HomeMy WebLinkAbout0043 HICKORY HILL CIRCLE - Health 43 HICKORY HILL CIRCLE, LOT 24
A=120-067 OSTERVILLE
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TOWN OFBARNSTABLE
LOCATION y 3 I4)b� f �'7)i � C IL SEWAGE #
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V .LAGE D f yr ASSESSOR'S MAP & LOT /010 OG-7
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY / 50 0
LEACHING FACILrrY: (type) (size) ��•�x a'O�X a'�
NO.OF BEDROOMS 3
BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the 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 leachi facility) / Feet
Furnished by Tn S G GtY► FO/ ! G
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Gar L AF--L,
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OAT '
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C TOWN OF BARNSTABLF c�
LOCATION CLo-' .2 V) Y 3 fl or #;Ilf -I:r SEWAGE# ! G —6 7
V LLAGE 0<'Te,, ASSESSOR'S MAP &LOT `�a 6&-7
IN NAME&PHONE NO. A. o,e. hLy
SEPTIC TANK CAPACITY
LEACHING FACII.rrY: (type) -Tin (size)
NO.OF BEDROOMS .3
lq;g DER`R R OWNER
PERMIT DATE: .3 -/V- '?G - COMPLIANCE DATE:
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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A ! (J�.
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Ll 33' 3�''
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ASSESSORS MAP In
No. _... PARCEL NO: / .
Fria. ..-
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE
,c lip iratio t for Di!ivmial Worlig Toustrurtion Vamit
Applicat/ion is her b ma e for a Permit t Const_-uct ( ) or Repair ( ) an Individual, Sewage Disposal
System at:
— - Ko, �y l�icc Cirz.
Z l�tc
......... _¢1. ...- .
Location-Address or Lot No..........................................._k_�w------------------------------------------ ....... _.F ...................----
Address
Installer Address
Type of Building Size Lot--/.�7M a.........Sq. feet
Dwelling— No. of Bedrooms---------------�-?.-------------------------Expansion Attic ( ) Garbage Grinder ( )
a`4 Other—Type of Building m 1 No. of ersons-...._--------------_._.. Showers
g ,u---------- P ( ) — Cafeteria ( )
Other fixtures -----------------•--------------------------•------
w Design Flow..................................rS.-gallons per person per day. Total daily flow------3-a-...................,......gallons.
WSeptic Tank—Liquid capacitvlsAZ-gallons Length...l0-.R:.. Width.4--_6....- Diameter------------ Depth_�_L-.....
x Disposal Trench—No. ------,(----------- Width._... Total Length---Z4.......... Total leaching area-- ft.
Seepage Pit No--------.._..------- Diameter-------------------- Depth below inlet-------------------- Total leaching area..................sq. ft.
z Other Distribution box ( 0 Dosing tank ( )
Percolation Test Results Performed by._A,(: G...a- =..J-- e�_4!:R.......................... Date---?t .........--..
Test Pit No. LL-.3--minutes per inch Depth of Test Pit----lQ'-------- Depth to ground water....-:�.........
44 Test Pit No. 2..--._.".....minutes per inch Depth of Test Pit----- al.------ Depth to ground water------ �---.....
------------------ ------------------------------...........................................................................................................
O Description of Soil--- .......... S 42-b..... =w c=��� `�r�------------
x
w
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 TITLE 5 of the State Environmental Code The undersigned further agrees not to place the
system in operation until a Certificate of Complianc as een issued y the and of health.
Signed ------------------------------------------ ----------------------- ---- ----- -
—`'-
- - / � -APPlication APProved - -.. ---- - --- -
Date
Application.Disapproved for the following rea.ron.r: .......- -- = - 7 - ..... .... -.........
------------------------------------------------------------------------------------ ---------- ----------------.---
Permit No. ,.------0-----'�-/----------------------------
Issued ......... -��.:.. � .
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiou for Di-tipw3al Marks Toastrurtiun antit �
Application is hereb made foLa Permit t Construct ( ) or Repair ( ) an Individual,Sewage Disposal.
System-at: �� 7 aG �.Z`� �-41,
1
L --- - ress- - �..... ...............................................-or Lot No.
Location-Add �
- •-•-•-----•..... ...........••--•-•---
- Lo
••---------------------=-- •--------- _ �.. S r �s 3�� �_ rr cam..
