HomeMy WebLinkAbout0004 HUCKINS NECK ROAD - Health 4 Huckins Neck Road
Centerville
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UPC 12543
No.53LOR
HASTINGS,LIN
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No. T / i
�._ Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
s
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
ZippYication for Mizpogal bpotem Construction Permit
Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components
Location Address or Lot No. uck I Owner's Name,Address and Tel.No.
C�Yt�pXls I lR. 7�cuj
Assessor's Map/Parcel Li Fj r
�5I -��
Installer's Name,Address,and Tel.No. `b �7 S" 3 j Designer's Name,Address and Tel.No. I)5'g S'<3ag3
'TrFa'► Men het'
fox ccerull�,, qf3 t 4 tee, .
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Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building bW No.of Persons 2 —Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) ZriehO bV4r't6dy--)h i)ox o.1 Rpm
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance ss of Health. /
igned I Date ` 0
Application Approved by Date f�
Application Disapproved for the following reasons
Permit No. C — Date Issued a G
y� VNo. ' w . FeeTHE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
ZIpprication for Mzpooar 6potetu Cougtructfon Permit
Application for a Permit to Construct( )Repair )Upgrade( )Abandon( ) El Complete System O Individual Components
`I
Location Address or Lot No. H UcKU1rj, ��a r-8 Owner's Name,Address and Tel.No.
CsZI't U i I�, �cti.� o f 1CR%pn
Assessor's Map/Parcel ^^ y a 5
Cexl 1 A (YIN-
Installer's Name,Address,and Tel.No. ���`b�77 Designer's Name,Address and Tel.No.
57.131010"Ibw ULd 50r1 '�ar�Q.Y1 1'Yt2yPX
. �o� Coca cs�xrl"�:v;11,�,�11.�.• W 3 �e �t,
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building bWe-1Ux1 j No.of Persons 7 —Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil,
Nature of Repairs or Alterations(Answer when applicable) Erie W( ` (A,,f C 1kJtJ-)h. �t,l)k 0,1-(A �.P.
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance h -been 'ssued_by- 's� ard_of Health.
igned ��..� Date C
Application Approved by Date G
Application Disapproved for the following reasons
Permit No. GO —�y Date Issued 9 L,5 G
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( x)Upgraded( )
Abandoned( by S- . i`l10 f�rn�e><' t).X� 5or7 rzG
t� /1�- t�Pt��_. /'c� C41l�Oftli �P). has been eonstructP�i �cordance
with the provisions of Title and the for Disposal System Construction Permit No. 2 U u V- tl� dated ) (�v
Installer '�T,D LacD" 0X 2-n JCn,e.. Designer 00ATSA VIA, yyllp
'
The issuance of thig pe 't shall not be construed as a guarantee that the system_ will fun �hon as esigned.
Date I 71 hq Inspector f /414/4-.
No....;) C�o / Fee 150 —
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Ot5po5al *p5tem Con5truction Permit
Permission is hereby granted to Construct( ")�Repair(�C )Upgrade( )Abandon( )
System located at Z! g � f uc.ILA' !Clt:.t�, 1-4 (C1AFC.%it P
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Cons1tr�uc on ust be completed within three years of the dal oaf. t.
Date: T �`�4 Approved by '�
TOWN OF BARNSTABLEL
LOCATION CA 1,11 S Ale C k SEWAGE # 200 q �t�
VILLAGE C &.41 f e 1/r AIL t" ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. ,/1iI A CC? —/d 8 P9
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) p A& y lU e1 L.s (size)
NO. OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: ..11,11d
— COMPLIANCE DATE: y (�
Separation Distance Between the: \
Maximum Adjusted Groundwater Table to the 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 leaching facility) ' Feet
Furnished by
Li
d`e
-2Jr�y - 1
Town of Barnstable
WE'O`y�. Regulatory Services
P O
Thomas F.Geiler,Director
BaRivsraer e. •
9$A �0 Public Health Division
rFD A Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office:.508-8624644 Fax: 508-790-6304
Installer & Designer Certification Form
Date: AP 4L 7 2004
Designer: '✓A R-� i� ���� Installer: j , 5c:�
Address: 43 Address: &-:A 44
On b trJ was issued a permit to install a
(date) (installer)
septic system at 4 N—U(kl,1)S /U Ga/--- _R-b A--0 based on a design drawn by
(address)
�/aC(1-Q t;A� ►"Lt;t��I� dated �qr 03
(designer)
XI certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system)but in accordance with State&Local Regulations. Plan revision or
certified as-built by designer to follow.
�N- s�
(Installer's Signature) '�►lo� i.�,, i
S4ANTAW
DI 'A
(Designer's Signature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTII. BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:Health/Septic/Designer Certification Form
TOWN OF BARNSTABLEf--
LOCATION X //-0 C A /A/S le c k SEWAGE #
VILLAGE C e-411P/Z V11Lif ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. Lfl A e 0 X
SEPTIC TANK CAPACITY fa y
LEACHING FACILITY: (type) r 1-91Z y w e1L S (size)
NO.OF BEDROOMS
BUILDER OR OWNE �►^
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the 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 leaching facility) Feet
Furnished by
�-
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�, _ `:
""`��� �
�,� �
� � _ �
r �,� � .�
_�-
,SSESSORS MAP NO:
Ni�...
