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HomeMy WebLinkAbout0033 BRACKEN FERN ROAD - Health ay- -j-e",Pv t-�Vn o M- 0 143 f�D I1 / 7 A) V o use 33 TOWN OF BARNSTABLE LOCATIONL -� �,Q �. �N,c//�,J, SEWAGE # VILLAGE 110P.22",r /5�-Zl ' ASSESSOR'S MAP & LOT 0Y3-0o-7•-Oaf _ 1471-,C INSTALLER'S NAME & PHONE NO. 'd��.f" ✓ lyr-u'/0c;v.q SEPTIC TANK CAPACITY �a LEACHING FACILITY:(type) (size) j,®®o c,NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER 74^c-s IT- DATE •�� PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes , No � l 3� l THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH �f 3 -? - $ ------....l..4.s.4v\.................OF...... aPnSic.b ....------------................--•---............-•- Appliration for UiopuoFal Works Tongtrurtion ramit Application is hereby made for a Permit to Construct (Y,) or Repair ( ) an Individual Sewage Disposal System at: ' `S!�_✓.. E?.v, a: .... ... ................... ©-•T.....7..--------•---------...•-----......•....................... . Location-Address or Lot No. _e ----------------------.T�+ ....it.... .chs 1+1--------•-------•-......-------•-- ..........----dt cJzCv!. !'�1...AggR.c........................ Owner Address ..............C7A 1�.��.TT----.. '_ fir'...------.......- 1??�r�.fr!w ..l........................................... Installer Address Type of Building Size Lot.....-16�_(� _._Sq. feet Dwelling—No. of Bedrooms._. m&. Attic (�o) Garbage Grinder WO) A, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Pa Other fixtures -------------------------------------- - W Design Flow.................................5,1-..gallons per person per day. Total daily flow-___._...................._..3ZQ....gallons. WSeptic Tank—Liquid capacity.lb,00.gallons Length... �.t�.._ Width_A-.isJ°.._ Diameter---------------- Depth..r.,__$'. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.__LmR.--------- Diameter.....lb........... Depth below inlet----tm.°......... Total leaching area...9 t 2...sq. ft. Z Other Distribution box ()( ) Dosing tank ( ) Percolation Test Results Performed by..... ;_ire C \ .i.................... ..................... Date___ , ,a/Ft_ .._.._...__.._.. Test Pit No. 1....a-_......minutes per inch Depth of Test Pit------L 2.-...... Depth to ground water...... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water OF��-- -----•--------------------•-----------------•-•--------------------••-----------------.......................................... O Description of Soil..... ?.-Z,_`.7._4.� ....-•-•-----------•------------•...........................................•• STEPHEN .....-•-----•-•.................... Z-`=�Z.�. ` fY11LA�uate!►----5a ...-•-•--•-••------•--------------•------•---....------......-----....-•-- ALLYN W S • WILON' x ...........................................---•--------•----------------•----•-----------•-----•---------------•-----......-------•--------------•-----••------..---- Ma 39225 U Nature of Repairs or Alterations—Answer when applicable................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in c dance with ,J/p 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 f health. Signed ........E� �•1 i j ... . .................. Application Approved By �`� ,... �,5 /`a'---------R,�----�,� � j y�e .. - ce Application Disapproved for the following reasons: -- ----- ---------------------------------------------------- - ----- -- ------------------ --------------------- ..... .................................. ......................................................... ... .................................................................................... ... ........................................ Dace PermitNo. ---------- cl ' .Y e.... ................. Issued ........................................................ ------------ Dare Fim THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH L.c�. ..,................0F...... raa ,bl Appliration for Diipnsal Works Tnnitrnrtiun amit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: Location Address or Lot No. .Ia.,., kC 5v+A;A-In i e/r« J�eCr7 oeGaw - .............................................. .................. Address- Installer Address Q Type of Building Size Lot...... lry__46 y '...Sq. feet Dwelling—No. of Bedrooms.............................................Expansion Attic (/✓o) Garbage Grinder (Alp) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a -- ------------•-------•• .-- •---••----••----- •..... ----.. Design Flow...................................5.�...gallons per person per day. Total daily flow--__.__......