W �� /> 0I� er Address
/7
---•--- -------- ------•-- --------------- -------_....---•-
Installer !.
`, Address
Type of Building S ,- Size Lot_./ �74c%........Sq. feet
►-� S Dwelling— No: of Bedrooms............... . ....................Expansion Attic ( ) Garbage Grinder ( )
Other T!e of Building
p., yp g _�-�h_�_(;/_:_K:.::-No. of- e-r'prsons............................ Showers ( ) — Cafeteria ( )
a
V V Other d
fixtures --------------------------------------- -------------- ----,- -----------
W ese 'Design'Flow----------------------------------5.5�_gallons per person prday� Total daily flow.------ 35.� --------------------......gallons.
N Septic Tank, Liquidcapacity�47 gallons Length-..IP-�-- Width_s.-_&_:. Diameter--- _... Depth--s'L......
'Disposal;Trench—No. .......I----------- Width---�(o,..5=.--... Total Length...�a-..------- Total leaching area__Z4��,z._sq. ft.
*J.: 1 } Seepage Pit No--------'.....------. Diameter--- Depth below inlet.................... Total leaching area..................sq. ft.
.Z Other Distribution~box,•(-Y)" Dosing tank ( )
Percolation Test Results Pe or' ed b 4:_ � n__ Z '
y� r ----••---• Date__- •.-Z
=��--•-•--•--
Test Pit No. 1._C-..3..m'i lutes p"er Inch Depth of Test Pit----e�D'.....__ Depth to ground water_:------------
.
L4 Test Pit No. 2...N..�_--.....minutes per inch Depth of Test Pit-----1_C7/------- Depth to ground water.....r~..........
Description of Soi ' L--__! �� at.d? �`` `�t '`2� ------------------------------------------•..--------•-•.
.. ................ Y'
V .................--••----•-•---•-----------••-•-----•••..---•------••----------•-•----•••••-------•----•---------•-------•-----••--•-•--•----•--•------•-...---••---•-•--•--•-.
--------------------• -------
U Nature of Repairs or Alterations—Answer when applicable.-.......------- ------ ........................................................................
----••-----------•----------------- -----------------------------------------------------------------•------......----
I.
Agreement. y
The undersigned agrees to install the aforedessribed 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 Compliant as een issued ,y the board of health.
Signed
--- ------ - ---------------------------------------------------------- ------......--------------------:....--
/ e
Application.A '/roved t
Application,Disapproved\for the following reasonr: ---------------------------------------- ....--.... :,... .. ............ ....... ........... --------
...... .... ...... .. ------------------------------------------------------------------------------------------- -------- ------------------- - --
................................................
Permit No
Issued
` --- -- Dare
��__._- _.__,.___`-��.-.._..r._.._c�.-,�--.-Mst-a—�,..-._.�.�.. ..,.-ate _. .,..,.«.►,���..� ._._-_____��.____._�.-...._: .-m-z,....-
i
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TO(ITTWN OF BARNSTABLE
X.Prtifirate of �LII1r plianre
THIS I�,10-4�ER IFY, That t�Individual Sewage Disposal System constructed ( or Repaired ( )
by 4r------ ''---------- -------------------------- .. . - -
at ...... -2...... .f...:�.F. ..�:f...if --Zith
-- --- ---'�-.Ls ,�s¢iurr -` ' ,
has been installed in accordancehe provisions of TITLE o The tate Environmental Code as described in
the application for Disposal Works Construction Permit No. _ y `r ...... dated .-.... ._._..__._7.....___
THE ISSUANCE OF THIS CERTIFICATE,�SHALL N BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE....................4.. ...e �1.."7.�....__._.._----------- --------------- Inspector ----- - ----.--------- ---------...:.....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
.... FEE. ......-•.....
Bisvof al , rkii (go strtuli.art famit
I
Permission is hereby granted.... / , � ..........................................................
to Construct or Re air ( ) an Individual 5ey.age D•sposal S tern /
at No........-- 1�-•• o �-- i ce... .4 2--'�"------- � i�/'"�' ��j-----------
Street p
r
J Q/
as shown on the application for Disposal Works Construction P m it No...._d__.(-0._.-..C.P._-' Dated---- . .�..1�=.�.............
•-._-.._.-.-.•• ---- •.• -•._
,OO Board of Health .
DATE------_------- '- '7... F4..............................
FORM 36508 HOBBS&WARREN.INC..PUBLISHERS
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