HomeMy WebLinkAbout0021 HICKORY HILL CIRCLE - Health 21 HICKORY HILL CIRCLE —
OSTERVILLE A=120-065
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TOWN OF BARNSTABLE
LOCATION SEWAGE #
VILLAGE dS,611-t/e/11_ ASSESSOR'S MAP&LOT f-A 0-64
INSTALLER'S NAME&PHONE NO. P IT—CM
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size) l DD y
NO.OF BEDROOMS
OR OWNER
PERMPTDATE: `-� � COMPLIANCE DATE:
t Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility. (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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No. 17ZF Fee $ 40•00
i THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
2pprication for Zigont 6potem Cougtructiou Permit
Application is hereby made for a Permit to Construct( )or Repair(XX)an On-site Sewage Disposal System at:
Location Address or Lot No. Owner's Name,Address and Tel.No. 428-4 3
21 Hickory Hill Circle 'William F. Dubiel Sr.
Osterville,Mass . 02655 21 Hickory Hill Circle Ost. MA 0255
Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—77 5—3 3 3 8
J.P.Macomber Jr. J,p,Macomber Jr.
Box 66 Centerville,Mass . 02632 Box 66 Centerville Klass . 02632
Type of Building:
Dwelling X No.of Bedrooms 3 Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Description of Soil Loamy Sand to medium sand to finesand.
Nature of Repairs or Alterations(Answer when applicable) Adding 1—1 000 gallan J eaching pit
to an existing Tank & nit_
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issu by this B of a lth.
Signed _ Date SZ 1 /A�h
Application Approved by —
Application Disapproved for the ollowmg reasons
Permit No. � / 70 Date Issued
7
lot
No. D'' Fee 4 0.00
THE COMMONWEALTH OF MASSACHUSETTS
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PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
01pprication for &5poot *patent Cougtructiou Permit
Appl%ation is hereby made for a Permit to Construct( )or Repair(XX)an On-site Sewage Disposal System at:
Location Address or Lot No. Owner's Name,Address and Tel.No. 42 8—4 5 3
21 Hickory Hill Circle illiam F. Dubiel Sr.
Osterville,Mass. 02655 21 Hickory Hill Circle Ost. MA 0255,
Installer's Name,Address,and Tel.No. 508-775-3338 Designer's Name,Address and Tel.No. 508-775`333
J.P.Macomber Jr. `y
Box 66 Centerville Mass. 02632 J•P•Macomber Jr.
Box 66 Centerville,14,ass. 02632
Type of Building:
Dwelling X No.of Bedrooms 3 Garbage Grinder( )
{ Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Description of Soil Loamy Sand to medium sand to firma sanrl
Nature of Repairs or Alterations(Answer when applicable) A d cI i n g fl n gall 0 1 1 gh i� �-t
to an existing Tank pit
-
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issue, by this B dvof e lth.
Signed Date 5/1 106
Application Approved 1'
Application Disapproved for the ollowing reasons
;
Permit No. Date Issued
f
THE COMMONWEALTH OF MASSACHUSETTS'
PUBLIC HEALTH DIVISION - BARNSTABLE. MASSACHUSETTS
Certificate of (Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replace�r-KX)on
by—J,P.t'.n()jjBF . fortAT41�-i_,g D'ubi el
as 21 HickoryHill Circle Osiervil. 6.M s has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. -. / dated
Use of this system is conditioned on compliance with the provisio et forth below:
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No. oe� Fee$ 40.00
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Dfi6pozat *pgteut Con5truction Permit
Permission is hereby granted to L P Ma c o m b e r -P
to construct( )repairXX )an On-site Sewage System located at '31 u' kory Hill Circle
Mass . 02655
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
All construction must be completed within,.two years of the date below.
Date: 4I� — Approved by
Existing 1000 gallon tank.
Existing Distribution Proposed new 1000
Box. --egallon leach pit
Existing 1000 gallon leach pit
21 Hickory Hill Circle Osterville,Mass .
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLAN
I J.P.Macomber Jr , hereby certify that the application for disposal works
corTstruction permit signed by me dated 5/1 /96 , concerning the
property located at' 21 Hickory Hill Circle meets all of the
Osterville,Mass.
following criteria:
• There are no wetlands within 300 feet of the proposed septic system
• There are no private wells within 150 feet of the proposed septic system
• The observed groundwater table is 4 feet or greater below the bottom of the leaching facility
• There is no increase in flow and/or change in use proposed
• There are no variances requested or needed.
SIGNED
DATE:
LICEN SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER
[Attach a sketch plan of the proposed system. Also if the licensed installer,posesses a certified plot plan,
this plan should be submitted].
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
V�c� ................... ... ..................OF.............................I.......
.._..... ..... ...............................
. pphratiun -fur Uhiopoiial Vorko Cnunutrurttuu Vamit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Syste>m� at
_ Location-Address or Lot No.
.......1AJ6j [flm1 ..................... ................
Ow Address
er ............................................ ...
Installer Address
QType of Building Size Lot-/-4.ZV4 _-------Sq. feet
U Dwelling—No. of Bedrooms_________.®.....................Expansion Attic ( Garbage Grinder
a, Other---Type of Building -------4WisC_...... No. of persons_.. 1_C_-___-_-__- Showers ( ) — Cafeteria ( )
dOther fixtures ---------------------------------------------------------------------f-----------------------------------------------------------------------------
W Design Flow_______________- 4b.__._...._....._...gallons per person per day. Total daily flow-__--_.. 00.........__.__...._.....gallons.
WSeptic Tank L Liquid capacityft_A--gallons Length-------------_- Width........-------- Diameter___-. --..-_-__ Depth--- ------_-_
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..... Diameter...IA. Depth below inlet............ ..... Total leaching area-.__--.._--_-___-_sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) 0 j. � s JC -3 d--- 7C
aPercolation Test Results Performed by------- --------------------------------------------------•---•-----•----- Date----------------------------------------
Test Pit No. 1................minutes per inch Depth of Test Pit-_.--_-_-_______-- Depth to ground water__.._-__:.--_..__._--_-
fZA Test Pit No. 2................minutes per inch Depth of "Pest Pit.................... Depth to ground water........................
SSr.O.Description of Soil---- / _-. .�
------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable-------------------------------------------------------------------------------------_---------
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in
6 operation until a Certificate of Compliance has be •ssued b the boa�he ---------------------
Date
Application Approved By------------ ---- --- --- ----- -- -- ....._..._. v --./r�...--�-4----
Date
Application Disapproved for the following reasons:.: - •-------•--------•-••-•----------•-------------------------------
a-'
--.......--•--•-•-------------------••-•-------------------•.........---------------...--------------......---...._..------------------------------....---------.._....----------------------------------
Date
PermitNo......................................................... Issued........................................................
Date
r
No.. y Fly$...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.................OF.........................................................................................
Applirtt#iou -fur MiiV ottl Workii Tomitrur#ion Vane #
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
11:Cke.,l---Al1_i...ISAC.....4 t-4--6......-•-•----• -••••---------------•---•-••-•..... f# ......................................
Location-Address or Lot No.
----------
1ol--- n +., i� .-.Cs. -TO&---------------------- ------------------- ---------------------------•------------------
Owr •----••-••..................................Address....•-----------...........................
Installer Address
Type of Building Size Lot..I6.�U.SL._.._.Sq. feet
U Dwelling—No. of Bedrooms------------ --------------------Expansion Attic ( Garbage Grinder (fib
per, Other—Type of Building _- ------- ------- No. of persons....3�1!_:'_C----------- Showers ( ) — Cafeteria ( )
P' Other fixtures __________________________________
--------------------------------------------------------------------------------
-
W
Design Flow.................5Q...................gallons per person per day. Total daily flow.........AU__0-_-_-_--..___--. --.....gallons.
9 Septic Tank'Liquid capacity-1- ._'-.j_..gallons Length---------------- Width—.............. Diameter---------.------ Depth.-.------_.-._-.
xDisposal Trench—No- -------------------• Width.................... Total Length-------------------- Total leaching area....................sq. ft.
Seepage Pit No----- ...... Diameter...]A4eo -,A./Depthe below Inlet Total Total leaching area------------------sq. ft.
z Other Distribution box ( ) Dosing tank ( ) _ o b.. i" C , J�' -,S' J— 76 .
aPercolation Test Results Performed bY------------ .................................................. Date-----------------------------------
,4 Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water...---_-.---.---.-.___-
fZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.------_--_--.-___--
Description of Soil---- /� `�✓_ �f/ � ''� ` � `� ' J'
' -- - - -- w --
----------------------------------------------...................................................-----------------------------------------------------------------------------------------------------..
U Nature of Repairs or Alterations—Answer when applicable.-------------------------------------------------------------------- -------------------------.
--------•-•------------------------------------------------------------------------------------------------------------•--------------------•-••----•--•----•------------------------------------------ 1
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of heealth�.`
Date
Application Approved BY. `�� 1-�' -- -��' 27-•--
----1� 7
Date
Application Disapproved for the following reasons------------------------------- ---------- ------------------------------------------------------
-------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------
Date
PermitNo............................:............................ Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALTH
1.........OF.... .. 4r��,/.. ' .......
i Carr#if� r of 10. umphattre
THIS IS -Q CER FY hat e JIn i ual Sewage Disposal System constructed ( or Repair- ( )
by 1 ...... -:
l stall ---- � —•�"
`. 2-6--------/ - -
has been installed in accordance with provisions of : i.le of The St to Sanita _v Code as descri in the
application for Disposal Works Construction Permit N .___. _.. __f__ ____________ dated...- ��_"�. ...._�_'�.......
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT TIME
SYSTEM WILL FUNCTION SATISFACTORY. X
. tC—i
'DATE--- ............ '_�� " Inspector.___ I
THE COMMONWEALTH OF MASSACHUSETTS
f BOARD 0HEALTH
..............OF....... ... ...G� ...........------.................----......... `� ----
No...........!....1-- FEE--1
�Permission��s
y granted • •. -•---
-�•�-
to Construct—1 ) or Re z r/ ) an Indiv'�fx 1 Sewage jis osal y tem I.
at No.-' . �'- ---.. ---- -
Street
as shown on the application for Disposal Works Construction Per it --------- _. Dated...�0_...__/. .' __.
U --••----••••. —
--- - ---------- ------
D
..................—____-_._........ Board of Health ATE...... --`3�-�-�-------
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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