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Home My WebLink About0053 KNOTTY PINE LANE - Health (2) S3 d�na-�t� Qr'y��. Gn.} 1nnj� No.--J..�?.=. �( Fs$.........1_.3�.:.00 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Uiipnsal Workii Tnnitrnrtion thrutit Application is hereby made for a Permit to Construct ( ) or Repair 6X) an Individual Sewage Disposal System at:,Kj 'Knott Pine Lane Centerville 53 ....---_...---y--......-•-----------------------------------..................... .................................................... Quitteo.- yLocation-Address or Lot ......................_.._...................................................................... ......................................................-----..................................... Owner Address W J.P.Macomber Jr. Installer Address Q Type of Buildin Size Lot............................Sq. feet U Dwelling—No. of Bedrooms..............3_.__.................--....Expansion Attic ( ) Garbage Grinder ( ) `4 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 ( ) � Percolation Test Results Performed by......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit...........--....... Depth to ground water........................ (Z4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water..---.------.---. ----. a ----------------------------------------------------------------------------------------•--•--------......................................................... 0 Description of Soil-•-------------•--------------------------------------•----------•--------- .------------------•-----------......----------------------•----------------------------- x Sand & Gravel v --------------------......... •------•-------------•-•---------- W U Nature of Repairs or Alterations—Answer when applicable.........................................................--------.......--...---........._...--. --•-----------------------------------------------------------------l-1..J�__. .................Pit------------------------------------------------...............................-- 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 e issued by the board f health. 10/ / 0 Signed-- ---- --- ........................... --------- ........................... Daze Application Approved BY ---- ---------------------------------------------------------- ----� ---.�..-..��'�.. Dare Application Disapproved for the following reasons- -------------------------------------------------------............................................................................... --------------------------------------------------------------------- .................---.................. Permit No. ./10..�... ....� Issued .....................................................---ate------ Dm ..fit=r._.. �0 00 Na....-��= .•�L/ ._.. Fps......... , .._......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appl ration for Disposal Works Tonstrurtion rnmit Application is hereby made for a Permit to Construct ( ) or Repair (XX) an Individual Sewage Disposal System at:5,3 - .�Kno�t ..................PineP... e_rlt�.e��i.�.�.Q...... �..---•--........ a ......--- ie - =J z� Location-Address or Lot No.- Quitt - __......._.............Ow" - . X-•res s .............................. .............. Addres W J.P.Macomber Jr. - -- -------------------•----------------------------.....-------•-----------•••--••-•••-•--•-•------• •.......... •-••-••••••--••-••••...................r., Installer Address Type of Building ; , Size Lot................ Sq. feet Dwelling No. of Bedrooms-.----•_--••---3.................:. .....Expansion Attic ( ) Garbage Grinder ( ) a Other—Type T e of Buildin r _..._. No. of persons..........................' Showers G-I YP g < P ( ) — Cafeteria ( ) dOther fixtures .............. --'�..............--- <.:••:.-------------------------------------------------•-----------•-------------------.........----- W Design Flow-------.....................................gallons per person per day. Total daily flow.............. ...........................gallons. WSeptic Tank—Liquid capacity_._`.'....igallofiK Length................ Width................ Diameter-,----------- Dept h•-•-.•-••--•---- x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft. Seepage Pit No..................... Diameter.................... Depth;bClow inlet....................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by...........-------......................................................... Date......r................................. ,� Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water•-.----_-__-__-__--_----- (r4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth'to ground water........................ p,' ` ------------------------------ - ..........._....-----....-----•----------.....-•-----------------•-----•...---- Or � r ., - Description of Soil-•--------------------------------------•-•-----------......... = °' -` x Sand & Gravel � - U •-••--••-•••--••-•----•••-••--•••----•••-•------•--•••-•-••-•-••--•-•-••-••-...--••...............•----••-•••--• --•---. . -------••--•---•......_..--•-•....--•-••-•------•--------••. W ---•-----------------.....................................-------------------•-----._...-------------•-•-••••--- -- ___J ...... _y -----•-------•---------------------- U Nature of Repairs or Alterations—Answer when applicable........................ ..-.-_--•.---_---.----•-•----.-----------.-•---------••-•--_--_-. 1-1000 E:a. lan... .t, ................................................................................. 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 •ssu d by the board f health. #r Signed... .&,y -.. ---- ,................ 1J/ /9�--------- Application Approved By,............:.' 4 � �6 g`� .. 9� - ----------------- - ----------------------------------- ................ --------.........--------- +..1 Application Disapproved for the following reasons- .............................................................-----------........------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------- Date Permit No. ......... ' f r = Issued ...... '--------- ....Date..................................... .................. COMMONWEALTH OF MASSACHUSE17S BOARD OF HEALTH TOWN OF BARNSTABLE (gertifirate of Corttylian.ee THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repairedl(XXX) by--........J...P.Mac-omb.er...Jr..---------------------------------------------------------------------------------- .....................................................___....................... pa. Ins[aller " �I .Kn . n _ : ��Pat t .L� e. _ ti' - ... has been installed in accordance with the provisions of TITLE 5 oj�TThe State Environmental Code as described in the application for Disposal Works Construction Permit No. ....... y....:L��---.. dated/7........ .................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR ED AS A GUARANTEE THAT THE SYSTEM W ILL FUNCTION SATISFACTORY. DATE ��' / '-= ----------------------------------- ""....------ Inspector ..... .............--------------------... 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � UU TOWN OF BARNSTABLE No. =.7. FEE.. -00 ...3`�............ Disposal Works Tonstrnriion "permit Permission is hereby granted-------------J...P t.Mn�e.Orr.Lk?P $1.r..................................................................................... to Construct ( ) or Repair (K ) an Individual Sewage Disposal System at No...... 43..•Knot.ty Pine Lane CenterAj��P. .................................... Street L as shown on the application for Disposal Works Construction Permit No :�� Dated.......................................... .................•-••••-.•-- .......................................................... 9 . qq Board of Health DATE.......... ---- .....->,..._l( ..................................... FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS