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Home My WebLink About0081 NICKERSON ROAD - Health - 81 Nickerson Road;" Cotut . A 018 Oo2 _�-- _. - --- ---� TOWN OF BARNSTABLE LOCATION F Ck-fvsp►v SEWAGE # k// — I VILLAGE—gf l V� ` ASSESSOR'S MAP & LOT INSTALLER'S NAME& PHONE NO. SEPTIC TANktCAPACITY OTC'). LEACHING FACILITY:(type) S�:(5 44e:4 (size) NO. OF BEDROOMS PRIVATE WELL O ° PUBLIC —WA—T-E BUILDER OR OWNER DATE PERMIT ISSUED: ). L� DATE COMPLIANCE ISSUED: as / �-- VARIANCE GRANTED: Yes No ,� .. <_ �' . � � � J _q � 2 �/ � � _ 7 �. b .� �' 7 t No..., .�- /.y F_uii ......... APPROVED THE COMMONWEALTH OF MASSACHUSETTS ftn ownm®ntBOA R® OF HEALTH QWN OF BARNSTABLE Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: ................ .�........ _.1 c� a\t. � !...... Q.. ..•-----------------------•-•-----•.............. ------------------------...........------. Location-Addr�si or Lot No .............�.. ......�(.A.f.__..Y//��:..--- ` 'Ce'-r u -- --- .. - --.. � wner a •................... .. ��✓�........................•---- .! ....... Installer Address d Type of Building Size Lot.....................:..... Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) �04 Other—Type e of Building yp g ............................ No. of persons............................ Showers ( ) — Cafeteria. ( ) Other fixtures -- ---7---�- ------- ---- -- W Design Flow__.._._.... ............,9. gallons per person per day. Total daily flow.......... ._.._..._.._._"gallons. Septic Tank—Liquid ca cit allons :__�_(�..._.. Width.�U. ..___.__. Diameter________________ Depth-,...,_......... Disposal TrenchNo.4/1Q) Width...... .tength ........ Total Length......�6r.. Total leaching area.........:-._...._..sq. ft. Seepage Pit No-------------------- Di meter-__--;----_____-____ 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........................ fX4 Test Pit No. 2................minutes per inch Depth of.Test Pit---:................ Depth to ground water........................ P4 ---•-------•--•--•......-•-•---------------- ----------------------------•----•-•----------=----•----•- ......... _............... O Description of Soil-----•---•...............................• --..........-----------=--------------------------------------........-----•--------------------......_•..-----• x x --------•--------------------------------••---------•---------------•---•------••-•------------•--•------------. •---- --- ----. --.............. U Nature of Renairs or Alterations—Answer when applicab .. :6 .� ._._.�_-�_- -- -•-_•T--'" -- !! ------ 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 Co issued the t \ Signed ..---......�--- ----- --- -- ------------'.. ---------- -----....-- .. ..:� Date Application Approved By .. � ...�.... ----------------------......................................- ---- ------��5.-�� .:-.. .� �� Dt' Application Disapproved for the following reasons- ----------- ------------------------------------------------------- -------------------------------------------------------- --- -- ------- ---- ------------------------------- Permit No. ! a — L,�!-�..--.....-- Issued ------------------------------------ Dare l Dare FBB., THE COMMONWEALTH OF MASSACHUSETTS V, BOARD OF HEALTH jtOWN OF BARNSTABLE Applirativit for Disposal Works Toushvdivit Tirrmit Application is hereby mad,e for a Permit to Construct or Repair (t/ran Individual Sewage Disposal System at: Location-Add, or Lot Na _.._ _-L --------------—--— Address--—---------------—--- ........... Installer Address Type of Building I 15> Size Lot---- Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic Garbage Grinder 04 Other—Type of Building ---------------------------- No. of person&--------------------------- Showers Cafeteria P4Othe _ges------------------------------------------------------------------------------------------------------------ -—----------------- --- Design Flow _.—gallons per person per day. Total daily flow- ------------gallons. 1:4 Septic Tank-Liquid ty is -Length--!-- ------ Width A?_'.__------ Diameter----------------Depth--------------- ---------gallons Disposal Trench—No. -Width......1�-----------Total Length------ ---Total leaching area-----------------sq. 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------------------------ rif Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water---------------------- N ------------------------------------------------------------------------------------ 0 Description of Soil---------------------------------------------------------------------------------------------------------------------------------------- W ------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- /I- -----------—---------------------- U Nature of Repairs or Alterations—Answer when applicable- -- --- ----- ----- --- r--------------- - ----- ------------- - ------------------—--—— 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,ley the board-of-healthf Signed ------------------- A lication Approved By -------------- V pp -------------------------------------------------------------------- -------4a---;L - � .7 ---J_ IkW Application Disapproved for the following reasons: ------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------_------- Permit No. ------------ ---—-----4// ----------L�/-------------- Issued ------------------------ikw;------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE alertifirak of (9mPliancle THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by --------------------- ------- -' - - ---- ------ - ---------------- --- - at ------------------------------------------------------- �-------------- -------------A-77--------------------(:-- ' 1 e ---`--------------------------------------- has been installed in accordance with the provisions of TITLE 5 oMe'State Environmental Code as described in the application for Disposal Works Construction Permit No. __________I___ _---------- i ' I Y----- dated --------------------------------------------- i THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCT, S I ON XSATISFACTORY. ' - Q'_ DATE---------------------------------- -- --- --- --------------------------------------------- Inspector --------------------- --------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Fw- Dispasal 19arks Tonofturfian 1krutit Permission is hereby granted------------- " , - 4 4 f r., --------------:. _. -------------------------------------- to Construct ( Wi v ) or Repair (--ra—n Individual isposal System atNo-------------------------------------------------- ------ -�Zrt_ 1 77 Street as shown on the application for Disposal Works Construction Permit No.-X?- Dated-------------------------------------_ ---------------------------- ------------------------ Board of Health DATE--------------------- ------------- FORM 36306 HOBBS&WARREN.INC,PUBLISHERS