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HomeMy WebLinkAbout0016 NOBSKA LANE - Health �� ib`Nobska Lane, Uenterville A= 170 - 031 I No. 42101/3 ORA a-K ESSELTE 10% • a o Q i TOWN OF BARNSTABLE A LOCATION �'�4�/d k6 SEWAGE # . `r VILLAGE G / ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.' 1 Q6 SEPTIC TANK CAPACITY Ad LEACHING FACILITY: (type) (size) NO.OF BEDROOMS 3 y BUILDER OR OWNER PERMTTDATE:A -t;LO - Q S COMPLIANCE DATE: /;L 9- Q 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) Feet Edge of Wetland and Leaching Facility(If any wetlands exist + within 300.'feet of leac, g f cility)_ Feet Furnished by —.v 1L �� G Y" 30 00 No.75--- / THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliratiuit for Biupuual Wor1w Cnom3trttrtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Sewage Disposal System at: 16 Nobska Ln Centerville .........---•------•--•----•-•---.....-•--••----.....-•-•-•---------------------------•-•--------. •-----------••-----------••--------------•--------•-----------•------•-•----.........•---.......-- L. Walker Location-Address or Lot No. ......................».......................................................................... -•--•-•--•--•--••-•••-----------------•-------"----•------••--•--•.................--=---.......•- Ow cr, Ad ress W W.E. Robinson S605fic Service P.O. Box 1089 Cendtgrville Installer Address Type of Building Size Lot.................... Sq. feet U DwellingNo. of Bedrooms______________________________ _ _ -Fa Expansion Attic— - ------:-- p� ( ) Garbage Grinder ( ) Other—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 ( ) Percolation Test Results Performed by------------------------------------------------------------------------- Date...------------............--------..... Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ..-•••••--•--•"•----....-••----•-••-•-••-•-•••--•-"-...--••---•--••-----•-•-•----------•••-•-----•-------••-•---•••......---••------•-•-• ------------ 0 Description of Soil.................. x_ave1.-----....................---•-•--•--•----•---••------- W U ....•--••••..............•--•••----------••--•---•--••--•------••----•-•------------••------•-• -"•----•-•-•----------•-----••-----......._.....•••••--•---•---•-•-•-------...."•----•--••-•----------••- W x •••--•-••-••-----------------------------•-•------------------ ------------------------------------------------------ ---------•----•--•----•••-•---•-••••......--------••••......••---• ............... U Nature of Repairs or Alterations—Answer when applicable--install a . . 000 ga.. septic tank gf d_boX--•to---&x-ist-.-rig--p-r-eeas-t----stoeepaeked---le-aehpi-ts:---------------------------------------•-------•-•---- 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 beenjssuejby the board of health. Signed . ' -------------- ------------------ ..-------------c3.:�0_.....9S Dare cy _ Application.Approved By ............. J ..� - ---------- " C�...--.<....J.... �'""`"""" ------------------------ Dale Application Disapproved for the following reasons: ----------------_----------------------------------------------------............................................................. . ...................................... ..... ... .... ...... ...--------------------------------------------------------------------- ..... ............... pp Date Permit No. .......... ��-�'. -.1. ` Issued ...............�� Dazl� — 5 i /_�y THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Applirativat for Diinpuial Workt5 Cnuatitrurthitt runfit Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Sewage Disposal System at: 16 Nobska Ln Centerville ---•.............•---•-------........-•----••----...........------••••--••-•••--••-•-----•--•-•-•- ••••-••--•---------•-•--•••••••-••--•....-•-••••---•-----•----•---•-.._..--•-•-------....._---- 1 Location-Address or Lot No. L. Walker ......................-.......................................................................... ------------------•--------••--------••--••-•••------......-•-••-......_.......------•--•-----•••. w Ad reess W W.E. Robinson SeO `' ric Service P.O. Box 1089 Centrville Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling— No. of Bedrooms....3......................................Expansion Attic ( ) Garbage Grinder ( ) 04 f� Other—Type of Building ---------------------------- No. of persons-_.-.----.-.---_-----.--- Showers ( ) — Cafeteria ( ) p' Other fixtures ......-_------------ -------- - - W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. Gi Septic Tank—Liquid capacitv------------gallons Length.........-_---- Width---------------- Diameter.---..---------- Depth................ 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........................................ t,• Test Pit No. I----------------minutes per'inch Depth of Test Pit.------------------- Depth to ground water_------------.-..----- L14 Test Pit No. 2................minutes per inch Depth of Test Pit----------------.--- Depth to ground water........................ a --------••---------------------•-----------•------•-•----- ................................................................................................. 0 Description of Soil-----------------gravel...................................................................................................................................... IV ...----------•-•-•----------------------••---...•-•-••-••-•-----•-------------------•-•----•-•••-----•-••-•-------------••--•----•-•-•------•----•-••----•----••-----•-•-•-....•-••...•-•-- ............. ---------------------------- -----------------. -- ................................................... 0 Nature of Repairs or Alterations—Answer when applicable.-install a - �000 ga eptic tank, ....&---d b©-x---to...max-isti-ng--- -recast---stonepa-aI.-ed---Lea chpats.-------------------------------------------------•---- r 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 beenjssuejky the board of health. e Signed ---/'t. ----------------..:............ ..377 ............................ Date _ Application.Approved By ----------- ^' �«_ _...... e.-�1� .... ...._. ............................... Application Disapproved for the following reasons: --------------------------------------- .. . .. ................... ....... ................ ------ ------- ---- ------------------------------------------------ ----- ----------------------- --...... .--- Date Permit No. ---. �. ------------------ Issued ------------- --------- Dat THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARl.�NSTABLE (gertifirate of Coraylianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( x ) by W.E Robinson Septic----S.e.rvi.ce------- 16 Nobska Ln Centerville at ...................................................................................... .._. ..has been installed in accordance with the provisions of TITLE, of The State Environmental Code as described in the application for Disposal Works Construction Permit No. `Jr----......f_.�. -...._-._. dated .---3-, THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE A AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. .....................................�..1:.....`......'-�..... `.. ------------...------ Inspector .... ....�_ -- --•--- -------........------------------------------- DATEV L. Walker 50 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 30.00 FEE........................ Uifipviiat Worho Towitrudivit "erutit Permission is hereby granted.....-.�V,E. Robinson-,-Septic.--Service...................................................... to Constr c ( ) or Repair (X ) an Individual Sewage Disposal System �i0 Nobska Ln Centerville atNo. -- -- ---------•--- ---- --•--------------- ...----. - ^....--------------- .................................. Street as shown on the application for Disposal Works Construction Permit No.- --- --- --- y Dated----- .Q....2`.,'......... •-•----------------------•--•--•-•---• ...................................................... Board of Health L DATE....................... -... d ..... FORM 36508 HOBBS R WARREN.INC..PUBLISHERS TOWN OF BARNSTABLE r Q L66A`i lON 43 KA D SEWAGE # 7 VIIIA E C: / r ASSESSOR'S MAP & LOT 59 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACFENG FACILITY: (type) ` / (size) lA` NQ:;.OF:BEDROOMS y BUILDER OR OWNER GtljV��(..'A, PERMIT- DATE:S -tA 0 — Q S COMPLIANCE DATE: ,; Sepaati.on Distance Between the: Maxit►ul Adjusted Groundwater Table and Bottom of Leaching Facility Feet ` Pr.vate�Water Supply Well and Leaching Facility (If any wells exist ;onvsite or within 200 feet of leaching facility) Feet Edge;of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaccIg cility) Feet Furbished by .. 1T/ • •--sue /�"'___ t