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HomeMy WebLinkAbout0160 PLEASANT PINES AVE - Health 160 PLEASANT PINES RD. CENTERVILLE A = 234 003 700 I J y UPC -12534 a �� No.2�153LOR HASTINGS. HN I TOWN OF BARNSTABLE LOCATION 160 PIn. ti o•3.4 QL5 / SEWAGE # � D� VILLAGE C 1 A-2.2u i re, — ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. W,61 1 SEPTIC TANK CAPACITY LEACHING F,4.0 LITY:,(type)'` d'Z -`:�'�'l a oyl tr S (size) ts06- C.,ar 1 NO.OF BEDROOMS.r BUILDER OR OWNER-- PERMITDATE: >�;16aC COMPLIANCE. DATE: 00 Separation Distance Between:the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching-Facility.(If any wells exist on site or.w..ithin 200 feet of leaching facility) Feet Edge of,Wetland and Leaching Facility(If any wetlands exist within 300,feet of leaching facility), Feet Furnished by � s � a 41. No. I.�v v ( 3 Q/ r Fee�5 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipplication for �Digozal *pgtem Cow6truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 1b0 Pleasant Pines Rd. John Joakim Jr Assessor's Map/Parcel Centerville same Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm E Robinson Septic Sery P 0 Box 1089, Centerville Type of Building: Dwelling No.of Bedrooms 2 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Sand. Nature of Repairs or Alterations(Answer when applicable Title-5 septic system consisting of a tank, D-box and 2 stD epacked. leach ctiambers wiTh stone all aroun . 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 Certifi- cate of Compliance has been issued by-thi§sj)eardje1Hea1th. Signed 1 Date ~ Z 7%"-& Application Approved by Date Application Disapproved for the following reasons Permit No. ZOVC 13 Date Issued 7 � TOWN OF BARNSTABLE ' LOCATION SEWAGE #VILLAG ©Cp ASSESSOR'S MAP & LOT . INSTALLER'S NAME&PHONE NO. 4M,►�� c (�,, , -,K YL76 SEPTIC TANK CAPACITY i 5 on i LEACHING FACILITY: (type) i (size) i NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE:_ I� COMPLIANCE DATE:_ p Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or'within 200 feet of leaching facility) Edge of.Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by Feet L d No. �"'_ � / ✓ �� � Fee$J 0 THE COMMONWEA&R—OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Migpogar *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 160 Pleasant Pines Rd. John Joakim Jr Assessor'sMap/Parcel Centerville same 03y_a�3-7o Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm E Robinson Septic Sery P 0 Box 1089, Centerville Type of Building: Dwelling No.of Bedrooms 2 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) r Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Sand. Nature of Repairs or Alterations(Answer when ap licable) Title-5 septic system consisting of a tank, D-�ox an s ,op.6-packed leach C a erS Wl S one a m arOUn .. / w- Date last inspected: Agreement: fit. . 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 Certifi- cate of Compliance has been issued by thisgJ�e!ard�dHialth. _Signed Date Z��Jd . Application Approved by o — Date 3 -7- eyvyp Application Disapproved for the following reasons' Permit No. 'Z�y f 3 y Date Issued THE COMMONWEALTH OF,MASSACHUSETTS Joakim BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( X)Upgraded( ) Abandon e,dd b Wm E Robinson i Septic Servile at 160( PleyasanPines Rd.. , centerviIle has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. '/d—(31/ dated -3/U � Installer Wm E Robinson Sr Designer '�. The issuance of this permit�shal h n ued as a guarantee that the sys will nctio as desi�nec�� l // Date � Inspector //�- /�k �I�'/l-G�`''"-'` Kj --------------------------------------- No. Zl� ' Fee $5 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS ` Joakim Miquar *pgtem Congtruction Permit Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( ) System located at 160 Pleasant Pines Rd . , Centerville and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date 3 of thi rmit. Q Date: ��/�� Approved by i/J 1/e;/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) i W ill iarn E . R o bins on,SAereby certify that the application for disposal works construction permit signed by me dated 3r' d � , concerning the property located at 160 Pleasant pines- ad, meets all of the following criteria: • The failed system is onnected to a residential dwelling only. There are no commercial or business uses associated wi the dwelling. • The soil is cl ed as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There are no etlands within too feet of the proposed septic system There are i private wells within 150 feet of the proposed septic system There is o increase in flow and/or change in use proposed • There a no variances requested or needed. • Th ttom of the proposed leaching facility will not be located less than five feet above the a.mum adjusted groundwater table elevation. f Adjust the groundwater table using the Frimptor ethod when applicable) If the S.A.S. will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(ld)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(ruing G1S information) B) G.W. Elevation +the MAX. High G.W. Adjustment .__.M_—. DIFFERENCE.BETWEEN A and B ` SIGNED : i DATE: ~ [Sketch proposed plan of system on back]. q:health folder:cent ,.� J a , � , I --- l ^ ^ --~-'-.--- THE cowMowvvEAcr* opwmssAc*ussrrs �/ / ������ ���� �_��� �� ���~�"" ^�� ��" " "��" ^ ��F A..---- ~~=""`~~~-------------- � ����mt�,�� ��� ��~ ���°K ����� i ���� �� ��rr���� - -v-xr-~-`~-~`- ~`-- ----n- -- -`-`- --- `~-- ---~--' `� -- Applicatio i made for a PermitConstruct or Repair -_ S Address Installer Address - "~ of Buildi, SizcLut-'-------.-Sn feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Typeof Building ---------------------------- No. of persons---------------------------- Showers ( ) -- Cafeteria ( ) Other fixtures ------------------------------------------------------ ...................... .................................. ---------_-- Dcsigo Flow-------------------------------------------- per person per day. Total daily flow---------------------------------!----------gallons. Septic Tank—Liquid cayarity----1gz|ouo Length-.