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HomeMy WebLinkAbout0036 FERNBROOK LANE - Health 36 FERNBROOK LANE Centerville A = 208 - 085 - 011 m S M E A D KEEPING YOU ORGANIZED No. 1253, 2-153LOR OSUSTAINABLE MIN.RECYCLED INIiIATNE CONTENT104'o® GrliliedFiberSourcing POST-CONSUMER my .dproArenorg SR012V0 MADE IN USA GET ORGANIZED AT SMEAD.COM No.Qg)c2 a..-3? r Fee J - THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for jBisposal *pstem Cunstrurtion permit Application for a Permit to Construct( ) Repair(,<pgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. , eP rJ5 y-o%yt- ( Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ®Y/(`j� c\(, �C'b���� t Installer's Name, ,cjdresk,�and Tel Vs,,, �a J 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. Description of Soil Nature of Repairs or Alterations(Answer when applicable) n(,%u_ 5�r-pr-N kc"vt 6 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 Board of ealth. r Signed � _ Date �� 12- Application Approved by Date L Application Disapproved by Date for the following reasons Permit No. 0 (77 —3 Date Issued �.© �� —7 No-,;N C7 -" 0 2-,-' r} � Fee -71- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: e PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS { ftplication for MispoSal 6pstem Construction i3ermit Application for a Permit to Construct( ) Repair(vUpgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. 3 �e �(�r o 6�- NC Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel Installer's Name,A_cjdress,and Tel.N � C Designer's Name,Address,and Tel.No. Scoff` ��.C_%O v 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. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �rQ r•A 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 Board of ealth. Si ed Date lO Iz 77 Application Approved by .(k�- �j YDate"/ a 571 c ... ;..q Application Disapproved by Date for the following reasons Permit No. -7 Date Issued 1© o�� / THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) -at - Cn C%Cl r.u t Uo\,< L yv j_ has been constructed in accordance )) % . with the provisions of Title 5 and the for Disposal System Construction Permit No. -i -�)3 dated Installer` �Gy� (� �f���/� Designer r""~ #bedrooms .�-'' Approved design flow /'� gpd -_ � The issuance of this permit shall not be construed as a guarantee that the systeml will functto as des)iggned-, Date fG�/SU�/ l Inspector x; No. [. F Fee THE COMMONWEALTH OF MASSACHUSETTS - PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS BispoSal 6pstem Construction permit Permission is hereby granted to Construct(, ) Repair L l Upgrade( ) Abandon( ) System located at I D OV` Lz N-( and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. tt - t Date l ( Approved by Y v'" LOCATION SIX E PERMIT 100. VILLAGE 1 ST LER'S E i ADDRESS 11 NE re , BUILDER OR OWNER DATE PERMIT ISSUED' DATE COMPLIANCE ISSUED f i � r.�y vl J 1 .: 2s L O CATION 1 S ENJ" E PERMIT N0. VILLAGE el-A v 1 ST�&)L-[ R'S E i ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED `� c- ce ` . f TOWN OF BARNSTABLE LOCATION Q, r 6e-rmLf;oo I % Lrhe SEWAGE# 0/ 7 7, tyILLAGE CenkC(), , it i� '_ ASSESSOR'S MAP&PARCE 09 9- j INSTALLER'S NAME&PHONE NO. -SCc-3 t'I�,r—A,d� 9 9 00 G, SEPTIC TANK CAPACITY �� LEACHING FACILITY.(type)e)61 (size) NO.OF BEDROOMS OWNER C6 G-o (-3 (: PERMIT DATE: �C�'/�Z S''//7 COMPLIANCE DATE: /® /3 6/J 77 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) Edge of Wetland and Leaching Facility(If any wetlands exist within 300,feet of leaching facility) Feet FURNISHED BY Li � 1 = y( 13 : 4 T �- `�` I 3 2 d07 ! THE COMMONWEALTH OF MASSACHUSETTS ~ BOARD OF HEALTH ...............OF.........6a�............................................................. Appliration for Disposal Works Tontrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at G 3 u.. C.�f. ................... 1 --------.........------....--.:................ Location- dress or Lot No. Q.Fj cG'Z ? ••-- • ......................•---....... - -----•-••---••---•--- a Ow ner Address ................... .. A ............................................................. Installer Address dType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.''_�.'..�.......................................Expansion Attic (�0 Garbage Grinder 04 Other—Type of Building .._.W..D-fl�..._..... No. of persons.........4................ Showers (� — Cafeteria O a+ �J C_ d Other fixtures ---- --•----•----•----------------•......._.............------------. ............................................................. W Design Flow..............E,577..................gallons per person per day. Total daily flow................�27.................gallons. WSeptic Tank—Liquid capacity..._V!%allons Length.....hv...... Width................ Diameter................ Depth_-.._...-..._.. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.._ .L_6 ..sq. ft. Seepage Pit No..................... iameter.................... Depth below inlet.................... Total leaching area...................sq. ft. Z Other Distribution box (� Dosing to 0-4 ( ) } l / Percolation Test Results Performed b ...... 1i� E2... N__ e Date...._._ � Sl..--.._ _ .. Y Y y 9 ..... ,aa Test Pit No. I...L minutes per inch Depth of Test Pit.................... Depth to ground water......11d........ _.. fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ............................................................. O Description of Soil................... .........t-A`....•---.5.,? ..5dz !• PSIS......S. "....--•---•----------------------------•-----•--•--•-----......------•------------•---- 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 ITI M 5 of the State Sanitary Code—The undersigned further agrees not to place the syste in operation until a Certificate of Compliance has been issue. board of health. 5 f �3 ......... ...........• •---- -----------•------•---------------•• ....... ..............._.... 1 - Date ApplicationApproved By............... - ....1, .. ......................................................... - ----•- ---------- ............... Date Application Disapproved for t l wing reasons---------------------------------------------------------------------------------•----•-......