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Home My WebLink About0099 LAKE DRIVE - Health qq I-akt d c ctafc cy,'I ft Wr et Ali NEW OWNER - 2012 y ?Y > ,1 'k i 4 i No../ .....t(• .. FF,s6....K.t.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diti-Vnnttl Wnrlw Towitrnr#inn Prrmit Application is hereby made for a Permit to Construct ( ) or Repair-W) an Individual Sewage Disposal System at: A^/ 99 Lake Centerville,Mass , ..................•----•-----•----•----•---••-------.........------------------........•-•-•-..... ..----•-•-----••---------••-•---•-••-•--••----....._..........-------------•--•-.....-•----------. Location-Address or Lot No. ]"O-w1PT.------•---•---••----•--•••••••-•------------•...........................•. ----•----------•...------•--•-----------•--•-••---••-•----•••-----•......----•••...............-•- Owner Address Installer Address UType of Building Size Lot............................Sq. feet Dwelling X-No. of Bedrooms----------3--------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) A4 Other fixtures ------------------------------- - - w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 04 Septic Tank—Liquid capacity._.__......gallons Length---------------- Width---------------- Diameter................ Depth..._--______---- w Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. x 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...--_-----_-__--------. 1:4 ----------------------------------••---•---•----•-------••------------------•-•-•-••--•-•----•••---..........-•---•--••--......-•--•--••••................... 0 Description of Soil..........Sand.................................................................................................................................................. W U •--...-•--------•-------•-•---•-•---......--•-••---••--•-•-••--••-•••-••--•--•--•-•-•--•-•---•------••---------------------------------••---------•----------•---•--••-•-•-•--••-•--•-•----•----••••--- Uw _______ Nature of Repairs or Alterations—Answer when applicable-----------------1 5.... tank . ..distr...bu£ion innx---and...thxe ..f lqw.-di f f us sors . 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 i sued by the b and f health. Signed ...... .............. ---- - ------ ------------- -'------------------------ ----------�--......t...4....... ' ....��. Dace Application Approved B ....... ...... _........................... ....� PP � PP y -- e Application Disapproved for the fo lowing reasons- ------------------------------------------------------------------------------------------------------------------------------------- ....................................................._................._..........................._..._...._............_..............._..._................_.._........._.................._........... ........................................ Dace Permit No. ....... }1- r' ----- .............................. Issued .... Dare q V -:..ate,__.__� _ ... FizR... ......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE P3 U 0 8 sc Appliration for Di,tVi1ott1 Norks Toustrnrtion Wrmff Application is hereby made for a Permit to Construct ( ) or RepairXR an Individual Sewage Disposal System at: 30/ ..............................................................9 L nterville,Mass . ................ .....--•-••• •-•---•-••--•---•----••-••--••......-----•- Location-Address r Lot ................ or Lot No. --.....FQ 1 x....•----•-••--•••••------•-----------•----•--•---•-......----- Owner Address a .......: ...J ............................................... .................................................................................................. Installer Address Type of Building Size Lot............................Sq. feet ►-� Dwelling.—, No. of Bedrooms----------3--------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) 0.1 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 ( ) aPercolation Test Results Performed by---- •------------------••-------•-------•-------••--•--------••-------•_. Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ f;I� Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 04 .......................•----...----••--•--•--••--...••--••.....•------------••-••---....-•--•-•.......-•----•---•-•-------•------•-•...............----.••... D Description of Soil..........S-I.nd...................................................................................................................................................x U --•---•••-••---•-------•••------------•-----•---••-•-•------•-•--------••-••--•----•---•---------•-------•••--••------••••---•--•-----------•-------••--•----•--•-•---•-•..............•-••------------. W U Nature of Repairs or Alterations—Answer when applicable----..._.._.1-1 5f?0 tank .. —CilstrTl�uti�ri.......... !I() a:nIft.-t��:pe...flow d ffussors . --------------------•---------------..._...----------------•---------------•-•-----------------........._.---•- 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 bee i./s,�ueed by the b and f health. Signed .... - - `'�/� 2/2 9/9 4 ...... �. Dale Application Approved By ------------- ,.. - ....... ......... c" Application Disapproved for the following reasons: ....... ....................................... ....................... .......... ------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ........................................ Da' e Permit No. ........ . /. — t - Issued ..................... Dace ——————————————————————_ ————————------------ ----------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE rdi irate of V l.�orayliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired-(.XX ) by .....J,P,Ma coln1ber__ir InmJler ----- ----------------------------------------------------------------------------------------------------- 99La =e Centervi 11 e►Massat ..... . .... ...::- ------------------------------------------. . - ------------------------------------------------------------..................----------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ----:9S ...-.. -------------------- dated .............._.._-------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �//�� DATE............ ...._..__.. . .......................... ----------- Inspe orb?... ---- -z, 'J,.---�� G THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH n , TOWN OF BARNSTABLE Roptial WorkD Tonotrurtion Wrm t Permission is hereby granted..._ -.-------------------------------------------------------------------------------------------- to Construct ( ) or Repair)(X ) an Individual Sewage Disposal System at No.99...Lake---Reac...Cent.e. v 11.e,Mass.............................................................. ............................................ Street �., as shown on the application for Disposal Works Construction Permit No7 _•__: _\_.\Dated____�..:--_�..__.�..�•:�........... ..............................-----=�y---1--�>'"""-'.....-............................................. DATE. ,� ............................. / Board of Health FORM 36508 HOBBS&WARREN.INC..PUBLISHERS TOWN OF BARNSTABLE C.. LOCATION mil ' `/� / //J' SEWAGE VILLAGEr'�.�,,�,�r�,.{f ASSESSOR'S MAP & LOT,,FY ./ice%7' INSTALLER'S NAME & PHONE NO.� ��}L� ,�j,�� SEPTIC TANK CAPACITY j_S�V U LEACHING FACILITY:(type) �(c�s l�c,r' Ea7 areS (size) NO. OF BEDROOMS 5 PRIVATE WELL OR PUBLIC WATER BAR OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE-ISSUED: l VARIANCE GRANTED: Yes No j� 2cA5 e—