--'_' VV�dh-----. D�mnter-----. Depth--.--- D�noou Trench--Nv- --_.-_-. Width-------------------- Total Length-------------------. Total leaching area--------------------sq. [t. Seepage Pit Nu--____- Diameter-------------------- Depth below inlet.................... Total leaching area------------------sq. h. Other Distribution box ( ) Dosing tank ( ) ~~ Percolation Test Results Performed by-------'--.-'''-----.--.--...- Date-----------.---' Test fit No. l----------------minutes per inch Depth of Test Pit-------------------- Depth toground nater-------' rXq Test Pit.No per inch Depth of Test Pit._-.-__'. Depth to ground water.. ------------ -------- -----------------'`---------_.--_-.-_-.-------'----'--._----.-----------_-- `^ Description of Soil---------------------------------------------------------------------------------------------------------------------------- .......................................... ---'----`-----------'---'-----`—'-------'-'----`----'-`---`--`------------'---- ------------------------- ------------------------------------------------------------------------------------------------------------.. U Nu�rc � D�a� m ��x�o —�o�o �b� a���b� �� �� �� , --_------.-.------------'-----'---__------._----._'-_--__---------_-._-- Agreement: - The undersigned agrees to install the aforcdeocribed Iodivikal,t Sewage Disposal System io accordance with the provisions of Article XI of �� S jhas ommy�c He ��m � operation until ~ Certificate .^ °~^*'^~^c ---'--'' -'- Appucuuoo Approved uy.-. � `m� �'��-�, ` �r ~Da e Application Disapproved for the following reasons:.......... --------_---'�-___.-.--._-_--'--.----_ ...................................... ........ ........................................................................................................................................................ Date Permit No. / ae ........................................................ NO.-• = w THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAT .. ... .................OF..............3.:J. r/C+^v �(._k ....................................` Appliratinzt -for Uispnnttl Works Cnomitrurtion Vrrnti# Application,is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System'at r � 1f( C1 ' 4 Location.Address 1i or Lot No. a Se p�j1J} `" Owner f j Address I Installer � p , Address U 'type of Build- Size Lot----------------------------Sq. feet -, Dwelling—No. of Bedrooms--------------------------------•.--____--__Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons..-____-.______-_---._••...- Showers ( ) — Cafeteria ( ) Otherfixtures ---------- ----------------------------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow........................._---------.........gallons. WSeptic Tank—Liquid capacity-_--_____--gallons Length................ Width--------.------- Diameter-------.-------- Depth--_.___-_.-.... xDisposal 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 ( ) .Percolation Test Results Performed by--------------........................................................... Date--------------------------------------- Test Pit No. 1----------------minutes per Inch Depth of Test Pit.................... Depth to ground water...--.--_____._.--.--_-- (q Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_-.-_--_-.-__-_____--- P4 .•-=----•-•----------------------------••-•----------------••-•--•---•--•-•..........----•---_-----......................................................... 0 Description of Soil............................................................................................................................. --------------- .......................... W ------------------- ----- - -------------------------- ------------------------------ - U Nature of Repairs or Alterations—Answer when applicab le_._._. .___.__. "' v. 'r _ ul -----------/�. - _ -----------------------•-------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with 'i the provisions of Article XI of the State Sanitary, Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iAued.#the board of health. l j yjigned..... Z111 _... .M . . ••----- �. Date Application Approved By--_---:_ ----------- - ---- Date Application Disapproved for the following reasons:--------------------------------------------------------------------------------------------------------------- .............•-------•...••--.....__.....----•------------------------------•-•-•--...---•-•------....----•--.......---_-••••••-•---•--------------•-.....-----••--••--------_...._..-••••-------•-----. Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ .................................OF--- ....... ......................................................... " Trdi$iratle of f nntpliatta Tr HIS IS T CE TIFY-pThat the Individual SewageyDisposal System constructed ( ) or Repaired t r ' l r t«�a J: Installer ` Jr '_]/j ✓ (/ �` at 1 �,''i` .d�?!r��... --. --r-�-:/'..'"..L y_....-•-`----.._... A- ��F ��,_..-:=--•_:!�._. s4yr�. ti�C�rL�!✓- PP P ��- dated r-_as descr' ed in the has been,(installed in accordance with the provisions of Article XI of The Sta e anttary Code application for Disposal Works Construction Permit No..................... .. ..G ..- /-� -• ._.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE C AS A UARA TEE TH T THE SYSTEM WIL FUN TION TISFACTORY. DATE " --•_.... Inspector-----------------�.------ ----- ---•-; r ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH F, _, y ......................d.....!%S.?�t .LOF.................�:...........�: —.r •------........ No.--•-------------------- FEE.......�=-•�-•--- �i��ia�ttl nrk��n���#>x�urtinat �rrmi�,/r Permissign is hereby granted_. •-` ........... /�/ - :.1��`. '- ,1 ( ' to Construct ( ) or Repair{{ (I ) an Individual Sewage Disposal Sys f "�' at No.. k�.,'i �2�_'I _... /r / �� .__.Y,.. ..c: �¢__='`%� '' '✓c.+:�`7-- /' Street as shownlon the applicatlotl/.,for Disposal Works Construction Permit No.-___-__::.,-._.___..fDated... _ , .. _ DATE. Board of Health - J FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS _.1 �� _ �' ' ifs � �/��'A`'+