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HomeMy WebLinkAbout0030 HICKORY HILL CIRCLE - Health Fhc4oryI CA ,�,9e. I � � osX r , la 0 No.... .-a_7?_. FxB.... THE COMMONWEALTH OF MASSACHUSETTS � .� BOARD OF HEALTH STOWN OF BARNSTABLE Cna�gt��rA�r��urt rruti� Application is hereby made for a Permit to Coiistruct ( ) or Repair ( an Individual Sewage Disposal S stem at: AA L atii ,-:\ddress or Lot No ----- O„�re �� Z s a ,. Installer Address X Q Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms---------------------------------------- -Expansion Attic Garbage Grinder aOther—Type of Building ------------------------ -- No. of persons_.----_-----_--_------_.-._. Showers ( ) — Cafeteria ( ) Q' . Other fixtures ------------------------------- - - W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. 04 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 . ,a Test Pit No. I................minutes per inch Depth. of Test Pit.................... Depth to ground water........................ t14 Test Pit No. 2............r...minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 -•-•-•---...----•----••-•---------------------••-------•----------•--•-------••-----------................................................................... 0 Description of Soil......4......................................................................--•--...--------•-----••--••----•--•----•---•------------•--•-•----•-•--•-................ U --------------------•------....•. --•---------------------•....-•-•-•-•----...---•---•-------------•----------•.....---•-------•-•••-•---...--•--•-----•---------•-----------•-----------............. W -----•--------------------- ------------------------------------------------------------------- --------- x . U at re of Res r Al ions— r applic __._ _.._.--._-. ............ 1 -- . ...... . Agreement. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Co —The undersigned further agrees not to place the system in operation until a Certificate of Compliance�hhasri issued by the b of alth. Signed .. ------- ---- .. � ..:.... Dale Application Approved By ................ J...�. - _:........................ .......�..—�/ Application Disapproved for the following reasons: ................................................................... ............................................. .................... ...... ................. ... . . ...................................... ......... ear Dace Permit No. / .--r---- ..�..................... Issued ......-----...----------------------------------------- Dwe `^"i�ar.^'--.r" .al.� �•-•�-r.ti..,....�v-er-..r;-��._w�� ...._ - �n-'e^-.....a..•w.a.x-.�+-..:.c. �..`a-.,,.mot.��Y... No....1...3.:a Fa$.....� C 7 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _-TOWN OF BARNSTABLE ,� �ltrotioYt for Khrip toal Works TOntitruIrtion Vamit Application is hereby made for a Permit to Construct or Repair O4 Individual S ewage Disposal System at - b�1cc,/ ,c�ry l�s Girt c� - #- ............ .......... ------- .._.._..---•-------••--•..... 7-54 / Lo t t it ddr•ssl or Lot No .._... ---------•----- ................ - .— ��'t�cr � frc s a � C-� 3ti� C�,�S` - . 2-3 2 �' Installer Address d Type of Building Size Lot............................Sq. feet V Dwelling N0, of Bedrooms._.._....`~_...... .^+ ...._EX ansion Attic Garbage Grinder p., Other—Type of Building ---------------__....__...__ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ---------------------------------- " W Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons. 9 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 ( ) aPercolation Test Results jPerformed by....................•----------------•------------.........-•-••--••------ Date........................................ Test Pit No. I...............minutes per inch Depth of Test Pit.--_-.-..•-__-__-_-- Depth to ground water........................ GT4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 1:4 .....•-••-----------------•------------•-----------------••-------•--•--'---•---••------•-----............................................................... ODescription of Soil.......................................................................................................................-•-------------------------------................ x U -•-------------••-•--•-•••••-•---••-•---•-......•••••----••--•---•--•••-•---•••••-•-•--..........-•-•-•••••---------••••-•-••--•-••---•--•-------•-•----••-•-•--•••••-••------------------•---•--....... W ................................................................................................................. �...�.._._.._. .______.__....`... U Nature of Repairs or,.Alterations-Answer When applicable .....i6l.�`�_---.-C '�.....=I� � - >f'................... f,C c..................... --------------/-.S .t? . _� ------------------. .._................. 