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Home My WebLink About0031 KNOTTY PINE LANE - Health 31 KNOTTY PINE LN, CENTERVILLE A= 191-023 I ASSESSORSMAP �7/ P V PARCEL THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Applirativit for Dinvotial Wor1w Towitrurtiutt Permit Application is hereby made for a Permit to Construct ( ) or Repair 90 an Individual Sewage Disposal System at: ........................................................... Location-Address or Lot No. r1 ► ... ' �� .---•----------•-•---•........................................................ O nr A dcs +fie ►-c.0�s`�- .... C.. __ 4 L�� ............................................. Installer Address UType of Building Size Lot............................Sq. feet t-t Dwelling—No. of Bedrooms--------------------------------------------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. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water..................... LT. Test Pit No. 2................minutes per inch Depth of Test Pit-_-___--_.._____-.-_ Depth to ground water........................ --------------- --------------------Description of Soil...P•-Z-•---•••.S`� -------------------2:..---- � -----------------------•--------------------------•-•---------- U --••--------------------•----------•------•------- -•-------------------------------------------------------------------•-----------------------•-------•---------------------••--•-•-•......--------•-- W U N_�z re of Repairs or Alterations—Answer when applicable.--- -.-__._b�l ------- 1 o�� G�r1 }... ................................ ......-•-.•--z\•.-•-S��5----------� ......--�?c\Sj��L-•--��`S 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 been issued by the board of health. Signed-- a,,.� - S� i ............ :'oY'-f ✓��✓� ----------------------------------------------------- Application.Approved B Application.Disapproved for the following rearons- --- ---------- ------------------------------------------- ---------------......----------------------- ----- ................ ................ Permit No. .... .....a........'.... � _ `� ''� ... . ...... .... Issued .. Dare TOWN OF BARNSTABLE i LOCATION _3> K.Jd%7� P)4,1� L.,A- SEWAGE # 9S- /3'/.Z. VILLAGE C&;t/ ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. (+t e y-L=c C'bj.SV- 7"ld P12,e SEPTIC TANK CAPACITY 1 , 6-O 0 LEACHING FACILITY:(type) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR CW�NER� (cb� DATE PERMIT ISSUED: ��, - DATE COMPLIANCE ISSUED: q �� VARIANCE GRANTED: Yes No �' 4 - C. 3Z THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BAR(�NSTABLE UErtifirate of IL mjj ian rE THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( xn ) by .«. -r`t..... � --�-.- -- ----- --------_--_-------------------------.-.....------..._................_................. -- _... at .. L ►.u5'...'t'`(......Ql-----Z.----..--------------"`-Z. -------- c '��/----------------------------------------------------------------.....-..------------------------ has been installed in accordance with the provisions of TITLE 5 of The State vironmental Code as described in -. s the application for Disposal Works Construction Permit No. -`� Fp��1 dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. � � DATE ....... - =. ..` {f- ~-L .- - Inspector - - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � No... TOWN OF BARNSTABLE..-....-•............. FEE.....-•.•-----`--...... Dispo.oal Works Tunitrnrtinn "rrmit Permission is hereby granted.....�tX6.lLe'f........ 2ZI.S ----------------........................................................................ to Construct ( ) or Repair ) an Individual Sewa e Disposal System at No.----•-3)-----------1!. Xi 't........... �4 _ .s Str e V ...�- as shown on the application for Disposal Works Construction Perm* `�_ ' l Dated__ ' _./::.'�-- ("} ....... v ------------Board e!„� _-_. - �../Z� _.... DATE........;''__.._.___t! .... . .......................•--•--- of Health r 4 FORM 36506 HOBBS&WARREN.INC..PUBLISHERS - J - f PNO. FEs........ . ....ej..n THE COMMONWEALTH OF 6SSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiuit for Di-aip ial Mirk,i Cnuii.itrurtiuii ranfit Application is hereby made for a Permit to Construct ( ) or Repair (/10 an Individual Sewage Disposal System at: . Gw T �------v� I jts..... ----------------- -- ---------------...---.......--•---•---.......•. Location-Address or Lot No. ...t�� vJ Icy o�''i3 Ow er Ad res �+� ....................................------------------------------------------- Installer Address UType of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building _---..-_----------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures --------------------------- ---------------------------------------------- Design Flow............................................gallons per person per day. Total daily flow........---..._---__:.-..............,......gallons. WSeptic Tank—Liquid capacitv............gallons Length---------------- Width---------------- Diameter--.-_---..----. Depth.............. x Disposal Trench—No. .................... Width-------------------- Total Length.................... Totatleaching area....................sq. ft. 3 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. I----------------minutes per inch Depth of Test Pit..----_-.-.._...-_ Depth to ground water_-.-------._-.-------... rZ4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ a Description of Soil---------------........................................ �=----••------.,------------------------------------------•--•-----------------.....---..........----••---- W .. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U N of Repairs or Alterations—Answer when applicable. .- :..'..... '�� ?.._...--1 p..............................................laet f 1 ,gyre1Z� S0.W -••-------------------------------------•....' >!�___------ ,�c�S L '1 ................................... 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 Oplace the system inVperation until a Certificate of Compliance has been issued by the board of health. Signed_ ar--o Va .-�"".. .........5/.4 5 J....... �.. Application.Approved By� t��.,.z _ '— e -------------------------------------------------- z` ...........� Application.Disapproved for the following reasons: .. .... .._..._._... .... .. ............... ............ ..... ......ate........ ...... ..... ............ ........... ..... . .............. ................... ........................................ Permit No. .... s.�.....�..... " ...... Issued k:/ ". ......- ........ Date CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) i I, hereby certify that the application for disposal works construction permit signed by me dated sAg1 1% s— , concerning the property located at \ YJo��\ `z N�\`N LA.1. I meets all of the C-tjV4zv\1`L following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. I SIGN$ DATE: s LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. _ � `�, ��5�� •. � ��G�J� 0 � e f� i' ,` ----- S`�-�-� � _ :__