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Home My WebLink About0569 HUCKINS NECK ROAD - Health 0VcAlh,f Vt ck Ra Ce tl f�CvrftG :k3Y r 4 1 S M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR �N�IE " MCOMEM LED CertifiedfiberSeurcing POST-CONSUMER® www.efipropram rg 9MI290 MADE W USA CST ORGAMM AT SMEWOM • r"M1•ny ��_3 (YAI THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Divi-paiial Wurkii Toutitrurtiun Permit ?r Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal- System at: - i........ ...� U. - i..4dls 1°��e ._..... _-•---- •�......-•••--�-------- --•--------•--------•--------•------------- oc \d ress r••• No. re Owner Address a -••••-..-•-•-----.� -�. •••. -------- - ....... ----••• ................. Installer Address UType of Building Size Lot.................... Sq. feet Dwelling—No. of Bedrooms----3----------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons-----------.------.-.--.---- Showers ( ) — Cafeteria ( ) dOther fixtures W Design Flow- _57..i7. -.......................gallons per person day. Total dailyflow P P Y• „�, 0-----.........................gallons. WSeptic Tank+Liquid capanity-J�vgalIons Length--- ..... Width..-.------- Diameter---------------- Depth................ x Disposal Trench—No. .................... Widt _._.--....-_--...-.. Total Length..........t........ Total leaching area....-...............sq. ft. Seepage Pit No-----I...------------ Diameter----f ..-.----. Depth below inlet---y............ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ 1 Test Pit No. I................minutes per inch Depth of Test Pit.-.-----..-..---.--. Depth to ground water..----.-.----.-------.-. LL, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water...-----................ Descriptionof Soil........................................................................................................................................................................ --- -----------------------•-----....---------------•---------------------------•----------------------------------------------------- ' ice--•••--------•-••---•--••--•-•-•----......---- •--•- U Nature of Repairs or Alteration Answer when app icable.. - 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 be i ued by the board94 health. Signe�------ ---- ............I ! Date Application Approved BY c ^E = 1= �' - Date Application Disapproved for the following reasons- -------------------------------------------------------------------------------------------------------------------------------------- ..----------"........................................—'-------------------------- —- .. ..-------------------------------------.........,......-....._. ........ - Dare Permit No. 0g 1. ......................... Issued /' -.1... J...... ----- D y- --7q0 o0 No..............:-....... FnB.... ..... ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diopo Sal Wor1w Tontitrnrtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repail (L4 an Individual Sewage Disposal System at /? .............. .� G � .......... --•...............•--- -'----•--••_...----- )'.ocafi n-Address .._...No - - �or Lob No .................. Owner Address ad1 1 �AlM 1-L----------------- Installer Address d Type of Building Size Lot...................`........Sq. feet U Dwelling—No. of Bedrooms---_-�_.a-----------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------------------------------------------------------------------------------------------------- W Design Flow_.... -- ________________________gallons per person pe-Lday. Total daily flow-.___�Z7. _...._._._.._.._---------gallons. WSeptic Tank�Liquid capacity-1_�Ugallons Length______.._... Width_..,,+________. Diameter._.-.___._-._- Depth................ x Disposal Trench—No. .................... Width-------------------- Total Length....................�1Total leaching area....................sq. ft. 3 Seepage Pit No_____ ______________ Diameter..._( --------- Depth below inlet.._.-._.__..._. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed bY-------- ---------------------•------------------------------------------- Date........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit_________-----.___-- Depth to ground water...................... fT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------.................. R: --------------------------------------------------------------------------------•-•----•-----...............---•----------•-------_.----•-------••----..----- 0 Description of Soil........................................................................................................................................................................ x U ------------------------•-•--------•-----------------------......-----------------------------------------------------------------------•---........................................................... -------.--f-------------------------l��------ -- -:------------------=----...----------------------------------------•--••--•-•----. U Nature of Repair/sj or Alterations—Answer when applicable Y,, �� '� ..__ � o` .:�?.Q. T ir ......•.......... w..l;•c'i ram..._.. -/-- f_/?..-; ..e..! � f a/!)! '.... .......... ................... •.... Agreement: 9 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 bee="'i'ssued_by the Ward of,health. (�"'� Signed -----....._. ..................��, ----------------- -------.e� Application Approved BY �' - � kt, "-` �'�'? -------------------------------------------- s............"'....•�"..... .'' Date Application Disapproved for the following reasons: .. ................................ -- .. .. .-- .. ..................... . . .................. .. ...................... ..........................------------------� ---- --------------------------------------- ----------------------------------........ . pp�� Date Permit No. L ............................. Issued -------� �r�....i _qV .. .......... Dare __.__--__—_. _.___.______.___.___.___ _.—___ ------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE TQrtifirate of Complianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by .... ---------------------------- .. ..... T ' .... .................................... Installer has been installed in accordance with the provisions of TITLE 5 of The t[att environmental Code as desfribed in the application for Disposal Works Construction Permit No. ..._�'. .._��..-------___--- dated _-----1- .-i..(.. ... _ ..... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARAN EE THAT THE SYSTEM WILL FUNCTION SA ISFAC ORYY. /, �.... `"""� '............ Ins ector� ---? �`�'" � DATE. P - ------------------------------------------- -------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ny L/ �yD TOWN OF BARNSTABLE b, Ob No......................... FEE..�................. �i��roottl ork� �on�tr�rtuan �rrmit ��, �--S rr- _l_� . Permission is hereby granted------. /^±_llln_. :-_.� ---------------------------------------------------•............. to Construct ( ) or Repair Individual Sewage Disposal�System at No............................................. ../'!.�_.... I.1/_-1. K� " Wit' ----j--........................ .._� ...... W Street as shown on the application for Disposal Works Construction t No.�Y ?-Yo�Dated...�..a ..�.I Board of Health DATE---- --------------� ..... FORM 36508 HOBBS h WARREN.INC..PUBLISHERS TOWN OF BARNSTABLE e LOCATION SEWAGE # VILLAGE e,-,V ¢C/, ASSESSORS MAP & LOT INSTALLER'S NAME & PHONE NO.e�o t_I-a.v SEPTIC TANK CAPACITY L yyti LEACHING FACILITYAtype) 61 j6 i (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER / o d 6 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes ✓ No �� - 1 � �� 7 �--- ob