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 ben issued by the board of health. Signed -----I-�...- �-'�..... G!a�,�y... ..1`�:..�'._�.�....:� Date ` Application Approved By --------------- J J---- 4—t.f.. ..................1 .............._ ..................... ............................ Date- Application Disapproved for the following reasons: ............................... . ....................._........................................ -------------------------- ................................................................... ................................................................... . . ................................................ ........................................ ear Date PermitNo. /........................................................c� ... Issued ............................................................... -'------ Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 'IT rtifira e of Tomplianre THIS..IS TO CERTI , That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by .......................... ..... ......................... ..... . ........... ... .......... ......��.............. .............. . ....................... _ It„taue. at ... I L -------- : :� . .J........ -`it .. -_.......... .. P !. 'l l .................. . ...... .......... .--..... has been installed in accordance wilah the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. --------- ?3.---A.7-51...--- dated ................_..... _------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL JJFUNCTION SATISFACTORY. DATE-..........._..Cam_ .�. -.. ...._...... _... Inspector ............... . ...---------_........................................... Lj THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �3 D-7% TOWN OF BARNSTABLE No... - FEE =:..�. Riip vial Vorkii Tnnitrudinn Prrmit Permission is hereby granted ` � J (SAS_ J I -- --------•----------- . . S....----------------------------------•-•----••----•--•-•-••---............. to Construct.( )_,or Repair (�an Individual Sewage Disposal System - . at No............ -�- '' -�C-1 r� = 1.��_... =-1 ..... l_ Street 99 as shown on the application for Disposal/Works Construction Permit No............ !� Dated........................................._. ----.....-•-......•••--..._..... �---------------------------------••-•--•••••--•...... DATE. �i --------------------------- v Board of Health FORM 36508 HOBBS&WARREN.INC..PUBLISHERS ................. THE COMMONWEALTH OF MASSACHUSETTS �D BOARS F HEALTH CI ._ ...._.............OF.... .. .. .._........ ...................... Apph abort for 13isvofial lgorkii Tonotrudion Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Typ" � .......�- - ... .........- L tion•A ��// �j� A'o. wner ° Address a .. t ....... . ..... ...:.... ...................Installer AddressBuildin y Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............. / ....Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building ..... No. of persons...:........................ Showers — Cafeteria P4 Other fixtures ...................................................... Design Flow................... d.............gallons per person per day. Total daily flow..................................... ...__gallons. P4 Wx Septic Tank—Liquid caP acrtY/d - a llons Length................ Width................ Diameter................. Depth............... Dip Trench No .... Width..... . . Total Length................... Total leaching area.._._�__........ sq. ft. _-_ Diameter -`.. Depth below inlet___:......_.... Total leaching area_.1a..4. .sq. ft. Seepage Pit No..:,.2.e________ Diameter_ ._ _ z Other Distribution box ("1 ) 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-_-___-_-__--__-____-__. P' -----------•-- - - -•------------- ----------•--------• -------••----------•-... ........._... -- . O Description of Soil..............: : - x V .....-••................................................•-•---•-•----------........-------------•-----------•---•---•-•-••-•--•-_...•---•---••---•--•-...___..........._.......__................._•----- W .......................•-•--------------......---...-----------------•---------•-...----------------•--••--•------........---------•------•--•----................_....................._............••. UNature 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 XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ber* ;s e by he rd f health. ned.._._ -- ....----- .......................... .• ................................ Application Approved By..._` .._. _ ce Date Application Disapproved for the following reasons: ---•-----------•.................•-•......--••••-•-•--•-••--•-•-••.......--••••......-•----. ................................................................................................-•----..-••••-••-----•........