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Home My WebLink About0121 HUCKINS NECK ROAD - Health Izi Hu ck(�s Ne�� ra zSZ _ 017 SMEAD KEEPING YOU ORGANIZED No. 12534 2-153LOR AINABLE FORS MIN.RECYCLED INITIATIVE CONTENT10%® Certified Fiber Sourcing POST-CONSUMER wwwapream oro SRIDIM MADE IN USA GET ORGANIZED AT SMEAD.COY � I /yTay/�NR .l. No....g ...117 FRis ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiou for Ui_nVv!3 tl Warks Towitrurtilau JIrrutit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: Location-Address or Lot No. 'C�_._....... - C ....................................... -•----•-•---....---------•---•-•---•-----•-------•-------.....----....-•---.....--•------......_.. Owncr Addre s Installer Address d Type of Building Size Lot................ q. feet U Dwelling— No. of Bedrooms............:--------------------------Expansion Attic ( ) Garbage Grinder ( ) p`L-, Other—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. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by---------------- --------------------------------------------------------- Date........................................ a Test Pit No. I._---_---_-----minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----•-•-----------------------------------•---•-------------•------•--•----------------------------------------•--------------- 0 Description of Soil.....Qcs ..--� .................�_ --�-------------� '" U _............. U -----•-----------------•--------..........-•---------------------------------------------•----------•-•---------------------•-----------•-----...-------•-----...-----..._._---------------------------- W UNature of Repairs or Alterations—Answer when ap licable._FIX. A4-----.E Ls._:_ ------------------------------------- �.. •v : 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 '�- \`> S . A Application.Approved By ..................... .. .... . z -" 1 � Application Disapproved for the following reasons: ---------------------------------------------------------------------------------------------------...._t------------------- Permit No. ------ ....�... Issued - - - - ...............fe...... Da[e ——————————————--—�I .. No. -J 1. 7 `*, Fes$.!. /) ca....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Diti-pit ial Works Tomitrnrtiun ramit , Application is hereby made for a Permii to COt1Struct .( ) or Repair ( j an Individual Sewage Disposal System at, / .........l Nv � s NF,cK- Czc C'E Localimt-Address or Lot No. Owner Address Installer Address Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms------------- ---------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons-_--_-__-_--_--_----..---- Showers ( ) — Cafeteria ( ) d 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. 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........................ ........................................••-•------•--.•----•--•-•---------•••-•-•---........._..._...........••--••--•--._.............•- D Description of Soil...... ....... . ... � S� C.�_...... x W x •-••••-------------------- ------------ - --- ------------------------------------------------------------------------------------------------------------------------------•---------.............. U Nature of Repairs or Alterations—Answer when applicable.- t«__._`----_.F: �_s?' �.'PQ°,- l f--�C. u._ \toaQ zix 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 � r Dare Application.Approved By ------------------1/ =j . --- -7 f 3-r��....... Application Disapproved for the following reasons: --------------------_..-_.... ...--------------------------------....------------........------......--------------------------. ---------------------------------------------------------------------------- Dare Permit No. .......C�oZi --- ----1.1.-7---------------- Issued Dare THE COMMONWEALTH OF MASSACHUSETTS w• BOARD OF HEALTH TOWN OF BARNSTABLE (11'Ertifirate of (VILT11jampliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired fr7=)') by -I BC E�..................................................... _------------------------------------------------------- --------------------------------------------------------------.` --------- Installer at ----�Z�------------�1uC �12r. �L Z1_I- e -v--- _...................................... --------------_-------------------.....-----------------------------------------------I----- ---------------..--.....-_... 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. ------,J�' .- ---1,/-..'7... dated ..-------............._..--.._.._.....-... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ) DATE...................... ..1 117--�-C-�f - -- ----------- Inspector .... - 1---- Z --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 9�; TOWN OF BARNSTABLE No.......r. ...� FEE--- � J.�--- Dispusttl Work5 Tlnntrudwn Vamit Permission is hereby granted..... ........ `b`.►`�s to Construct ( ) or Repair an Individual Sewage Disosal S stem atNo. 2 K.�e K-� ...............................................F c ° ` ..----LN --------------------•---•---------•-•-----. Street Cf/1 as shown on the application for Disposal Works Construction Permit No 1_�-_f��Dated-----_---� DATE.............. Board of Health FORM 36508 HOBBS♦i WARREN.INC..PUBLISHERS n , � o . 0 , 4� N � o V � r o �� T1UGKi� I�f�C v TOWN OF BARNSTABLE LOCATION 12,1 tAOC IQO� S N P-K SEWAGE# 9S-- It 7 VILLAGE L-. ASSESSOR'S MAP&LOT d) INSTALLER'S NAME&PHONE NO. N tG�--4 ftOJ SN' 271 _ 1 121 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) I t3'`—r `1 t4-4Nt`=&�, (size) 8?X vLoZ 1 NO.OF BEDROOMS �- BUILDER OWNER M Q L_lz>o b PERMITDATE: 'Z-- 13 9_�L COMPLIANCE DATE: /�' -7 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility If an wells exist PPY g h' ( Y ,f on site or within 200 feet of leaching facility) I" Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) I®� t Feet Furnished by I _ _ h i� �� . , �� ! S 4 ��