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Home My WebLink About0134 HUCKINS NECK ROAD - Health f 34 H„cK,As C2Aftrvilit S M EAD KEEPING YOU ORGANIZED No. 12534 2-153LOR AINABU FORESSTRY MIN.RECYCLED INITIATIVE CONTENT10% Cer iedFibusourcin0 POSTCONSUMER® WWWARprogmmor0 9,01m MADE IN USA GET ORGANIZED AT SMEADZIN .............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Works Tons nr ' n rrnti4 Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal S st at ep�;-------------------------- �� Ad s or Lot No. ...................... ............. --_.....---••---.......------•J. • y./ .f •- ` /�' Qwner Ad � Installer Address Type of Building .t� Size Lot............................Sq. feet aDwelling—No. of Bedrooms............!-----------------------------Expansion Attic ( ) Garbage Grinder p., Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 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........................ 44" Test Pit No. 2................minutes per inch Depth of.Test Pit---................. Depth to ground water........................ 0 P4 .-••---•...--••-----•-•--•--...-------•••...••--•----•-•---••-•.....-•-•--...-•----•---------•---•-------••......---•--.....-••-•-••----• ----------------- Description of Soil............................................................................... ------------------------------------------------------------------..................... x V ................•-•--•-----•----•----•-•--••-••••-•-••------•------••--•••---•----•-•-------•••--•---•-••--•--•--------•----••----•.....•-•-.......--•-------•-•--------•----•••---•----•--------------- ---••-•-•-•-•------- --------••-•...............•-------------•-•--•-•---.........._......--•---•......._..... U Nature of Repairs or Alterations saver when applicable_ �� _.___ _..._......_`....�7_G-�._3.... _._. ------ �� -------------------------------------------------------------------------------------•----•......------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environ ode—The un s' neck r agrees not to place the system in operation until a Certificate of Comph � -Signed -- -- ---------- - ---- .... ......-------------....-- --- -...----- -- ---------- -- --.. .----- -- --------- Date Application Approved B ...------ ... s�....r- '; ............. � ..e =:-.-........ Dare Application Disapproved for the following reasons- .......................................... .......................................................--------........................ to Permit No. -- '"J ..1 ...... Issued ....../ a � " Date -,%'�D� � h � � �13 D i7 No. .v................ Fxs.....L ................._ * THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Applir`ation for Dispati al Works Tons#rur- iuu ramit Application is hereby made for a _Per'mit'to Construct ( ) or Repair l ) an Individual Sewage Disposal System at: 42-- - orations or Lot No. ......................=—_.....-----....---•---•----•-----•••-•••----•.........._..............._ ---................._............. Owner Address Installer Address . Type of Building Size Lot.............................Sq. feet a DwellingNo. of Bedrooms............................................Ex ansion Attic l7 — p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. G; Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ 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........................................ ,.a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......._................ f 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ON ......••-•-•----•----•--•••••--•••••--•---•-•-•---•-•-•---••---•-•-•--•-•---•••••••-------•--•-•--•--------•-•----•-••----•••-•........-•--•--•-------.....•. Description of Soil...............................................................................------------------------------......................................................... U ......-•--•---........-•-•-•-----•-••---•-•-•-------...-•-------------------------------------•--------....----------------------•----------•------------•-----------------......-•----•....-•••••......- W U Nature of Repairs or Alterations—Answer when a licable� _?_ _..._..---� 7 ✓7 _ P PP e `$ - -- •• --.. .M� :� a........ � ..f--,;_...---••.......................................••---------•. ........................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmenta ode—The and si ned further agrees not to place the system in operation until a Certificate of Compliance a- .ee�ssue,�i• x`la Qa d'of�th. Signed ----- .......- ...... � /...... 7 Date Application Approved By,..- ? 5 ------------------ 3 Date Application Disapproved for the following reasons: .................................. --------------------------------------------------------------- ----------------------------------------------- -------------------------------------------- --------......-- --'------.... �..................."---..... Date ..:. Permit No. `j"v C -------------------------- 1. --------- f Issued //1� Date li THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 TOWN OF BARNSTABLE Ter#ifi ate of (foutlalian' re THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired b - t 4 ate. nstaller _ has been installed in accordance with the provisions of TITL of The State Environmental Code as describel in the application for Disposal Works Construction Permit No. ---Fa '�....... ...... dated ....G1�.....---:'..,....^- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR D AS A GUARANTEE AT THE ' SYSTEM WILL FUNCTION SATISFACTORY. �� ,ram !' ', - .- . DATE---- / Inspector ------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No...,............... .. FEE...3o OLD Maposal Worku Tonstrudivit frrufit Permission is hereby granted-----------------------•-------.....--...-•--.--••••------••-•------•---•••-•------••----•-•--•--••-•••-•......••-••...................------ to Construct ( ) or Repair an Individual Sewage Disposal System_� Street ��// •.qq as shown on the application for Disposal Works Construction Permit Fes'-' ........... rj,,,�. � / --- -- ------- Board of Health DATE--------/---------•-----•-•----•-----/--•�-•--- FORM 36508 HOBBS Q WARREN.INC.,PUBLISHERS TOWN OF BARNSTABLE LOCATION 134 HUCKINS NECK ROAD SEWAGE # VILLAGE CENTERVILLE � ASSESSORS MAP & INSTALLER'S NAME & PHONE NO�LLIS BROTHERS CONST. CO. 362-6237 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) 94A,(_" (size) q Y NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATERPvf>+-cam BUILDER OR OWNER {� (N �t QQ_ DATE PERMIT ISSUED: 9 -- g- `7 DATE COMPLIANCE ISSUED: J� / .ze /l In Y VARIANCE GRANTED: Yes No � 0 s ��