HomeMy WebLinkAbout0007 BRIARWOOD AVENUE - Health 7 Briarwood Avenue
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LOCATION SEWAGE # A
VILLAGE ASSESSOR'S MAP & LOT g R --;-
INSTALLER'S NAME Si PHONE NO.
SEPTIC TANK CAPACITY /OOU r
LEACHING FACILITY:(type) (size) -71
NO. OF BEDROOMS PRIVATE WELL OgP_(IBLIC W��
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: ,
VARIANCE GRANTED: Yes No�
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THE COMMONWEALTH OF MASSACHUSETTS APPROVED
BOARD OF HEALTH Barn .able Conservation Department
TOWN OF BARNSTABLE
Appliratiou for Dirpati al Work,Workg Tonfitrurtila • rv"mit oats
Application is hereby Made for a Permit to Construct ( ) or Repair (, an Individual Sewage Disposal
System at 'i3r'�rcwood.pv�.
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C' `�- y --�-�-n--.... ...Q�-AJ is........................... ---•-
Lo soon \ddress �-- or Lot No.
. -•- � D .41E Ncs
..............
Owner44 y r�ddress
------
Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons__-__-___--________ --_--_. Showers ( ) — Cafeteria ( )
a' Other fixtures __________________________________
W Design Flow________________.?__ _...............gallons per person per day. Total da�'I flow...__.._.....I?3d.................gallons.
WSeptic Tank—Liquid capacityAOPgallons Length--__—K Width-_.:J-f, Diameter................ Depth................
x Disposal Trench—No. ...........ee!�_._• Width..... --------- Total Length.., 7VTotal leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
.4 Percolation Test Results Performed by......... --------------••--•-••---•--•-...._-----•-----••-•-------•------ Date........................................
aTest Pit No. I................minutes per inch Depth of Test Pit---------_.......... Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit_................. Depth to ground water........................
p+' --•-•- •-•.......................••--••---••••-••••••-•-••---••--•--• ••••-•••••------•--•--••--••.........................................................
O Description of Soil---------------0--'< ?-••--..!!;f -'-�--'-'-'n--... - = ........................_' `,
x
•.............. ............................................ --•---•-----------•-----•••••-••-•-------•--•••-•----------------...--•--------••--.-•••••••• •••-••••••••---••.-...-----_..._.
U Nature of Repairs or Alterations—Answer when applicable-.,/_ ! '�-
.._----�iVL •-vrC --___ Td�► .....................:.......
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 ha 'bee iss e y t board of health.
Signed uo/. � :.... ...::: ..... . i ........-....... ...... ..........9 .:......
ce
Application Approved By .......... ..... ... ...... ...... .. ...................... .. .. . .-
Application Disapproved for the following reasons: ................................... . . .................................. .......................................... .........
................................. ..... .............. .......... .. ............ ..............................- - . ................... .............
Permit No. � .. ................- Issued ........ ..... .. ��.... .... e.........
ate
----------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSE17S
BOARD OF HEALTH
TOWN OF BARNSTABLE
(9ertifirate of Comlaliartre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by G�2T�Ln �� C �fs��� U ..-'.rr�1................. ................... .. .. ....--.. ......._.___................................. ...._.................- .._...............
Installer
at ......................................................... 5'V....._....,,. --� 1 -�1v--- -*"��L:...... .... /h is
has been installed in accordance with the provisions of TITLE 55 f Th State Enyi. onmental Code as described in
the application for Disposal Works Construction Permit No. ...�!/... _.�"" � dated ..........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE/C NSTRUIED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.----------------- ....`..h..>...�...�� ---_............. Inspector ......... ............ ...:..................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
No....:.- = FEE........................
i ,a tt1 nrk.5 C onotrutuan Illern it
Permission is hereby granted.....................W,�L C.G.�.._...........'.....- .......- CT!G�)
to Construct ( ) or Repair (--,<) an Individual Sewage Disposal System � \
at No......................................... r-���i�1nJGu_ - Ito,
`s =•••••- '�I�`�!/<
Stree
as shown on the application for Disposal Works Construction Permitr �_� __ D�/t d-----------_...................
+/�.p.......
Board of ealt_h
DATE--------------------��....-•r-•---�-----•Y. ---•---------------••--•
FORM 36508 HOBBS at WARREN.INC..PUBLISHERS
No........- o- F�$..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiott f or Ali►ivasal lVurkii Tottstrfirttun rrrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at
................... ............. __.._._ ..... _.__._.._ , -T ..........................................
Location-Address — or Lot No.
...... ......... •...
Owner r ddress
Installer Address
d Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms------------------_----------------_---Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ----------------------------------
W Design Flow................... .................gallons per person per day. Total daily flow..______.___. -3d_...._._.........gallons.
WSeptic Tank—Liquid capacity,! Pgallons Length-_._F�57. Width---- Diameter................ Depth................
x Disposal Trench—No. ...........Z..... Width-----_7......... Total Lengtli...�.ZT Total leaching area....................sq. ft.
3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit................_... Depth to ground water........................
LT Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a ....•--••.........................••----•-••----•--••-••-•-•---•--••-••••••••••••-••--•----•.......-----------.......................--•--.....-----•--......
0 Description of Soil-------------- ------- C_�1 , ..- S_C !3,..5..o< c .._._:. = -? /rr -• /�
x _
W .....-•-•--•..............•••-----•-----•---••-•••--••-•••-•-------•-•-•---•-----•---•----•-•---••--•----•---•------•--•-----•---•---•......•...----•-•-•-•-••----•. ........•--•--
.--•-----------------•-••------- _.....
UNature of Repairs or Alterations—Answer when applicable. >.L..... %/--.vdti,---
.......... . .....
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-bee y th iss ed� e board of health.
Signed ............:.... .,.�' �.1-.._....... A ,. �.�............... ......... � .. -
Y V ace
Application Approved BY ... ..... ....... . ...... .....:........................... ...... .....-
Application Disapproved for the following reasons: ........................... . .......................... ... . ..........._.......................................
- ................................. ....................................sd".'.R..............--.....-...-.................................................................................1 �/} r.�
'-'') Date
Permit No. ........ .. -5.................... Issued .........�...�a., ..........\ ..............
Assessing As-Built Cards Page 1 of 2 �--
C TOWN OF BARNSTABLE
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LOCATION_3 �►,J SEWAGE dam_'�39
VILLAGE J �iy�S ASSESSOR'S MAP& LOT -a9J
INSTALLER'S NAME& PHONE NO.,Qr, "a i1_ C�r�I,t►" XJFBS�,
SEPTIC TANK CAPACITY /OOU fd/
LEACHING FACILITY:(type)/-vf_,17_t F,� (size) -7/y cAl•-7S
NO.OF BEDROOMS PRIVATE WELL O BLIC_WAT
BUILDER OR OWNER C� Z_41J.SX�*4
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: y 1 - 73
VARIANCE GRANTED: Yes No --1
FR.WT OF Ho.-+:;s
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http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=289091&seq=1 6/13/2016