THE COMMONWEALTH OF MASSACHUSETTS
,ARP-04� HEALTH
.......................
......................OF
Appliratiou for Disposal Works Toustrurtimt Frrutit
Application is hereby made for a Permit to Construct or Repair Individual Sewage Disposal
Systemilt:
�Hl.....tLLY- -,_AL,Y, ,.......n.JZ.1............................. ..................................................................................................
Location-Address or Lot No.
.��..
-----------------------*-------------- ---------------------------------------M------------*------------------ ------------
Address
........L.p..c-&Z .......................... ..................................................................................................
Installer Address
Type of Building Size Lot............................Sq. feet
U
Dwelling—No. of Bedrooms ..................Expansion Attic Garbage Grinder
44 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria
Otherfixtures ....................................................................................................................................................
Design Flow................................... *-----gallons per person per day. Total daily flow............................................gallons.
< �. ",I
00
1:4 Septic Tank—Liquid capacityy�.....gallons Length................ Width........___.._.. Diameter__.---__--__--__ Depth......._........
Disposal Trench—No. .................... Wi4h.................... Total Length................... Total leaching area....................sq. f t.
Seepage Pit No--------------------- Diameter-,b.............. Depth below inlet..J............. Total leaching area..................sq. ft.
Z Other Distribution box (&,I— Dosing tank ( )
aPercolation Test Results Per-formed by.......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit...._.............._ Depth to ground water-__-_----__--_____-__._.
Gi, Test Pit No. 2................minutes per inch Depth of Test Pit._..........._.._._. Depth to ground water..._.__.................
........ . .......................................................................................................
--------------------
0 Description of Soil..1.1.1-1-9. IM.le........... - -------------------------------------------------------------------------------------------------------
x
U ........................................................................................................................................................................................................
............................................................................................................ . . ... .... .......
Natu�epf Repairs or Alterations Answer when apullicable., It" t�_ 4_ ICA_-sy-i
U I
........o.,L 6.....t...f---F----------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TH TI 11,t, 5 of the State Sanitary Code—The undersigned f t1 agrees not to place the system in
)�,'t her
operation until a Certificate of Compliance hair *..s I , r S. .Zn sued V1by t bard o
. ..... .h.
......... .... ........
bc7
. ............. . 2.. ........=n ......
Application Approved By------------- .............. ................. .... ........4.................
Date
Application Disapproved for the following reasons:................................................................................................................
........................................................................................................................................................................................................
Date
Permit No -------- ............. Issued..................................................
Date
N -- Fps...... ��....._
THE COMMONWEALTH OF MASSACHUSETTS
_.._.BOA RD - O- HEALTH
Appliration for Disposal Works Tonstrnrtion ranfit
Application is hereby made for a Permit to Construct ( ) or Repair ( J�}an Individual Sewage Disposal
SysteYL,
t
t
� �
1.... _...__ .s .............................. -------------•--•---•-----............-----------------.......---------------------------.........
••r Location-Address •--•---.• ---------------•or.
Lot No.
..O.� �( ..—�.......................................... ............ ..................................................
I) wner Address
••-•-•-••-••-•-------------
Installer Address
d Type of Building ✓)) Size Lot............................Sq. feet
Dwelling—No. of Bedrooms/_/1-..1e.-t....................Expansion Attic ( ) Garbage Grinder (---y
W Other—Type of Building ............................ No. of persons............................ Showers — Cafeteria
a' Other fixtures .....................
W
Design Flow.................................. .......
v..gallons per person per day. Total daily flow....................._......................gallons.
WSeptic Tank—Liquid capacit) ___...._gallons Length................ Width................ Diameter-----........... Depth___•-___-_•-__-.
x Disposal Trench—No..................... Wicjth.................... Total Length.................... Total leaching area....................sq. ft.
ter._Seepage Pit No..................... Diame ............... Depth below inlet_............... Total leaching area..................sq. ft.
Z Other Distribution box (k-**r Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-.___._____._-__-_--._.-
�1, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
y�, - . ...
O Description of Soil.lt-_._.l.C'_,GI--�t_t.w......---S.•3. •-••••-••••---••---•--••-•------•------•-----••••••••------------------------------•---•............---
x
V .....•-••---•-•--•-••---••••..............................................••-•-•-•-.............••••--...............-••-----•••-----•••--..........---•................................................
-----••----•----------------•-. --------....................................._....---..................--
U Nattlr�q� Rep�rs alterations Answer ap�ilicable____ .t.�_..��_�.... 't__[_�._....�,�"- ._�
.................... ........ <7 •--••- `'1 ''!••A---------6 ---- ---------------------------------------------..---- .
Agreement:
The undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance with
the provisions of T i_1,714, 5 of the State Sanitary Code—The undersigned tier agrees not to place the system in
operation until a Certificate of Compliance has en ' sued by oard o lth.
- •- -------- ----- .--..-.....------------•----•-----------------
................�•---
` �--� Date
Application Approved y....._.... ,� -
a
Application Disapproved for the following reasons:-••-••--•---•••••••-••••••-•--•••••-••••••--•-•--•-•--•••--•••-•-•---•-•----•---•------•......................
--•--•--••••••••••••-•••-•-••.....••-•--••f•-•••••••••-•.............•••••••••........--•-••--•••-......••-••••-•-••••-••••• ••••-••--•••••--•••••------------------•••----••-... ----•••-••••--
Date
Permit --------------- Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF
.... ... ^HEALTH
..OF...
(Irdifiratr of Tontphaurr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( }
by .....
�� Installer_
at ...... � 1 `1- !� lv......................... r` ----•--------------•-------•--•--•-•--•----•-----.-------------------------------
has been installed in accordance with the provisions of TIT E j of The State Sanitary Codq as described in the
application for Disposal Works Construction Permit No. .....5 .>.. dated_.�,'. ..�_. .........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GU RAN�EE6•IAT YHE
SYSTEM WILL FUNCTION SATISFACTORY.
j
DATE........................ .. / ............................. Inspector---•--�..............................._.....................---••-•----.....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF-.. EALTH
l
Diopos o ork.5 Tonstr ion unfit
Permission is hereby granted........
to Construct gr Repair Fir an I ividua Sewage Disposal System
at1�T0. �`'� .G•.� L ......•••M. ....... -------••----•-------------------•--------•----•----•---
Street
n on the application for Disposal Works Construction Permit Dated......r c o _._�'/ f� -----------------
as show t. __.� j
^� ................ bard of e
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
LW
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' I E L A J ASSESSORS MAP'NO. ;Z5-t'
�v� v V a ( '�. PARCEL NO.- ����
na
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' 7
:
ASSESSORS MAP : 11j (
TEST HOLE: LOGS NOTES: '
+` LTC PARCEL : L 0 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH
FLOOD ZONE : C SO I L EVALUATOR ::D. meyggt R-S , CSE THIS PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF
yLO WITNESS : NOT R� vZ__=f (.. BOARD OF HEALTH REGULATIONS.
S REFERENCE : C-9$�30 DATE: P1Z-IL 10 Z003 2; THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES,
s PERCOLATION RATE: : 2^^'N ING14 rat SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO
GI.-flSS O. �i INSTALLATION.
y poi+ C-T> p , y
n
C \�� pr TH- I E„ TH 2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYS T L ; iNSTr,LLATION
A SAP D�� IDY��/ ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE
Rb S +r �j M Z, DETERMINATION.
4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS
SPECIFIED OTHERWISE)
LOCATION MAP( /tI
5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A
M1;T)lL)M/coA P-,� � GARBAGE DISPOSAL.
6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED)
G MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON
2,Sy��� A BASE OF 6"OF CRUSHED STONE.
/-/T '70 eE
132 3�1,23 _����,'v'r���•r� ��n 7�iz.� � ,�?��l�{� w� Cc.��9-�l SAD.
/% �fotlydw� ,� 065.
(Vt.LL, Who
SEPTIC SYSTEM DESIGN !9:) { we 4A14)s
o
�f8 FLOW ESTIMATE
/ 1 3 BED1000MS ,AT Ilo
GAL/DAY/BEDROOM GAL/DAY
SEPTIC 'TANK
r
3or to i �GAI,./DAY x 2 DAYS - (��U GAL
S ! r p� / USE 150 GALLON SEPTIC TANK
E��N 4 SOIL AB ORPT I ON SYSTEM
V /
rl\ a 1 /,✓�,�. - VSE � ? � �� G�3t,c.r��v!_PP�c�9srmC�r�c He� ...w.._ ,. _ . _ _. _ . - . __ ,
SAVE� 'S 1'&iv£' o N S!U�S
D!ZwE I 21� \ SIDE AREA: G.
SD.c7 SOx� , B(TTOM AREA: 3v>< � v r O. ��/ 22 2-
Ec , 3yo. -/0 410v
\ SEPTIC SYSTEM SECTION 7 �� ��� ����
/ s►xo _ ,
3 Q2-
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(overS w�,h `f / •T'o
I I � II EX($!70
� � J�-'/tic%.
To =s ?s I ^-- - �s 2
I ('4sss�MC-0� y7 to„noN� Ct "
D-BOX (16 -LS
o 14 GAL /Wq7c2 T,rSr
I i SEPT I C TANK l ��LrVT1Je`S
�j i v l
i ► �X(sTi� � 4 I ZLOT
------- 30 r(.. k /O (,v
+2) / 37 �_(K Of gss9OE SZZ3
.•�. RR
M MIN
M. SITE AND SEWAGE PLAN
No. 1 1-M
/coo .
/ �F S LOCAT ION :
c�TF.�-
SgNi7AR1 ,
PREPARED FOR : �,gyS�9��5Unl
C)ARREN M. MEYER, R.S. SCALE :
43 VINE STREET DATE: -"-�
J
DUXBURY MA 02332
3
�� (� �( DATE HEALTH AGENT (781) 585-0293