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HomeMy WebLinkAbout0100 BREZNER LANE - Health 100 Brezner Lane 230-048 Centerville UPC 12534 ' .2-153LOR /* 095� 'lo.. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: WYes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Rpplication for �Digo!gal �&pgtem Cow6truction Verna Application for a Permit to Construct( ) Repair'N Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. m, Assessor'sMap/parcel too 3c`-q~ r ` f•# Ins�I�r;s Na dregs,Janes Tyle}IoppQ� Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. F)(ja60 t I P Description of Soil Nature of Repairs or Alterations(Answer when applicable) c ao 1 V L O V7 1 y VdLm 4,0,0�� �C) � T_ 1� - yt , uuipw.-Lk mcoo t ,� �ItrU7 Date last inspecte 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 Certificate of Compliance has been issued by this Board of alth. SigA Date O Application Approved by B Date Application Disapproved y: Date for the following reasons Permit No. 1E Date Issued 7 Fee Entered i computer: } THE COMMONWEALTH OF MASSACHUSETTS - n ., PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for Migpogaf *, p5iim Cougtruction Permit Application for a Permit to Construct ) Repair(�� Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components d 11 Location Address or Lot No. 100 Owner's Name,Address,and Tel.No. l�/+ v�L ' a3o-oyti Assessor's Map/Parcel 1005 r - �r'1X1� Installe YfW WW's Name,Addres ,and Tel.N Designer's Name,Address and Tel.No. ' 5 , PO gI-N 0t"D CllX1 'eM/'t"��- ' Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures !" Design Flow(min.required) gpd Design flow provided gpd. 1 Plan Date Number of sheets Revision Date n Title Size of Septic Tank Type of S.A.S. jI ek `j � 1 On O Q Description of Soil r J Nature of Repairs or Alterations(Answer when ap Iicable) n g oo l r O� QJ 0�'1 C. 1� - o � ie-)h "-k a( 1li 0 1 , A,� a ' oQ- o 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 Certificate of Compliance has been issued by this Boa d/ofrHH.alth. Signe( 1 `(i�T,/ !/ I \.-, Date a � pO_ Application Approved by 1 {l��]%�//1 U o �,�! _ ) Date G5 Application Disapproved by: Date for the following reasons Permit No. Date Issued _. THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS 4. 'Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( Upgraded ( ) Abandoned( )by �1 (X 0- Va S On at A Ont, 1) has b en constructed* accordance w with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer k sb^ l Designer - #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as'a guarantee that the system will, 11, '•bsigned. Date / �/� / i� Inspector ———— ———————————————————————-- No. � FeeA� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Iig ont * gtemY Congtruction Permit Permission is hereby granted to Construct ( ) Repair ( Upgrade ( ) Abandon ( ) System located at ( c-*)c> 1C.4 r1QP VA Ms;, 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. Provided: Construction m t be ,ompleted within three years of the date of this qfi�ermt'"- 1 Date r Approved by I TOWN OF BARNSTABLE C' ' LOCATION /00 13re2nerlan SEWAGE #Q'QQS 7 vmLAG Ce 24 e CVII/Q ASSESSOR'S MAP& LOT 24;STALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY �,. �6 `/w5 LEACHING FACILITY: (type) l��ci�lnTA�O iS}14(size) l boo NO.OF BEDROOMS BUILDER OR OWNER �- PERMITDATE: 1Z:1'0-5 COMPLIANCE DATE: � 3 1 LY 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 Feet 4.i �. � �� T � ', ��� � ,�. :c,�. � � -�,✓ � � \ �� .. \ � F�% %`�� Tip 07P' I�X Oro No......................... Fjm$.d....................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a _Q � F �...........O F�f. �c.&).. :Ta__.1..1................................... Appliratiun -fur Uiupuuttl Works, Tunftrnrtiun Vantit Application is hereby made for a Permit to Construct ( ) or Repair ( do Individual Sewage Disposal System at: c (� �jcation-Address �/ or Lot No. L.[...l. ... ..... `. e„d �` � ........................................................ Owty� Ad ss Installer V Address 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 ( ) Qxtures ---------------------•---------------------.. ------------------------------------------------------------------------------------------------------- W Design ow............... ...........................gallons per person per day. Total daily flow............................................gallons. WSepti T, k—Liq 'd capacity------------gallons Length................ Width................ Diameter--.-- .......... Depth.....-...-.....- xDisp sal T ench No. .................... Width--------i----------- Total Length-------------------- Total leaching area......-.------------sq. ft. Seep e i N Dia . .Itafth below inlet.................... Total leaching area......._....-.--sq. ft. Othe z box g ) aPercol tion Test Res er rmed by---------------- ......................................................... Date------..------------------------....... a Te t P t No. 1----------------mi utes per inch Depth of Test Pit...-.--------.--.--- Depth to ground water.__._-_---------- ---- f14 Test t No. 2................minutes per inch Depth of Test Pit.................--- Depth to ground water....------.-_.._----_- P4 -----------------•------------------------------------------------------------------------------------------------------------- --------------------------- ODescription of Soil------------------------------------------------------------------------------------------------------------------ ----------------------------------------------- x U ------------------------------------ ----------------------•-----------------------------••-•----------•---•-----------•••---•-•--------•--•--•--.......-------------------.....------------------------ W ---------------- -------- ------------------------------------------------------------------------------ -- V ure of Repairs or Alterations—Answer when applicable...........