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Home My WebLink About0060 NICKERSON DRIVE - Health 60 Nickersonle: cotuit A= 035-066 h' UPC 10334 EL..2-1.53 -"Tom*w i �I �i i ' - �_-_ TOWN OF BARNSTABLE LOCATION�2 16 pt,-,) yh ,"191Z/4, SEWAGE # ,`O VILLAGE C6 �vc ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO.�I��t6�✓ SEPTIC TANK CAPACITY / 5� D 0 LEACHING FACILITY:(type) 0 o (size) -41 NO. OF BEDROOMS PRIVA4 WELL OR PUBLIC WATER BUILDER OR OWNER e g r,) Spy c� DATE PERMIT ISSUED: -' /91- DATE COMPLIANCE ISSUED: Z5 — 9 o VARIANCE GRANTED: Yes No '—"- — �� "'� M� �� 'I 6 , tC 0 t � �� ', �� ._..�.� THE COMMONWEALTH OF MASSACHUSE77S BOARD OF HEALTH TOWN OF BARNSTABLE Allp iration for Disposal Works Ton .rrutit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal Syst at• r fr anion-Acjdress r- or Lot No. ,� � - Owner Address 14 W Installer Address dType of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons____________________________ Showers — Cafeteria P� 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........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ •----------------------------------•----------------------------•--•----------------•-------•------.......................................................... 0 Description of Soil........................................................................................................................................................................ W x _ ---- U Nature of Repairs or Alterations—Answer wh n a Iicable__% _____________________ __ _�___� _ �__. .......... .. ..... ....7. ...... 6ul.... 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 been issued by th oard of health. Ave Signed - ----------------- ...... .........5..., ------J.-- .-.---�.---..0 Date Application Approved BY ............... ' --I ........................................------------------------------------ ----�-/ ...—. Date Application Disapproved for the following reasons- --------------- -- ------------------------------------- .......................................................... - - - -------------------------------------------- --------------------------------------------------- ------------------------------------------------------------------------- -------------------................... PermitNo. 20 '-------3. . ......... Issued ----------............................................. to...... Date No...Z/2-3-�..:51 FEs.................._...... c> THE COMMONWEALTH OF MASSACHUSETTS .' BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Murks Tonstrnr#iun Frrmit Application is hereby made for a Permit to Construct ( ) or Repair (� an Individual Sewage Disposal S stenfat: ..y.��...o__-�:�-��°f-�-��---.....� ...--��---.............-•......................................... Idncation-Ad Press or Lot No. ..... �. •l: ' .......... .•--------------------------------•-•• •-------------•------.....---.....................•--- Owner Address W Installer Address Q Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms.........................................:..Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) P.I 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 ( ) N-I - .1 Percolation Test Results Performed by.......................................................................... Date........................................ / Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... fi,' Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_-____-_-_-_-__-----__- P+ •---•---•--------------------------------------------------------•--•-•---------------------•--••---......................................................... 0 Description of Soil............................................................................................-'--........................................................................ x ----------------------------------------------------------------------------------------------------------- ---..._......--•- U Nature of Repairs or Alterations—Answer whe (applicable_._ . ____________ J.__l� .h- _.................. / 1�-------------------- Agreement: The undersigned agrees to install the aforedescribed Individual'Sewage Disposal System in accordance with the provi`sionsroi 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 theXoard of health. ^' Signed---- ' ! .-_'[- `l" iY ------- ------------------- do, •�' to A lication Approved B Application Disapproved for the following reasons- ------------- ------------------------------------------1-----------------,---------------------...........--...-------------- -- -____--_--,__-----------------___._..--_______._______... _-_-- If Permit No- ----------------:--0..-_..-----�- c{------- Issued ..------------------------------------------------------�------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ' Cgertifi ate of Tampliunre THIS��IS�O C�`T FY, That h�'I�tdd- tid�;ai wage Disposal System constructed ( ) or Repaired ( ) T . .--- ------------------ ---------------- 1 Installer t a - I '! '.I-L'�:�.�J--h. --------�- ------------------------------�-r---Q-----�ku--1---- 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. .........?5------ _ _� dated _.._...__.....� �____________________._ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU41D AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE - ------------------------ ----- --- ------- --- Inspector .. .. ---:...._... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,^� TOWN OF BARNSTABLE _ e No.....7n ' �• FEE-=- ----------•------ .--- ...... DispuVlnrhii T ant atutitrmit Permission is hereby granted. J ..................................................................................... to Construct ( ) or Repair (�an Individual Sewage Disposal S Ist �.. --- t Street �; as shown on the application for Disposal Works Construction Permit No______��______________ Dated.......................................... ------------------------------------------------. DATE.-------.. ey ............................................ Board of Health �_'.�_:.1._0 FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS I AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION, G . �C l�id/'`J orb 19/L/k• SEWAGE #_7'0 VILLAGE C6 �vi ASSESSOR'S MAP & LOT INSTALLER'S NAME 6i PHONE NO.4�yA jtp✓,,ECC/r'S SEPTIC TANK CAPACITY LEACHING FACILITY:(type) , e (size) / . NO. OF BEDROOMS__!�Z PRIVA WELL OR PUBLIC WATER BUILDER OR OWNER� �_@ DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED:' VARIANCE GRANTED: Yes No '"`�`� IN C http://issgl2/intranet/propdata/prebuilt.aspx?mappar=035066&seq=1 8/28/2012