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HomeMy WebLinkAbout0063 FERNBROOK LANE - Health 63 Fernbrook Lane - Centerville A=208-085-019 ;a A-3 nk I 1521/3 ORA 10% P2 i F.Ez...... ..C?.a..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE XpVtiratiun for Bi-nVuiittl Works Tomitrurtiun f rrmit Application j1,Ve�E—I�,ade fqq��r a Pern •t to Construct (V) or Repair ( ) an Individual Sewage Disposal Syst a : �.�i'Atl ��/v ... 3.. � ...... - �; � ....................................................Loc io -ilddress t 1 or Lot No. �_. L ncr Address 1 Installer Address � ype of Building L Size Lot... 0,-.�� Sq. feet U Dwelling— No. of Bedrooms.__.___.___�,____._----------------------Expansion Attic (�� Garbage Grinder ({/U) Other—Type of of persons..................... ( ) ( )_...__. Showers — Cafeteria a' Other fixtures ------------------------------- -- --------------------------------------------------------- ------ -•------------ W Design Flow..............//0...__...._...........gallons per p per day. Total daily flow..._._.��Q....._..___..___..........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 ank ) // aPercolation Test Results Performed by.. .......... .. ...c.__.....__.-------------------------------------- Date--��Cl-. ._Y__._._.._.__.. Test Pit No. 1---`�L.--.minutes er inch Depth of Tes— -------------_ Depth to ground water...� .P P P g'r' Lc, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water..---------------------- ------ O Description of Soil...... - ._.._. x C� ---------------------------------------------------•--------------------------------------------------•--------....---------- 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 TITLE 5 of the State Environmental 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. Signed/ ------------------------------------ ........................................ �e.v� Dace Application Approved By --------- ....... Dace Application Disapproved for the following reasons: ...... .............. .. ................................................. ............:............. .... ........................---- -- .-- --------------........----------------- ---------------------------------.........-- Dare PermitNo. �- f.�-- ------------------------------- Issued ............................. .......................... .... Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' TOWN OF BARNSTABLE Appliratiou for Dhipwial lVorlai Ta' astrur#ivit Famit Application for a Permit to Construct (l/) or Repair ( ) an Individual Sewage Disposal Syst at: T Z f$1�1e' e � .. ---•----•-------••--•----------------•----- .................................. .................... -------•----............-------------•-------...-•-- ',! LoAddress or Lot No. ��''__._...• — 7-------- ---•------- ----- Ot}lner A a1 ' ddress--------------------------------------------------- Installer Address ( i/`� Type of Building 4 Size Lot.... ....................Sq. feet U Dwelling No. of Bedrooms.......... .g— ____________________________Expansion Attic (�✓( Garbage Grinder ({/o) aOther—Type of Building M _-------------_ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Other fixtures ............ -- -------------------- �� W Design Flow..............�✓ ......................gallons per per_sek per day. Total daily flow--------Z/YQ...........................gallons. WSeptic Tank—Liquid capacity _gallons Length................ Width---------------- Diameter._- -_._-_.__ Depth............... x Disposal Trench—No_ ___________________ Width-------------------- Total Length-------------------,Total leachingarea....................s ft. Seepage Pit No.-__--____--..-.-.-- Diameter-------------------- Depth below inlet....................kTotal leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.2`....__., ._°.................................... ......... Date_ /rr� 9. � minutes per inch Depth of Test . it-------------------- Depth to ground water_.