% ------- ............... ------- __ 1 1 - -----------V. ----- --- ------------ -------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal Sy in accordance with the provisions of Article XI of the State Sanitary Code Th , dersigned further agrees n t to pace th. sy em in operation until a Certificate of Compliance ha bee s �d o It Sign e -- J - ---------------------- --�---- --------- A lication Approved B Date PP PP Y ... 4Z— ---------------------- ---- -----`----- ------- Application ` ' Date Disapproved for the following reasons: ------------------------------------------------------------------------------------ ----- ------------------------------------------------------------------------•------------------------------•-•---------•-----•---------••--•-----------....----------...--------....._•..--- 3 —-7 Date PermitNo......................................................... Issued--------- -�--------------------------------•------ Date ���___—----------------------->-------- - ,3.. THE COMMONWEALTH OF MASSACHUSETTS � `BOARD OF HEALTH _.1�.©..t..(�N-.... OF .f1K.2..h.1 ---------------------- Appliratiun -fur Bhipuottl Works Cnunntrnrtiun Prrniit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: ..........�..,---- 1 c. 2•aJ ta C =......./ `j.. ................. - j �" Location-Address or Lot No. n ? �F3 'V.�� ,-r----------------------------------- ---------- ........................................................ rr�� Owner, r Address Installer f------Address'• -•- ------- � l Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 1-2 114 Other—Type of Building -_----------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) 04 d /6&er�fixtures ----------------------------------------------------------------------------------------------------------------------------------------------------- W Design Flow............. .............................gallons per person per day. Total daily flow--------------------------------------------gallons. WSept Ta Ik—Li lfid capacity_........_.galions Length..-........... Width................ Diameter................ Depth..______._.... x Dis osaj ench No. ..................•. Widt11....__�........... Total Length.................... Total leaching area...............-----sq. ft. Seep g o..................... Dia ______JDPji�p�th below inlet_______________.___. Total leaching area._.._._________.sq. il. Z Othe� ibut box' ) ` >e�Ing�tok ) aPerAo Test Res -- Per ormed by--------- ------ -----------------------•-------------------------•--•---- Date-•-•-------- Teit No. 1....._.........minutes per inch Depth of Test Pit____________________ Depth to ground water_..-----_--------...___- fX, Teit No. 2________________minutes per inch Depth of Test Pit.................... Depth to ground water--.--.---_------_-..._.. a --------------•-------------••----•-.....---•••-----------------•------....-------------•-•--•---•-.......................................................... 0 Description of Soil----------------- -------------------------------------•------------------------------------------------------------------------------------ ----- --- --------------- x U -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------ --------------------------------------------------------------------------------------------------- ---------------- ' U N-&tpre of Repairs or Alterations—Answer when applicable----------- ......G.'Q.L........r --- S._--_.... .V -t � ` STi `` ----------. . - • -- ' ) ` .- ---- . - -' ............•. /,1 Z r- ------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal Systez in accordance with the provisions of Article XI of the State Sanitary Code T undersigned further agrees not to�)lace tl sy tem in operation until a Certificate of Compliance has be rI'is ed 0d�Qf: e'alt Sign ........----•-•--- -------------••----•--• •.. ...... .................... / Date _. Application Approved By----------- - ­- -- --- ------ ....... ... ....... - ' Date Application Disapproved for the following reasons: ----------•------------------•------------.-----.--••-•-----------------•-•---•------- ••..........-••--------_•--------•---------••----------------------------••••--------••-- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .... ................................O F............. r1........................................... w1rrtifiratr of Twuntplinnrr TH IS CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.......- Installer ,� at---------------=-- ��+�Y—-----------/----' ��!' ..............CIJ�_..._._... ._...... has been installed in accordance with the provisions of Ar 'cl XI of The State San rtary C cle as described in the application for Disposal Works Construction Permit No. �................. dated- c---------------------------------------- THE J / ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................................................................... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD 07 HEALTH l�` J 1.....OF........ .................................................. ..... del/ No. .......... FEE.-2--------------- Die7-0 Permission is hereby grantr;d._ ----------- ........�}-.._..... ------------------------------------------------------------------------------- to Constru t (�) or , .pair ( ) an Individua Sewage Disposal stem , at No. __� c --------- .... D U ! -!tl L '� ------ •-------------- Street as shown on the application for Disposal Works Construction �ermit Dated.. 7 /F--•-/ --•----- - --- ---................................... 7S- Board of H DATE...... -----------------•-----------------------------. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS — a-3 n,;s i -a:)Nv m d vV o7 3-_L`V a - - - --- Z� a3nssr Uw�,a3d 3ido- -SS3a'Q ---a"V l 9-23301{ng --- --— ---- -----ems 77'1177 r 75 '- - --ss3t�oa�r-� _3ywn s,a3�nvs��_, 7-:t ,or-A .L114213d 317VM3S 1