-------------�z-•-��--- -- .................................... Date Permit No.......................................................... .......-----•-•...... Issued. --- •-----.7........................... ate Noa « r ................._ THE COMMONWEALTH OF MASSACHUSETTS BOARD /QF HEAJLT,{H .................. T dR/ r. "� ...r! _±�.s"'� ,,�,«'.� Apli iraiiun for Disposal Iforks CInni#rnrtion Prrntit Application is hereby made for a Peritlit to Construct ( ) or Repair" ; ) an Individual Sewcige Disposal S a L Loc`lation Adrfrer f �pOr j of lTo. t / J�. q �•7 _i•y^J!'xI:K .._..... ,�r ..«.e:....p.......................... .. i K/•:'G.f «M J•-b�_ ..._.. ��.+e•.-. •_____ t Owner I� o Address a ..:..r 4�/d-1::.i�f........�.�"``:..v..Tt'.�„I�.y!•b^"'f4y,.� ......:.:"•.. _._._._......-•--------•-••---.._.._..-•--•--...-•---..._......................................... f d � L, � Installer"' �. Address e of Buildin Size Lot............................d ypSq. feet U Dwelling—No. of Bedrooms................ •.Expaision Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria � Other fixtures ----•--•--•-•----•--•---••..............•-•-----•--•-- . ------.....•-----------•-••----•--..•-•..--------------------•--••---_.. Design Flow--------------- ... , f t:`"� W g ....�_..._�l.............gallons per person per day. Total daily flow________________t.._..__._. �...'.....gallons. c4 Septic Tank—Liquid capacity/Er,E:'.gallons Length................Vidth................ Diameter................ Depth................ Disposal Trench—No.................................. Width............ .... Total Length ... Total leaching area............. sq. ft. Seepage Pit No.__ ............ Diameter_ p .�` � Depth below inlet._..._............. Total leaching area._ ..... .sq. ft. Z- Other Distribution box ( : ) Dosing tank ( ) Percolation Test Results Performed -bv................................. Date.________..._._._•-_----.....:--:-:-_--- Test Pit No. 1... '' ..__.nunnutes per inch Depth of Test Pit___________________ Depth to ground water------------------------ f� Test Pit No. 2................minutes per inch Depth of Test Pit....... _....... Depth to ground water........................ •-----• .. ....... •------- ---------------- •-•--------- •-•...... _--------- ---------- ODescription of Soil...................s .__.' z.. ?. -�Y �'�r -- �--------------------------- --------------•--•----•------------------ V '•.................•--------•---•---•---•-•--........•••••••..._.........._..------••---•--•..._...............•---•----••-•-•............... W VNature 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 XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beendss-ied*by he hoard ;f health. . f fined i = .................................. •------ Application Approved By.__.:'.' �� ' __ •, `' - �•__,._a.._.__ � ` __a^'" ...................•--•_.... Date Application Disapproved for the following reasons:..................`............................................................................................ ---•.............•--............_.....----••...--•--•---.....------------•••---••••....__.......•-----.._. ••--•••-•----•-------•••........----•••-•----•-------•--••--..........-•-.........---•-_.._.. Date Permit No.....................: �-'-�� � `_ ................................... Issued.-� !- --.-I�--- -...--•-......-•-- ate THE COMMONWEALTH OF MASSACHUSETTS BOARD OF , ALTH a. f/ Tntifirate of Tnntpliaurr T#S IS17'e CERTIFY,�I-Plih the In idual.,S/e^�wage Disposal System constructed ( � or Repaired ( ) list at., .....+._... ,... n r has been installed in accordance with the Provisions of Article XI of The State Sanitary Codexs. desc >>�d in the application for Disposal Works Construction Permit No-__--_-_--__-_--____-.._�_.�._ dated �- �' f �f_:�`:_...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIONS SATISFACTORY. DATE........ ......................................... Inspector......... ._. . .... ............................................. THE COMMONWEALTH OF MASSACHUSETTS ,. .� BOARD f3 HEALTHY4 -' No...... °..:_... FEE .`«............... Cho it ton Prrutit Permission j�/h ereby granted. :r'4, .. ............................................................. to Constr t '1,Ar Repair ( Yan Individual;4ew�ge< isposal Sys�? ;� � at No.. l, ._ ycw Street - 1 s as shown on the application for Disposal Works Consti uctio emtit Now Dated ' 1... .. .......... -oard of Hcalth r DATE... f ......................Pnvld�� FORM 1255 HOBBS & WARREN. INC., PUPLMHER$ t TOWN OF BARNS BLE © LOCATION- SEWAGE # Z�� VILLAGE �� ASSESSOR'S MAP & LOT lad,,_ j)S S INSTALLER'S NAME PHONE NO. � r.S + � ' ��� U2-4237 SEPTIC' TANK CAPACITY LEACHING FACILITY:(type) l ow (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER. DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED- VARIANCE GRANTED: Yes No r