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Home My WebLink About0054 LAKE DRIVE - Health 54 Lake Drive Centerville A= 230-078 �I TOWN OF BARNSTABLE \}}7 LOCATION (r -e r to e_ SEWAGE # VILLAGE CCnie(\J% I� ASSESSOR'S MAP G LOT ASS 3A-6�8 INSTALLER'S NAME & PHONE NO. (26 n C O SEPTIC TANK CAPACITY_=[S _ LEACHING FACILITYAtype) 6 t 11-t i 1 (size) (, 3 3Z"iOne- NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER., BUILDER OR OWNER � o DATE.PERMIT ISSUED: DATE COMPLIANCE ISSUED• 6- 30 - [ y VARIANCE GRANTED: Yes No `/ d� ►q �4 No.--.T41•--•-�Q FIn$......... .......... APPROVED THE COMMONWEALTH OF MASSACHUSETTS rust le Co servation apart ant BOAR® OF HEALTH Y a-r 5� OWN OF BARNSTABLE 1gned Date Appliratiun for Biripwial World, C outitrurtinn Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ,fin Individual Sewage Disposal System at: Ll .. .L..._.__. l .....O1-=iuq. ......................................... . . ...............----------......---•--...........--- ication-Address .or.Lot 1 r_.._... ^ ................................................. ••••••••-•-----••-......---•••.....•... ••-•••_... ................ ------ -------- O cncr A ss 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 ( ) 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. 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. 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..._.................... 0 Description of Soil.................................................----------------------------....----.......-----------•------------...-•---=---------------•••......•-•-..........••••- x U ............................ w x •••••••....••---------------••----•--•-•••-•---••••-----------•----•--•-•---•-----•. --•---•---••••. ---•••-------------------••-•--------------•-----•-•••.............................•......... U Nature, of Repairs or Alterrations—Answer when applicable—IA 4— -----I_'-_ (O0.......I. 6.._.�'e .......A4.0_. J......® .._. _...... - !.�f d'!4 12 P ... �.off....t� ??Xi i �-► � lci .[�2 �t/R l/ ......... ............ 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 -- .-�--- ---0..... - o Date Application Approved By ............� ...... y....�.<^... ..C�/ ............................. ........................................ % Date Application Disapproved for the following reasons: ... ............. ...................................................................... ......................... ............... . ................................................ ............ ... .......-. ............ -..- . -.. .... ........................................ Q Date Permit No. 7.Y. ..... ..... Issued ................... ..................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH %FyTOWN OF BARNSTABLE Appliration for Diripuuul Works Towitrurtiun Permit Application is hereby made for a Permit to Construct ( ) or Repair ( a-'an Individual Sewage Disposal System at `� ........................ ......................................... Location�Address or Lot No. �� ray/ •la ................................................. -••••••----`------------------••----.......----------.....------...------•....•--........_...•- Owner Address _ ('A,�1�e••-_---• ••••-•••--..•••-•-.-••-••••••-•••••---.......... --••- •S o•-•----n'ra ...klf-....•.-•• - = � Installer Address U Type W B g- Size Lot.- q feet No. of Bedrooms............��_-___. -----------------------Expansion Attic ( ) Garbage Grinder ) aOther—Type of Building ---------------------------- No. of persons.------------------------.-- Showers ( ) — Cafeteria ( ) dOther 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. I................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......................... 9 _....---••---------------------------------------------•--------•-•-----•-•-•--------•-•---------.........._........_........----...._.. ................. 0 Description of Soil...................................................................................................................................................._................... W U •--••-- ------------ -•------•-------••-••---------••----------•------------------•----------;----------•-------------------------------•-------•------------ W U Nature�ofRe{ars or�Alter�ations—Answer when 1 i=il-� !Av-�S )� licSfa S ��i -�' - ,r f �,�.. 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 ...................... t 4,4 , .. , , ,............................ " l Date..... ... Application Approved By ............ `��.,� --..:..... ...�.-f...... ..�� Dare Application Disapproved for the following reasons: ........................................... ............... . -- .-- ............................. -- ........................................ ... Permit -.................................. I �( y.....-.....(.5 ----- ------------------ Issued ........................................................Dare...... Dare --------------------------,—ti--m =,_—rr--"s---.=.3.. -----,,--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cfertifirate of Tompliance i THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ✓� by ._ ......._... /U<G ....---- ------------------- _... ....._..... ...... ...................._................................ 1/,� _......- Installer at ..... .. . ......F`.'........... ...............t.lj./. - 1 , /".:. �..........._..... ...... - has been installed in accordance with the provisions of TITLE f The State Environmental Code as described 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. DATE.......... 3 0 ........1... .... ...... - _..... Inspector ._... ........._....._.........------.____--------...------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �J TOWN OF BARNSTABLE No. .�:.-'.'.7�. FEE.........................'� Dispwial Workii Tomitrnrtiun Permit Permission is hereby granted-------------AtA -----6!9J4165----=-----•--------...--------•-------------------.....--------------------•-•-•----•----- to Construct ( ) or Repair (✓)an Indiv�yidual Sewage Disposal System atNo.• = q "!Ap......>r•�'' Q �ai•rc�;/� ------------- ---------------------------------------------------------------•-----________-_- Strcet q / g as shown on the application for Disposal Works Construction Permit No.-?y4'.9�.�•. Dated.--.._�^.-� — I ----•- 8.._.. �-------•--- •---................-...............•------... / •...........................•----._.... Board of Health DATE . ./ ;� FORM 36508 HOBBS h WARREN.INC..PUBLISHERS