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Home My WebLink About0071 HICKORY HILL CIRCLE - Health 71 Hickory Hill, Circle Osterville A= 120-069 C 0 I LOCATION S EVV A G E PER FAIT NO. VILLAGE + � � � �� INST LLER'S NAME 8 AD INESS cot oe. OC. BUILD 0 OR OWN ER DATE PERMIT ISSUED DATE C0MPLIAWCE ISSUED n eN No.,,........... ..... THE COMMONWEALTH OF MASSACHUSETTS BOAR®- OF HEALTH .........................Town.....0F...Barnstable....------------------------------..................-- Apptiration for Disposal Works Ton rurtion rumit Application is_hereby made for a Permit to Construct ( ) or Repair ( x) an Individual Sewage Disposal System at: „-,71 Hckory..Hll,.Circle • ............... ......................•-•...........--------------.............._.._._._..--------.............•-- Location-Address O$to rvi l le or Lot No. ---•Robert Haugen..:.:..............................•••--••-=-•----••_... ........_....-----...-••----...............-•-•--•••-•-------......................._._.._---•--•- wnerAddress.............. ........... W Joseph P. Macomber .. Son Inc . Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............. No. of ersons....._............_..__.__.. Showers — Cafeteria P4 yP g --------------- P ( ) ( ) 0.� Other fixtures -----_.-.._-_-•---------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ I 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........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------------------------------- .......................... ............. -•---------- •----•--•--•-------- -------- •-•-----••-•---•---------••_-__........ .... 0 Description of Soil..........sand---&..gXail_e_�.------•-----------------------------------------------------------------•----••-•---•-----•-------------.._..........---- x U W ------- -- UNature of Repairs or Alterations—Answer when applicable..p.U111ri 'p1ts...and__ a.cking... heEtl.......... -----------------------in---&tone--•-•-------.,---•--•------••--------------------------------------•------•--------------••------------------•------......._...••---.....-••••......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI:LE 5 of the State Sanitary de—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has 44 en issued by the War of, ealth. Si 'e d-y►1 Date Application Approved By_ . .....0 �' ........................................ 1, Date Application Disapproved for the following reasons--------------------------••••--•-----------•--------••----••------•--•--------------------------------........_ � �� Date PermitNo......................................................... Issued_--•--- ------....................................... Date No....................... ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............. .... ....Town......OF...;W�PSI'-I ab. e ...................................................... Appliration for Disposal Works Tonstrurtion "truth V Application is hereby made for a Permit to Construct or Repair x) an Individual Sewage Disposal System at: 71 Hickory Hill Circle . .....................................................!....................................... .................................................................................................. Location-Address or Lot No. ........................................................ ........Os.tei- Illi.................I......................................;..... .......................... OM&ner & Son Inc Address Joseph P. Mac. er ...............Joseph .................................................................................................. Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder Pk Other—Type of Building ............................ No. of persons............................ Showers Cafeteria P4 Other fixtures ............................................. .......... ................. ............................................................. Design Flow............................................gallons per person per day. Total daily flow.............................................gallons. P4 Septic Tank—Liquid capacity...I.........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. f t. 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........................ Test Pit No.'2................Ininutes per inch Depth of Test Pit.................... Depth to ground'-watu........................ ............................................................................................................................................................... 0 Description of Soil.........Sand.A..9iralbal..................................... ................................I.......................................... W ..................................................................................................................................................... I.........................I...................... .............................................................. ................................................................................... �1 .............................*------------------------ U Nature of Repairs or Alterations�Answer when applicable_pulling��Pkts...and..Paakina...th=,........ ........................ ......................... ................................................................................... ....................... ........... ...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the p 68visions of T!TLIE, 5 of.the State Samtary,.C�?de—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ee0issued by the�b%/,P;alt,� • 4) S, , ........................................................ I/ Pr Date s. Application Approved By....' J. . . ........ ..... ...:!=....................7 ........................................ Date Application Disapproved for the followingreasons..................... ................................................................................... . ......................................................................I......................................................................................................................---------- Date PermitNo...................................................... issued.."..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH table Tom OF Barns ................. .. .......I.....................i........................................................ %Tprtifirate of T�utpliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal. System constructed or Repaired (X by......_..Joseph_.P......M...a..c.o..mber..&.......S......o.....nl..e Inc' 1 . ...I.....e..... ..e.... ...................................................................................................................H....a...u...g...e..n... ............................... at.1 . Hckqry QStrVf . .has been instilled in accordance with the provisions of-T 'Pq' 5 of The State Sanitary Code as described in the application for Disposal Works Construction; 'Perffiit NoT 3-,l•F (_11?z.... .. ..... ---------------- dated_..j0_,/ 7!7j............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..... .............................................. Inspector--------; --------- ----------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town OF BArns,,WbIO ................... ..................................................................................... $5.00 .................. FEE........................ Disposal Works Tonstrurtw- tt rrmit jostph P. Macomber & $on 910. Permission is hereby grand__._. to Con t et r Rem )Cti ic vidua�letaM* Sal System Ali ; d , e� s e Ne at No.._ �id)Oory Haugen .......................................................................................................................................................................................... Street as shown on the application for Disposal Works Construction W.VerV o... -L)r J ted.... .............. eU14- -- ---------------------- DATE.... Board of Health Y----------------------------------------------- f 7 FORM 1255„ HOBBS & WARREN, INC., PUBLISHERS 10 CAT 1O.NHJC�br_V SAGE PERMIT NO. CKAI V VILLAGE INST LLER'S NAME & ADDRESS can hC. u. B U I L D I R OR OWN ER DATE PERMIT ISSY E D 2 DAT E COMPLIANCE ISSUED _i.�C�� i -