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Home My WebLink About0052 GREENBRIER LANE - Health (2) 53 Greenbriar L;aiie West Hyannisport ° A= 268-078-01'6' ° e n ° ° _ = TOWN OF BARRJJNSTABLE LOCATION Gf ,apt at • SEWAGE# VILLAGE AS. ESSOR'S MAP&PARCUAY-Q 7'8 -O/1 INSTALLER'S AME&PHONE NO. ./✓ SEPTIC TANK CAPACITY 6Ob LEACHING FACILITY:(type) (size) NO.OF BEDROOMS c3 OWNER PERMIT DATE: eo COMPLIANCE DATE: t Separation Distance etween the: ' Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on f site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY � r ' 4,3 If � ;v u z a IV N n /6D0 GAL .. T� Ii N �\ Ll cr- 0 m - - 9- - :rf.i�a ✓� r y rr No..........511 ...... FEB....-.'�.i......�............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ��. -- -OF......... S.171�:4-'I6............................... Appliratinn for Uiipunttl Workg Tnnntrnr#inn ramit Application is hereby.made for a Permit to ConstructA__*j,or Repair ( ) an Individual Sewage Disposal System at • 4 I�aaZ ...... ............ ---...--•• - / Location- ddressf onto ti c ................. �x_. ...... . .. ....... O .n Address Installer Address Type of Building � Size Lot - s"d.....Sq. feet U Dwelling—No. of Bedrooms......... Expansion Attic ( . ) Garbage Grinder ( ) Other—Type of Building No of ersons............................ Showers — Cafeteria a' Other fixtures ................................. WDesign Flow...............././ -----------------gallons per person per day. Total daily flow............... ...............gallons. WSeptic Tank—Liquid capacitye.10�.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....0,jes�-sq. ft. Other Distribution.box (41 Dosing tank aPercolation Test Results Performed by....... �4t............. Date.... fir.. .__.. Test Pit No. I------ ...minutes per inch Depth of Te Pit.__f_.�......___ Depth to ground water:._____.��.._. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ---------------- ......... ----... ............ ............................................................ O Description of Soil............... . d0 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 Sanitary Code The undersigned her agrees not to place the system in operation until a Certificate of Compliance has been iss d by t e ar o Iealth. l] ��1:�`""f- �� Date c � A lication Approved B ..:.. ..__ ' l'.... . . .. _:�.. _J -It- ' PP PP Y ---•--......_..Date••....•. Application Disapproved for the following reasons:............................................................................ �...._. .........................................................................•-•-------•-•--•--•---------•-----••••••••••-•-••••--------------•-----•--------.............................................. Date PermitNo...........................-----•--------................ Issued-..................- ...•--••-••-- - Dazee .............. No......... .'... Fus..:......................... THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH ..__....... f17.......OF....... � . Y'i! I.S .11e Appliration for Piupuual Works Tonstrnrtiun In it Application is hereby made foi=a.-Pe mit to Construct,6 or Repair ( ) an Individual Sewage Disposal System at: ..... ! " r.'. ' ..� ' . >..j ..l l fi" _ ri 1.° --•-••-•-----•-- d............................................. Location- ddressd �^ orr�Lot No:, /�/J..... p� /�v�..��Ll.....� �i2��Y✓I�/�. O n rp y► Address W , `: -!�'_• = ••• l�/�' 6�.! .... .....................................:�..... _. ........................................ Installer Address Uz .Type of Building Size Size Lot.. .. .::... .:.......Sq. feet a Dwelling—No. of Bedrooms..... _/-, ...................Expansion Attic ( ) &rbage Grinder ( ) a 'Other—Type of Building ........ ::.....•.......... No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures -------------------- --------------•----------------------------------------------•----------------------------- ••------------------- W Design Flow............... � 1 ........... per person per day. Total dai y flow._....._....... ................gallons. WSeptic Tank—Liquid*capacity#.�'l4?0.gallons -Length......... Width... Diameter................ Depth................ x Disposal Trench—No...................... Width......>........... Total Length.._........,.�. _... Total leaching area.........._.:.....sq. ft. Seepage Pit No....._�':..:_...... Diameter.__ j►..._..._. Depth below inlet....e-e._. ..... Total leaching area... .sq. ft. Z Other Distribution box ( ") Dosing tank ( ) f a Percolation Test Result Performed by...... !� :""r%�4e1_Ce._.e-"'I ........... Date---' �`.. ............. .37 =.:-... Test Pit No. 1................minutes per inch Depth of Teo Pit.. ! ....___.. Depth to ground water.......... fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ xDescription of Soil....... ®=% .. �,�T"� U .............. .............•----------- ..'` ! .r�' J;� ' `''±l" y¢r ''"�"` ........ ....................... ... ...— — ..::..— ................................................ " ~-----------'�t'? 'S'�°�------.. ' -•- ------------- ---------------------------- ------------.--------- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -----------------------------------------------------------------------•-•-•••-•---........••.-•-•------------••••-••••-••••----•-•-•---------•--•----- ............................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with !•1T l•1:^ the provisions of l� : ,:, 5 of the State Sanitary Code The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss ed by t e boar of�ealth. d. --•---. ''� �_r/ - / t A... •--•-•... r.---........_.._. Date Application Approved By-- • r .. _...G - 1"' 'Z,f' s"- V. Date Application Disapproved for the following reasons-------------------------------------------------------------------------------------•••---•--•--••••......••••- ...............•-•••••--••---•-•--•---•-•••--••••------•-•-•••-•-•----•-----•-=-=•---••-•-•-----•----••--•-•----•------•---•-------•-------•--•-••-••-•---•--•------ ................................... Date PermitNo......................................................... Issued.......................................................J Date THE COMMONWEALTH OF MASSACHUSETTS BOARD` OF HEALTH Trrtif irate of Tuntp6ftt' rr THIS IS TO CER�[FY, That the Individual Sewage Disposal System constructed (error.Repaired ( ) by----------•••-------•-_- 2' ..................................... t * ✓r C 1� s / `� t/ Inst3kter �rl(' fr!/r P/ f ,• �i° IrJrrl.at .................... /,' = ---- ------------ .. has been installed in accordance with the provisions of 5 of The State unitary as described in the application for Disposal Works Construction Permit'°�' '{ ................ dated.... ---_ ,...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. t DATE.... . t......................................................................... Inspector°'............................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ae ._........ pp .............. ..........OF..........,.........:.. ==�1.. ............. N .�....... FEE........................ Disposal ur Tunutrwtiun rrutit Permission is hereby granted........ ��'r1 "C ._...�, ' ............................................................... ---------- - to Construct ,(-V)-Or l epaaiir ( n Individ i Sewage Disposal Syst� e �/ at No....................... ..✓=./1._ / �ih Street ' / -....... as shown on a application for Disposal Works Construction it N f....:.: ..._ _ Date :: ._..: ' "' ."'.... ....................... Board of Health DATE.... •-- ----'-....2--`r! .j��. �------- ,- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS '