•--'-•-�'✓. A...t�.........---------
Owner Address
a �-� C✓�- ou1 y, C �.t 7(�� l,tl,4-1�.'$"f f...............................................`
.................................. .....•--------------------------•-----------•-
Installer Address
Q Type of Building Size Lot............................Sq. feet
U 113 Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
pi Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a
Other fixtures --------------------------..--..._..--------------------------------------------------- -------------------------------------------------...---------
W Design Flow................v��.J..........____gallons per person per day. Total daily flow............ 9.....................gallons.
WSeptic Tank—Liquid capacitylQPP-.gallons Length._............. Width---------------- Diameter-___._-_---.-- Depth................
x Disposal Trench—No. .................... Width........t........... Total Length.................... Total leaching area....................sq. ft.
� Seepage Pit No---------- ------- 40....... Depth below inlet___.�v............. 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.....................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.-____-_.__________- Depth to ground water........................
9 ---------------------------------------------------------------
----------------
•------------------
••----••......
•-------------------------
•-•--..............
ODescription of Soil.......................................................................................................................................................................
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UW --------------------------------------------------------------------------------------------------------------------------------------------------------------------• ---- --------- ------••--
Nature of Repairs or Alterations—Answer when applicable._.. iJ:S' 4-1 .. .. --_____�.U00 (' . ...nZ
--' 1........ - �,�� / LOB!¢ 1 "`
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 h�bened tlye9board of health. iSigned ................. - .................. . ....
Dace
ApplicationApproved By ----------- _j................. ............................... -------1
Application Disapproved for the following reasons: .....__.........................................---------------------------------...-----......--------------------------_---
.......... .................. .......... ............................... . ..........._.......................
C, Dace
PermitNo. ------------------- Issued ------------------------ --------------------------- -------
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TOWN OF BARNSTABLE
LOCATIONc:)oa �/ �'pn9G ;%vRS' SEWAGE # YV 66
VIL LAG E� ASSESSOR'S MAP & LOT D/3
INSTALLER'S NAME & PHONE
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) ll'� 'D� C /) (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER O 00��NER"__ ,6 f�%
DATE PERMIT ISSUED: Z2 41-9v
DATE COMPLIANCE ISSUED: m` 57 `-7
VARIANCE GRANTED: Yes No
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of Tontyliance
THIS IS TO CERTIFY, That_ti Individual Sewage Disposal System constructed ( ) or Repaired
by ................................................................... U/U� -40—'7T'1..------- ----- l/�vs'?L..�'it...:J ..................................... .....
Z:lc at
------------- ---------------- ---- -- ------------- ------/-----------
---------------------------------------
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. .... ... —r --6--4-7----- dated ---- b^ --9._c.�/'y--------
PP P Y
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAR NTEE THAT THE
SYSTEM WILL FUNCTIONSATISFACTORY.
DATE------- .. !. '...../f.... - .........} `--------------------
Inspect
- -------------------------------------------------------------------- -----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
q TOWN OF BARNSTABLE
No....(. ..-. .7 FEE............. .........
Disposal Workii Tun.o#rWivu Vamit
Permission is hereby granted.............. .... Ui _�J [tl 7T7NS'.
to Construct ( ) or Repair an Individual Sewage Disposal System
at No.... s—> '. 4!� .......:`._..... ..rv�r. --------C.......`�./�-u�c �.�
Street
as shown on the application for Disposal Works Construction Permit No.?V_.667_ Dated_____(_-
•............................•-i_j• f ...............................................
`/ Board of Health
DATE.......... ....-- -�=f.............
FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS
' 14 '
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No....(.. -
.............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
AvOratiuii for Diirivnutt1 Workii Toutitrurt"inn remit
Application`is hereby made for a Permit to Construct ( ) or Repair (--*'-) an Individual Sewage Disposal
System at
--c� F ;'-1. &4-.:S'A,-rT"_ �)N L Eire/ t
...........................................................•------•--•--.......------..... --------------------------•-•••-•-•-•--f..................................................
Location•Ad�res or Lot No.
s w(�......................�. ..�� �� � �--•�•r-.•3--_---"-"------•--;-
t ,
--••�......�......•.......... ..................
v Owner i LL Address
. C6,vs ' M , /Y l
-------------•-•-•••---:•.••-•••-••---•-•- -•....•--••••••-•••............................. -•-•--•--•--------.....•. •---------- _..
Installer Address
UType of Building Size Lot.................... .....Sq. feet
Dwelling—No. of Bedrooms.__---_.--__•___•--•________________________Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons_--_-_____.______---_-_-_. Showers ( ) — Cafeteria ( )
QOther fixturrees.-------------------------------------------------------------------------------------
W Design Flow..............._................____gallons per person per day. Total daily flow.......... G---------------------gallons.
Septic Tank—Liquid capacity/-UP!�._galIons Length________________ Width__.._-_____--___ Diameter---------------_ Depth----------------
W Disposal Trench—No. .................... Width-------------------- Total Length.._____-.-.�_______ Total leaching area....................sq. ft.
Seepage Pit No.___-___-/........ Diameter.......410------- Depth below inlet----�............ Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by..............................................--------------------------- Date........................................
Test Pit No. I___.___--_-___minutes per inch Depth of Test Pit____________________ Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit-_-___-_-__.___----_ Depth to ground water........................
W •--•------------------------•••••-••••--••-•----•-•••--•••••-----••--•-••-••••......---.....---••---.........................................................
O Description of Soil........................................................................................................................................................................
W
V .....•-••••--•---•--••---••••••••---•-•-•---•-._...------•-••••••--•...--•-•-•••-•••--•••••--------••--•-••-----•--••----••••------•••---•-•--•-•-••----•------------•-•••------••-....-•••••............
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------•-------- ---•------------•- --------------------------------------------------------------------------•----------------- ............................................. -
Nature of Repairs or Alterations—Answer when applicable.__.- sT \ -A-
...................../ UOU�v.� ryL
5
.............
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 be n i ued 'y t e7board of health.
Signed ..... ............ ..... �/ ..� .
Dace
Application Approved By .............� - .t �.,�.,,�..........------ . ------..//�.. ._- 1
.....-'—'--'-------.........-'-----.................. Dace
Application Disapproved for the following reasons- --------------_-----------------------------------......._........--------------..........------......----------------------------
.... ..... . ........................... ....................................... . .................... . . ............-------------------------------------- ........................................
Date
Permit No. ......J� -^....... -6_72................ Issued
...........
Date