--.............---- ......................................................-.................................................................................................................................................. Date 'Permit No....................................................... Issued-....................................................... Date J f" NO,K>.. - .!O FEs............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - ---..-.OF....................................._...--.-....-...... Appltratiun fur Di-.puuul Workri Tunutrnr#tun Fumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ........... ......•. --•--• ...... Location-Address or Lot No. ..-•---•---•--.................................................'..........................-...... --•-•----------•-••-•--------•-•-•-••..........................---•--............................. Owner Address W a -•-.....•...........•................ --•- Installer Address Q Type of Building r Size Lot............................Sq. feet U Dwelling—No. of Bedrooms------ ...............................Expansion Attic ( ) Garbage Grinder ( ` ) aOther—Type of Building _-------------------------- No. of persons--_-----_-:-•.---__-_--_-- Showers ( ) — Cafeteria ( ) QOther fixtures ---------------------------------------------- -•--...-----------------------....------......--------------------------------------...._....-••-•---- W Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length--------_------ Width................ Diameter---.------------ Depth................ 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......................................... Test 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........................ •---•-••---•----------------•-------------•-----.......----•---••---•----•-•---•--•--.........--•-•-......................................................... Descriptionof Soil. .:--••-•---•-------------••--•--•--•-••-------•-----------------------••--------------------•-----------------••--••--•-----•---•-•- x V -•-------------•--------------------------....---•----•--------••---------•--•..._...--------•-------•--••-----------------•--------•-----•-------•-----••---•---•-•--•-•-•••-------•----•----••....... W x -------------------------------------------------------------------------------------------- --------------------------- --------------------------------•-••--------•------•------•-•.._.............-- 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:ITL E 5 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 health. f Si --•-•---•==Date--•-•-•------• Application Approved By-._--_--.-_. Date Application Disapproved for th ing reasons---------------•--•-------------•--------••---•......----------....----------' ---.............---•---•------•-- ................................................. •. ••-----------------------------•----•......... ..----•--•-------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.................................................................................... CInfifiratr of Tontplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by..........................-------------------------------------------------------------------------•-------------------------•--•---•--••----•-•---------------------------------------•------------ Installer at------------------------------------------------------------------------------------------------------•-•----------•-------•--------------------------------------•-----------------•--------------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No----------------------------------------- dated------------------------------------------------ THE IS5 ANCE OF THIS CERTIFICATE SHALL NOT BE CONST AS A GUARANTEE THAT THE SYSTEM /W L 2CTION SATISFACTORY. DATE.. !- ./..................................................... Inspector... ------------------------------------------------------------------ - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF................................. -----•------............................... No...••......••--•......... FEE........................ Uiupoiial Workii Tontrt ion rrnttt Permission is hereby granted------------------------------------------------------------- •-------•----••-•-------------•......_.....................................•--- to Construct ( -) or Repair ( ) an Individual Sewage Disposal System atNo.........-...............................................................--_-----.------------------------------------------------------------------------------ .------------...........---- Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... --•-•-•-•--•--------•-----...--•-•--•--•---------------------------•-•----------••------......----...... Board of Health DATE................................................................................ FORM 1255 A. M. SULKIN, INC., BOSTON ►J•� GA2BAGE (�2iNDER. i �I pA►t .{ �oW 330x1 D% � �9iG.Po +� �I S�PTIG,.rpNK = jl LJ5$•--r,l000 GAS.-. • �I D15Po5n� Pt"t" v5E tvo0 GAt_. ,- ' BOTTOM AREA- • . Sp S.F �I "TOTA 1•-. 17E5►GN ' q-25 G.P D. I i A--TOTAL I j= -ow = 330 �t Z � PE2Go1_ATtON RATE � I'�IN 2MIN opt-E55 / �_ �r i y KA jl -IN�/.ice G S�-,- `� 9 of ALA VY @AXl LFi 'JOIN( l �1, O 3 /.3 I STBt� v sua _ 99� Top FNu=1oo.s T E`�T s�3/B.3 �Y�Y 9 c,j000 EP'<<G l B G°'`-. 9 ill L.EALL1 Ij PIT INV. INY. ,NEo w I T u 9G. z 9G•5� 4 .s�•�a I'�3/q•I%L WsuGD 6'Tu N E /L •it/o�T C f= R.T 1 F 1 G D P►-oT P LA W 8L•G PRUFIL. 1.o C A-r 10 N C��/�;6'�'✓/GG.E No. SGAI.E ScAI-E /"=Gv SATE 91/.3/83 P >`AN REFS26N GE " 'CE i2N GOMPL`f 5 YET N NER.EO A u D o f �C N�- SvIaD/✓/�`;���.�/ o ,�E�i4/iS/��c To W N or- MWK5ZABL-e AND ►S kloT LOCfaTED WITN1 OOD L. IhI DATE 13 63 n FE-i?•V�%34��� i4•��L. G IJ� BAxTEQ.e 1.1`(E INC. � REG l s�E.�6�'I..A►.►D 5 u f�Y E'(oe5 • "(1�15 Pt t.t 15 N oT a n 5 c r� o►d A" o s-r E 2 v l l.Jr - Mi�•5 5 INSTR�M6NT SuQvE`( Fr ? NE DI=F,SE"T5 SUUUL APPL1GArJT f���/A.t/ �AGc� NoT D� U5EDT0 C�trTERl^INE L.-T k-INES � 3b - LOCATION SE E PERMIT NQ. IFf, f j -oel , VI LLACE v 1 S T L.E R'S IIN E i ADDRESS inn Is UILDE R OR OWNER DA T E PERMIT I S S U E D DAT E COMPLIA,NCE ISSUED lr �� I I