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Home My WebLink About0064 KNOTTY PINE LANE - Health (2) 64 Knotty Pine Centerville A= 191 102 i ASSESSORS MAP NO: PARCEL NO: N-1 .......45(o Ficis 3 ..Q..0 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliratiun for Disposal Works Toustrnrtiun thrutit Application is hereby made for a Permit to Construct ( ) 'or Repair ( an Individual Sewage Disposal System at ............................... .................................................................................................. `� y�oca�tiyon-Address or Lot No. Y......\` .. .\� .�2......... � J.. ................................... ........................... ...................................................... W 0ICILE� woJ S�............ K..a........../.f-0SArZJ. Tess 9t, A Installer Address UType of Building Size Lot............................Sq. feet ., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a Other—T e of Building No. of persons............................ Showers — Cafeteria Q' 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 ( ) '-. Percolation Test Results Performed by.......................................................................... Date..................................... aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ------•-••-•-••--...---•-----•-••------•-----------•----....---•--------•...............•----•--••-•........................................................ 0 Description of Soil------..0.:..L...........SU�3 _ eD�Si. S t,� v- a �aV L I x •-------•-••---•------•----•-•-••-•--••--------------------------•-•- V ---•-----------------------------------------------------------•-------.............---•------------•-------------------•--•--------------------•---.................................................. W UNature of Repairs or Alterat' ns—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 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 ..- � k.------4---. � ..................------ ----- t M� t--- -- Dare Application Approved By .. ..... ............ ...................................... ........................................ Date Application Disapproved for the following reasons- ---- ----------------------------------------------- ----- --------------------------------------------- ------------------ -- -------------------- -------------------------------------------------457�5, - ....---....-------------------------------- ------- -------------- --------.......... Permit No. ... �/ ----------- ---- ---- ----.--.......... Issued .......................�.e....................... Date.--. TOWN OF BARNSTABLE LOCATION PIAI C- SEWAGE # 9/ -YS� VILLAGE Ca�aD w�1�� ASSESSOR'S MAP & LOT/ - 0a' INSTALLER'S NAME & PHONE NO. '77 P - ql7 d SEPTIC TANK CAPACITY /, 00.0 LEACHING FACILITY:(type) P>T_S (size) l NO. OF BEDROOMSPRIVATE WELL O PUBLIC WATER BUILDER OWNER Q0�'LCrC� DATE PERMIT ISSUED: d DATE COMPLIANCE ISSUED: 101 13- VARIANCE GRANTED: Yes No f r� n 3� Noll. -45 Fss..3 .:. .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE AvOration for Disposal Works Tonstrurtion Frrmit Application is hereby made for a Permit to Construct ( ) or Repair (?a an Individual Sewage Disposal System at: r...-----p✓_.J..`.....-----------------•--...-------- ------------....--------.....----------------- .....,,Location-Address or Lot No. 3� ........... . � ---------- ............................................... Ownes� Address ac� C'O�-s. . 30- zos• ....5 -..': Hy�wN► 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 ( ) d Other fixtures W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. r WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter................ Depth................ 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........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------------------------------------------------------------------•----------••••----•-•-•••-••-••......................................................... O Description of Soil........0.....-Z=-----------S0 ... Z �'o�cnS� Shad C. Ie,,v Lt_ U -----•--------•--•---------••---•----••--------••----------------------•-•-•-------....--•----------------•-•----------•--•••---------•••----•-------•-----------••-•-•---•-•------••---•---------- x - -------------------------- -------------------------------------------- V Nature of Repairs or Alterations—Answer when applicable__._^ ____.__ �r?` - tiro�_______. `Lp_ _______________ Q...................................................... x1•s•!_/,... ----------=S. ...T __________S`'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 ..-.....� \ ------- - ).- ?- .�G( ...-.. -�---------------------- ---- Due Application Approved BY ---- --- .........� -- ................... Da[e Application Disapproved for the following reasons- .................................................------------------------------------------------------- --------------------- .....................................-...................... ------------------------------------------------------------------------------------------------------------ ---------------------------------------- Permit No. �./.�---45�� ........... Issued ............................... ............... Date Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Eerttftra e of Grapttttrtre THIS IS TO CERTIFY, -That the Individual Sewage Disposal System constructed ( ) or Repaired (10 ) by ` \c\ -4..........Cb-a S� i� -------------------------- -----------.........................----------------------------------------------------------------------------------------------------------------------------------- Ins[alter at ....... y ................o� I . ........................................................... has been installed in accordance with the provisions of TITLE 5 f he St to Environmental Code as described in the application for Disposal Works Construction Permit No. .-- 7.�... --.-..� .-- dated ------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON RU D AS A GUARANTEE%,4 THAT THE ¢ SYSTEM WILL FUNCTION S h!F WTORY. DATE.....................-..--... 1 --Q - ---------------- ---- Inspector ---- ... 7 �1/t.----- % THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No.q.t. TOWN OF BARNSTABLE r' Disposal Work, Tonstrttrtion rrntit Permission is hereby granted____. �. "'3-3 s 7 to at Nonstruc6A(._.)... Repair (1�) Individual Sewage Disposal SaleeSystem a./ = as shown on the application for isposal Works Construction Permit ( ........ �;a r_.__._11_ .. .1/7 h---.�---- ............ ................. ...... ........ ;................ -`) _1_........................ ____ Board of elth DATE................�_��•- ��//--r --`I- FORM 38808 HOBBS&WARREN.INC..PUBLISHERS R