__-.._... Test Pit No. 1.._�<:�____ �U/��•= Test Pit No. 2................minutes.per inch ,Depth of Test Pit-_--__.__---___--- Depth to ground water........................ --------------------..................................................................................................................................... DDescription of Soil----- 2_P4---- .�6.W—----------------------------------------------------------------------------------------------------•------------------------- x w UNature of Repairs or Alterations—Answer when applicable----------------------------------------------------------_...__................................ II ..................... 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 been issued by the board of health. Signed -------? r— /---------------------------------- - ........................:------ Dare ApplicationApproved By �2 --- -------------------------------------------------------:........ ..--- ..... ...-.. �. Date Application Disapproved for the following reafonf: ............. .......... . .......................... . ..................... . - - - ----- --------------------- ----------------------------------------------------------------------------------------------------- Date PermitNo. �71....... ------------------------------ Issued ..... ............................... .. . ........... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE VI Qrtifirate of Cantl1tianre / TH SAS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ✓ ) or Repaired by .... ............ ..................................... ( ) � sZ_-t c U L c - ... ... - - ... - - -... ........................ ... lacrdler at .. /- --- -- - -- 1-------�/��............�'P�-�� -----------------------_-------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. -------gL/--- _._ dated .................._------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE .............................................................�"- � Ins ecto .. ----�1 *`:......... ..--------- ...----- ------------- --------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Permission is°hereby granted....:_ __:_..___ �,.�.�C�L�- to Construct ((-/) or Repair ( ) an Individual Sewage Disposal System . ............................................................. at No. ! 3 � t Street as shown on the application for Disposal Works Construction Permit No.A &g---- Dated_-----:_��.__�-�a.'_ - Board of Health DATE Iy------------- FORM 36508 HOBBS a!t WARREN.INC..PUBLISHERS Slt�l-1 FUIP( A- $Et�M� ef 7 Ado , I 5t:i l C TANK 4d cal Sn%' Y'GD Cr?D SEE 1`PL.ArJ atJ Az N1=7ZEdF LOT 23 ISPoSQ PIT �_�.lafld�'A�-�3 STv�I� 51DcVZ&LL -ARW.A -B- 01 MNI I 3cw. ; T DfALVa ,16tJ tV ,A ,. �T�E2�a'�ATtOW OF BAXTM a .o tI aSULLIVAN �" t ' I ' No.1297F. t47 r d -U u�L � M F PuC /N✓ �w✓ a R¢:e 5r�ric .44 °� 44,,E r , r 'i orb a µ/%�,aE�' Au SrQucruszEs sue,- vi TINE ! MOt7E T}14ti1 44 DEEP: , 2o4 f p t . _ J '2 A 6Eon pLOr Lor _. ' ,c�l� U4TI�� PBL l44To EM 1 + GF.l�CI vNbAT*A SN�ur N `NazeaN '�oM'PL`S A , F-l3ers,4l5TAS,g w , 4t�1tao� 49 I aF Q�aT N i l4'TQ O�Gt'E+J'T' � rwftQL d..LC1C+DJG'tS'(4 NuE Et�eSl/:a: S w : N !�v1 40Ul PalpAt7i u! ,i t ._.l.a NHS 11 [p APPLtcANT. 51E f.�Ur�bi�J //, rr I Ex�2uSfY rtlL6s K.c,.,"CI +f' W'+IN`—-, u r } 20 if Rm�$200(._. .. . T , ... k�r, !, 'y�o tl LIi. i \ 9 , � 44 i to F170 J SETS I �I. j i F0I-NIZAn014 , JL Z3 F. � h j q L Y PETER a SULL1VAPt _ tN of No 29733ICHA o A. Q.n. sTeR� ��� - ;BAXTEA a. �s�/OA1AL' V tN� TOWN OF BARNSTABLE LOCATION _Ld Z3 �eet4hrosj LAke SEWAGE # VILLAGE -e�►tC(v��� ASSESSOR'S MAP 6z LOTZ09-09, INSTALLER'S NAME Sz PHONE NO. ,T•,"f, 0k,t5t l 771- (©qO SEPTIC TANK CAPACITY 1,5700 �,lt 11614 S J LEACHING FACILITY:(type) 1.2e1G1n Q (size) (,000 14Iw�S ENO. OF BEDROOMS -! PRIVATE WELL O PUBLIC WATE UILDER OR OWNER (314�s"de 6u',4.(,4 Ca' �71" Ord Qy DATE PERMIT ISSUED: y Z- 1 q DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No Lai z3 75 I } 3S