HomeMy WebLinkAbout0055 PINE CREST ROAD - Health 55 Pine Crest Road
Centerville
A= 247— 125 —001
INISMEAD
No.2-153LOR
UPC 13534
amead.com • Made In USA
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No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ftpfitation for Misposal *pstem Construction Permit
Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System �l�'lndividual Components
Location Address or Lot No.95' 00,-17 x G fes- k D Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel CC 6 A r76
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
1
Plan. Date Number of sheets Revision) ate
Title
Size of Septic Tank_ d D L Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) -Z df e
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 Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Si Date '"—
Application Approved by Date��—L --�
Application Disapproved by Date
for the following reasons \
Permit No. �T z/ Z Date Issued
r
♦ t
No. V ( , '� Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ftpliLation for Disposal 6pstem Construction permit
Application for a Permit to Construct Repair �U ade Abandon pp ( ) p ( pgr ( ) ( ) ElComplete System Dfridividual Components
Location Address or Lot No.S5— P',t�e e or PSG Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel C r y Q r vi/l-e 2.q 'Lj�-4 9 , �� C6,.,r7o f f
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. "( e;
Type of Building:
Dwelling No.of Bedrooms /" ,`r ' ! Lot Size sq.ft. Garbage Grinder( )
r '
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided {{ gpd
r
Plan Date Number of sheets Revision Date
Title
Size of Tank Septic d s7.S v^
p a Type of S.A.S. Q •J
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) 4<E e e X
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 Code and not to place the system in operation until a Certificate of
—i"'--
Compliance has been issued by this Board of Health „�,,,.'-�'" .:.:..
Sign Date er � t� f.
Application Approved by _)r"�6� ill. Q / — Date
Application Disapproved by �j Date
for the following reasons
Permit No. Date Issued
• e
THE COMMONWEALTH OF MASSACHUSETTS
�}r BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(IIJ Upgraded( )
Abandoned( )by D 1 //1r60 0C_.�
at ��`/► C.S `fl has been constructed in.accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.>1-7— ' dated __7 " f
e ,
Installer 1 Designer
#bedrooms 1 Approved design flow ,_,K) � gpd
The issuance of this permit shall not be construed as a guarantee that the system will fun•t" io as designed. _
Date Inspector ...°
--------------`------------- -----'--------------------------------;' - - -- - - - -
No. 04 U Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal 6pstem Construction i3Ermlt
Permission is hereby granted to C truct( ) Repair( Upgrade( ) Abandon( )
System located at
r and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construcc ilcm bst be completed within three years of the date of this permit. � ` ! �
Date �f 1� f �/ Approved by �' ��r / ``
C.eicST tZoA1> ,
!o l n f A
H �
31't VIV— . 10,00`
N>
_S
CER T l FI E D PLOT PL A N
I CERTIFY THAT THE routilDF�T� atJ LOCATION C'Z-Alc-vl 1. z . HISS .
SHOWN HEREON COMPLYS WITH.. SCALE DATE 2-7-9-7
THE SIDELINE AND SETBACK
REQUIREMENTS OF THE TOWN OF PLAN REFERENCE
s-r'HguC AND I S No T Lo T I
LOCATED WITHIN THE FLOODPLAIN, RAQ FOM M4rTIN1 -n-ZA-4w«K--
DATE : Z �`�t- f r A � � �`-- BAXTER 0 NYE, INC.
THIS PLAN IS NOT BASED ON AN REGISTERED LAND SURVEYORS
INSTRUMENT SURVEY AND THE OSTERVILLE^- MASS.
OFFSETS SHOWN. SHOULD NOT BE A.J
s-� TOWN'OF BARNSTABLE
LOCATION 1 of f R` &_ (re34 , EWAGE f f-653
VILLAGE /`G i a v� i s�Q ASSESSOR'S MAP & LOT-�d-.�/7" f 6 I
INSTALLER'S NAME & PHONE NO. X z;r
SEPTIC TANK CAPACITY i�d0
LEACHING FACILITY:(type) J. 0®c) (size) x�
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE.PERMIT ISSUED: CA/a/,
DATE .COMPLIANCE ISSUED:
VARIANCE'GRANTED: Yes No V
IG04
b ., �
I r
Fiz
} ` THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
f..N...............OF.... 15 ...................................
App iration for Dispusa1 10orkii Tomitrnrtiun amit
Application is hereby made for a Permit to Construct (14/or Repair ( ) an Individual Sewage Disposal
System at:
Location-Address or Lot No.
................. II }CIJ W== , .............
- ...................................................... ..
w i Address
►Wa < ....._ :. '.l I-!-!..xll..1.�.�.�`- ---------------------------•..-----..................................
Installer Address
Type of Building% 3 Size Lot.__I®.�°b._�.......Sq. feet
U Dwelling!?No. of Bedrooms..........................................Expansion Attic Garbage Grinder (pJ))
Other—T e of Building No. of persons............................ Showers — Cafeteria
a' Other fixtures.
W ._.... ................ gallons per person pier day. Total dal low.......... a�Ca._............_._..._gallons.Design Flow...._.
WSeptic Tank—Liquid capacity.) allons Length-_I...6..... .... Diameter---------------- Depth................
x Disposal Trench—No.......71.......... Width.... .......... Total Length............Y...... Total leaching area....................sq. ft.
_... Depth below inlet.....:........... Total leaching area..... ..s ft.
� Seepage Pit No.................... Diameter..._..... .__ p g q.
Z Other Distribution box Dosing tank ( )
N-.4 OX' y� I II Date.S-'6_-�5
Percolation Test Results Performed by..L._5 t!?-1.�_y V...__._�................--�_-•-....L-
Test Pit No. 1.... ._minutes per inch Depth of Test Pit.....13�....._.. Depth to ground water..b:]��
G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
-----------------------------------------•--.....-•---•----•---•--...----------...........---•-.........................................................
O Description of Soil --•--••------
_. ..`__2-�_....,.f-� '^. .._S� S�� L- Z� 13� �� SA At>
x --- ------------•-•--------------•...-------------------------•••......------------••-
U ---------------
•---------
--------
•------------------------------------------------
--•---------------------------------------------------------------------
.---------
.-------
••----•-•------------
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 iITL U 5 of the State Sanitary Code— The undersigned further agrees not to place the system'in
operation until a Certificate of Compliance has been issued by the board of health.
Si A
....
----------------------•--•-------__--..............................
..---...--............. ------ --Dat...................
Application Approved By-•........-- �'-C�.......................•-••--....
- - ------- ---
Date
Application Disapproved for the following reasons:-----•-------------------------------------------------------------------------•-•••............•--•----•---•---
......................................................•..................................................................................................................................................
Date
Permit No. ........ Date
Permit
Date
No�C Fxs ?
THE COMMONWEALTH OF MASSACHUSETTS
..; BOARD OF HEALTH
Appliration for Disposal Works Tons rurtion Prrutit
Application is hereby made for a Permit to Construct ( -4/or Repair ( ) an Individual Sewage Disposal
System at:
LbT I Pl N L C 16 Lz7ST' {� v�i) L C�
..... ..............._.........................---------.....-----..... ................................L.......... ...-•----
��, a!Location-Address
"/V or Lot No.
.... .....- ---•--... -- is .�1�. e -....... �-� �C�11/yU L �"PcG±...r:!�:.._..........--t r n1\ ...................
...................r n_.. �.l V .. ..1.!_�_�_�.�. ......•......Address.... .....
..........----------------•-----
Installer Address
U Type of Building/ Size Lot.
...
I ......Sq. feet
Dwelling—No. of Bedrooms.........---------------------..............Expansion Attic (tiu) Garbage Grinder
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixt .....
----------------------
Design Flow_._............. ..........+ .gallons per person per day. Total c ilb flow..........................._.........._gallons.
WW (�� g
Septic Tank—Liquid capac.ty... _..... allons ength._....._�?_... Width... ........... Diameter_............... Depth................
x Disposal Trench—No. ___...�. Width_.... .__..... Total Length...__...___-1----.- Total leaching area............. .sq. ft.
Seepage Pit No........I........... Diameter..........g__..... Depth below inlet_.......-....... Total leaching area...... ft.
Z Other Distribution box ( () Dosing tank ( )
`- Percolation Test Results Performed by... :. ur�t-!_U .._..1 �_ro� I L_-IN(- Date..S_:.L..........................
Test Pit No. I....!Z: .minutes per inch Depth of Test Pit......1.!a......... Depth to ground water-__Q.J�_%t-_._l' -,
rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Ix ....-•---------------------------•----....-------•----•-----...------...------•--•---------•---.....--
O Description of Soil•-•U Z------.LL)ft"N.� S J Zsso� Lr Z 1 , t 3, Mtc-b 5.A. 1.��.
x .....................•---•--------.... -------------------------•--------•----------------------••-•---....._.------
U .....-------•••...---•-•---------•••---•--....---•-----•----•-._...-•-----------------------•---•-•------•-•••-------•-•-•••-•-•----•-••-••----••••-----••---•-------------.....------•------••---------•
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 IT the provisions of TL% 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Sid--•-•- --------------------------------------------------------------- ---------------•-------•-------
Application Approved BY--- ................... -------�'I+r('�-��-!�5_-•-----�-
Date
Application Disapproved for the following reasons---------------------------------------------------------------------------------•---------------•----...---•--•-
•...................•------------•------...--------...------......---------------•-•--......------------.••---------.....-•--------------••-•----------••----•-------••--•-------•-----•-•---•--------•-
Date
Permit No.------ -~ Issued--------------
..------. ......
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
" OF.
N
Cyrrtifiratr of TompliFanrr
THIS IS TO CERTIFY, That the In iyidual ew Disposal System constructed ( 1/j or Repaired ( )
by----------------------- , Y� ®.
1 -------------------------------------------------------------------••--•----•------•--•.
at----------------- r `---- nstal
I �yr �f (O)_ �, l
has been installed in accordance with the provisions of TIT of The tate Sanitary CC d, as drscribe in the
application for Disposal Works Construction Permit No .2> dated `�-' l -----------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GU A ANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. t(�
DATE.......... ..:--c:..��'.vY:.$. . Inspector__J��e ... .......................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
O F...........
No............."t'...54E. l FEE
O
Dispouaa o ko Ton #ruction Frrutit .
n �l
Permission Is hereby granted. -- -------- -----........-- -
to Construct ( Vor Repai ( ) an Individual Sewage Dis osal S stem
at No.......... ! .........--------••--•-.)v l== �=�j-----•. l d,= Z N }--/i C- Z. L
l
(� r
as shown on the application for Disposal Works Constru Street ction Pe No. :.__. ?Dated
....`r'" __ { j .......
Board of Health
DATE...... ----------••-----•-••-------------------• --
F1R1).,,1255 HOBBS & WARREN, INC.. PUBLISHER3j,
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DES IG•-N DA\T'f\ �(
SINGLE FAM►Uj _ - 3 SC-DtZ.ao�
No Cs/��Zl3AG-E Gt2tN DGtZ-.
DAILY F•LovJ • s Ito x 3 =' 33o G.P. D.
SEP71 C- TA cJ IC- = 3 3 o x 1 So"o - Q-q S G.P. C�• I r l C R S 7- �-a Pb17
USE 1000 GAL. TAtU, 49g o -o
7 ;a'°
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I TO s,F Z .S 3 7.15' Cr.P. O.
6-0S,F. X I.: o = Sc� G, P, D : m
TOTAL- OESI&Q = 4Z.S' G, P. D.
ToT/-\k- UAIC`Y FLoW = 330 G-. P. D.
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