HomeMy WebLinkAbout0063 PINE CREST ROAD - Health 63 Pine Crest Road
Centerville
A 247- 125 _002
No. 42101/3 ORA
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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��
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/?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
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SE C.PTI TANK = 33o x 15070 • 4q5 CG-P.o.
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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/
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