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Home My WebLink About0113 ANSEL HOWLAND ROAD - Health 113 Ansel Howland Centerville A = 171 — 231 S M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR FORESITRYeLE MIN.RECYCLED INITIATIVE CONTENT 10% Carrifiad Fiber Sourcing POST-CONSUMER www.eprogramorg SFW1290 MADE IN USA GET ORGANIZER AT SMEAD.GOM 9 4/ No............... ip FEB 3 a .o 0 8arn8b!8C0111iE COMMONWEALTH OF MASSACHUSETTS �1L r BOARD OF HEALTH �7�- �-�J Signed; Date TrOWN OF BARNSTABLE Apphration for Di-wipoittl Workii Tatuitrnrtion Ituntit Application is hereby made for a Permit to Construct ( ) or Repair �XX) an Individual Sewage Disposal System at: Helen Allan ... .......-- ------ --- Location-Address or Lot No. t L 3...Ans?1_..RQT�t�.aae,..R.Qa-a._C2nt Owner Address W J,P-Macomber Jr . Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling-X No. of Bedrooms-----------------3-------------------------Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other 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 ( ) a 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....--.................. P4 ..--••-•--•...................................•---•--•---•-•------•---••-•-•-•-•-••-•--••------•••-...................................................... .... 0 Description of Soil....................................................................................................................................................................... W Sand. .& Gravel U --•---------•------•-----•------•-•••-----•----•---••-----------•--•-•-----•------- -------•••-------- UW ---------------------------------------------------------------------------------------/....---------------------------------...---------•-•-•---•---------------------------•----•--.....---..••.... Nature of Repairs or Alterations—Answer when applicable_--------------Adc;___one___1-1.000 gallon_ eaeh__- ait to eX............... Tankbox and--- it ... p . •---------------------•-•--------•--••---------........-•--•--- 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 Complia ce has b en 'ssue by the b,ard f health. d Signed = ' �'/-I. 9.4.-...:...... to / ApplicationApproved ByC � �v. r.---------_------------------------- ----------------------------------------------------- �- I?ate Application Disapproved for the following reasons: ...... . ...................................... ... . ......... .............. .. . .................................... ........................ ......................... ............................ ..... Permit No. 9 ...-1....— - -- --SY............................... Issued . . ....a_e ....... ......-----------to------ No................_....... Fas.... .--.30.00 .••••........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiuu for Di-npuittl Wurkri C owitrurtiurt tirrmit Application is hereby made for a Permit to Construct ( ) or Repair �X15 an Individual Sewage Disposal System at: Helen Allan ...••---•--•--._........••••••----•••••••••••-•.....------•••--------------------•-__...--•------- -----••-----••••---••••---••••----••----•-.._...--•---•----------•------_.....___---••----...----- Location-Address or Lot No. 113 Ansel Holrl.andd-.Rnanl-_CentgrviIIe Owner Address W J;-P.Macomber Jr. Installer Address UType of Building Size Lot............................Sq. feet .. Dwelling-X 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........................ G�+ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... a .....................................................:.................................................................................... _-••••••----------- 0 Description of Soil...................................................................................................................................... ................................. VSan & Gravel Z --------------------- ----------------------------------------------------------------- --............................................................................................................. U Nature of Repairs or Alterations—Answer when applicable-----------------Add one 1-1000 gallon leach �it to existin. Tank box and pit. ........................................... --•----•-----------•---•--•--------------• 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 Complia ce has b en 'ssuec� by�ard f health. Signed -------L. .. . ......... :.................................... ... ....--------------------- ....4../.1.2/94.....:...... --------- X:� Application Approved By L2 Date--------------- Application Disapproved for the following reasons: ...................... . ..................................... .... -- .......... .. . ..... ....... ..................................................................................................................... A ............................................. ate....... .........................--............ ec�� r Date Permit No. ......I--L(---- ---��---------------------- Issued --------------- 2 9 fit' ---------------------- THE COMMONWEALTH OF MASSACHUSETTS + BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of C�umpliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( XX ) by J.P.Macomber Jr. ............................................--------------.....------------...----....------ ------------ ------......-------...----- -- - --- --------...------- ---- ------------------------------------.....---.. In,,alle, at ----113 Ansel Howland Road Centerville ..................... ...... ....---------------------- ----------------------------..-............................................................................................ has been installed in accordance with the provisions of TITLE 5 1 .- State Environmental Code as described in the application for Disposal Works Construction Permit No. ..._....-....._..`.. ---(&--0 dated ---- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE WHAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............. .L'"------- ... ----1------- Inspector ... _......._.. ------------------------------------------ ------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C TOWN OF BARNSTABLE No. .................. FEE......30.00 . Rquipal Workii Tonotrudiun rrmit J P Macomber Jr. Permission is hereby granted------ ----�-------------------•-----•--•-•.---••-------•---------------- --------------•---------------•-------•-----.....---..._.....---- to Construct ( ) or Repair (U) an Individual Sewage Disposal System at No....113 Ansel Lowland Road Centerville . . • . •--•----•--•-•--- -----••--•---••.....-----•----- --------------------•----------------•------•---------------......-----••-____-•-....... Street C� / ,(� as shown on the application for Disposal Works Construction Permit No-_:t_q.�—A/ADated_______--`(6?Z 1_7 L� -- /Z Board of Health )ATE....................... ........................................................ FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS