HomeMy WebLinkAbout0287 STONEY CLIFF ROAD - Health STon2y Ct{FF
Ce-Att(Vitte
Ito- 041
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S M E A
No.2-153LY
UPC 12934
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FORAKW
ESTRY
INRIATIVE
CartlBodAbuSourcino
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH APROVED
TOWN OF BARNSTABLE
Appliratiun for Ui"vii l Workii Tonutriirt"inn Date
Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal
System at:
287 Stoney Cliff Rd Centerville
..... "'--...-_-'-.........""""""-----'----"---------------•--'-'--.............-'-'" "--.....--------------'---•---"'---""-----'-------"""'--'----""-...--"-........."......
E. Gilinski Location-Address or Lot No.
Owner '-Address
-' ..............................
a ........................obinson_,Septic._Service__________________________ P.O. Box 1089 Centerville MA
. .
� Installer --------------•----.....-•---.._......---•-•-----...--•-••-•---•-------•---•-----•--
Address
Type of Building
Size Lot............................Sq. feet
Dwelling
Other—Type B oof Bedrooms -3.....................................Expansion Attic ( ) Garbage Grinder ( )
a
g—
g ............................ 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................
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........................
f14 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................
O Description of Soil.... avel-.............................................................................................
U -•-•---••••••-••--••-•----•----•---•-••------•-...---•----•••-----••-----•-----•-•-••--•----------•-•--•----•---------••-•-•---•----•------••------•--••------••-••---------••......................••.
W
x ....................-...................................................................................................................................................................................
U Nature of Repairs or Alterations—Answer when applicable.__2..stone-packed--infUtraters____________________________
-------------------------------------------•-----•--------------------------------------..................................................
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 n issued the and of health.
Signed _/t,0 ..................... ........... ..........................................��
--
4.
re
Application Approved BY '\ ...... ----------- .............................
Date
Application Disapproved for the following reasons: ..... ................................. '.
------------------------------- --- -----I..---------- ---=---------- --...-------- ...........-- ------------------. ----------...................................... ....----...----------------------------
Permit No. � �" l........ -----------
Issued 1-. G
Date
J -� G 0
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiun for Disposal Works Tonstrudian fermi#
Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal
System at:
287 Stoney Cliff Rd Centerville
._.......... -- -__; -----................................................-........... ------------------------------------------------------------- -- _.__:_._---
----
E. Gillnskl Location-Address or Lot No.
------------------------ . ... —- ................................................. ---------------------------------------------------------------------------------—.—........
--,Owner Address
a W.E. Robinson-Seotbar Service--•------- P.O. Box 1089 Centerville MA
Installer Address
U Type of Building Size Lot----------------------------Sq. feet
�-, Dwelling—No. of Bedrooms-----3------------------------------------Expansion Attic ( ) Garbage Grinder ( )
PLI Other—Type of Building ..-_•----.-_--_._•----_-_- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
0.1 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. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water...
._.._.__._..__.__.._.
44 Test Pit No. 2................mins per inch Depth of Test Pit-------------------- Depth to ground water--.._.__-----__-_--•_--_
a -•--•------------------------------------------------------------•--------------------•--------------•------•-----------•----------------------------------
O Description of Soil....ctx'?Wal------------------------------------------------------------
V .....••-•••-----•---------•----••-------...-•-------•----•-••-----------•-•---------•-------------•-•--••------•••----------••-•-------••--•--•-•---•-------••-----------•-------•--------•---------•----
W
U Nature of Repairs or Alterations—Answer when applicable._z_.Stone-packed__infiltrators_____________
-•-•---•--•••---•-••-•••----•-------••-------•-••-•••-•---------•--••-------••-••--•---------•------••---•-----•------------------------------------------------------•----------------------------•----
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 bpn issued bylthe bboard of health.
Signed __l lam%—, `7 ... .. ......... --9 9 �—
------------------------------_-----/----------------------------------------
Application Approved BY �•- ----- �fi -- /✓�`------�"�
Application Disapproved for the following reasons- ------------------------------------------------------U -note
------------------------.......................................------------------ - ----
------- ---- - -------------------------------------------------------------------------------------------------------- -
Da-
----- -----
Permit No. -`- / Issued -cam
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
(9.er#iftrate of (guncyliance
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( x )
by......, Robinson-Septic. Service
-----------------------------------------I..........--------------------------------------------------------
at
287 Stoney Cliff Rd Centerville Installer
----------------------------------------------------------------------------------------------------------------------
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Codf as describ ij in
the application for Disposal Works Construction Permit No. ___... -.. -----
dated _._ --
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
1 DATE 1 = ...................... Inspector -------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
No....-G�'.��� FEE$30.00 ...----
Disposal Works Tuntrnr#iun Vamit
W E Robinson Septic Service,
Permission is hereby granted_.._._ .........................
to Construct ( ) or Re air LX) an Individual Sewage Disposal System
at No.......287-_Stoney._..li..f -Rd- -Centerville
Street
as shown on the application for Disposal Works ConstructionDated_._._j/!.` _._
�� "•-- ..........-
1 ^ � ....... Board of Health
DATE------ ------- ---- ----`--5--------------------•-----
FORM 36508 HOBBS&WARREN.INC..PUBLISHERS
5EW&C,E PERMIT U0.
- �VILLAGE ' - - -
Ihl aLR IJ�,NIE ADD ESS
15UILDER S E A DRESS
Dh,TE PERIv -r.- 1'55UED
D ATE COMPLI WQCE ISSUED :
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TOWN OF BARNSTABLE c,
LOCATION �'7 51®��.� �,. Y SEWAGE #
VILLAGE L��i ►'r zv ��' ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY w b 0
LEACHING FACILITY:(type) ;I-
NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER 1
a
BUILDER OR OWNER L-► 5&5 -� -.�i t� 1
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: //_ —rG ,-9.:2,
VARIANCE GRANTED: Yes No l/
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