_........................................... . ther xtures ___________________ __ W ----------------33o---.gallons; WSeptic Tank—Liquid capacity.MQQ_gallons Length..k tw..... Width_4.:.i�.._ Diameter..:............. Depth.-��__ '.�r__.. x Disposal Trench—No..................... Width..................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit NO._( --------- Diameter.....1�?----__-___- Depth below inlet.....4?_�..._..... Total leaching area.... ft. Z Other Distribution box Dosing tank ( ) aPercolation Test Results Performed by.... .,_ 4?.L....................s--------------------- Date...90� ./ 1 Test Pit No. 1..... -------minutes per inch Depth of Test Pit......0__i�........ Depth to ground water.._....—Fu....._........................ (i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground wa 04 ----•------ ------------••-•---------••---.....--•-••--•-•---.......................__..._....---......_....---•-•----.._.. . ..... .... 0 Description of Soil......0._7".&_.' 1_P 2,_0..r.5 u 6a0!..r..._ ST PHEN-_: $ V 2,_ .�2. ,� =1 i�-�. ''��"�3 '•c,13j'L4 ......ALLYN... WILSON Z; ,TI -•--•---•---•---••----- ••---- - ,�No.30216 1U Nature of Repairs or Alterations—Answer when applicable............................................................. -- ------- ....................••---•----•-•--•-•••---•--------•----•-•---•--••------•-------•-•-•............•-••---•-•-•--••-•-•--••-•---•------..... ......................... r 1-- '• ! ' Agreement: The undersigned agrees to install the.aforedescribed Individual Sewage Disposal System in or ance with-* Of v the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the ev.Z4. 'Y system in operation until a Certificate of Compliance has been issued by the board ,f health. Signed . '-. ----------------------------------------- /� /------ to Application Approved BY ----------- -� ----------- - - 17t-•- e=.. ../..... Application Disapproved for the following reasons' ..................................................... ..... ... --- -- -- .........-----...... . ---..--.. ----- -- - -- -------- -------------------------------------------------------------------------------- ---- --%------------------------------------------------- -- . ---......------------------------------- Date PermitNo. ...........�..�/..-...�..�1f ........................ Issued .---..------............-------------------- . ---- -- Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ----------------- OF --- 1 I /w1 7 r3 GG�.......................--- CEPrttftoate of 01-lontyli.attre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ......................................... ............... --- -- -- --------------------.................----- -- ---- -- _ Installer 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. .....��.�1 l.t,�.�................... dated ...-....-.---..-.-----.-.----------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-- .. .. .......................... .... .. .. ............................... Inspector -.-.---------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................I............... ............................ No.__ t.�l::layl�.... FEE.-- ............. Biiip n1 nrk$ 'wonion ami# Permission is reby grantedean .......................................- � /�� _ ..._ ! 'C/� �.. . .................................•...... to Construct ( or Repair ( Individ Sewage Di os d System at No.. 0 7".,c�. ,C,<C:�7/ 7r�r/ � , f11.+`= ,7 �,��5 /t /4 G J ----•----.....-•....................................................---••--•-•-----•-•-••---•-------•,--......... Street as shown on the application for Disposal Works Construction Permit No.._CO' _/! C_ Dated.......................................... Board of Health DATE...........................----•--------...................................... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS .1 —/oy .-z — —/0V - g..._ .,— - lo5 I- — S/n/4-L� M/L /v3 q \ /oS 7 1 i t E 2ia 79 x /.o z '7�j /oz. 7 /d 7'DTl4L �E�/ �-�/ - . SZ �_P� /03' rr 9 y . 7 y N&Y. o ay.v I 5� � � FG• = /D y O fl. � /d�D ;1�, To,�.rvd- /���.b /DOD BOX /NV GAL, • � it�.Z ,, � 7-.v.vic � o NIE7] y. SraWa9 •: LL ',; /A/, Z. /o/• c.E,G�r�F/EO PG OT �L:4r1/ MIL& 2, STEPHENALL r q WILSON .o No.30216 �GI Eat No wA W P�o�o�t�r} �Fss�o�r a. LC.'7- } / CE.er/�Y Tf/.4T TNE' �our✓�r�o.✓Shia - a y ,t� �L�.! /3� _ �/y �<r_°. �'r:, 1 ,d.VD fET"I//�Gf` ,QE4V/�'EH1�NrS o.� Th'� ,2.EGisrE.2c=�.Garvv.Sli,2� " Tox�.v of /3 ,P�/Sr�U�LC' d�v� �S�.GYfLLc a- iyf�� �oCdr�•v �ti/rH/�Y 7'N.E �L aooPLQ/�. T!l!S Div /.s �/07- 13.4sEp aiv,4,v fiYST,e- f� f�E.2EdN �aT, � o� Ta E.ST�I G/S,y ,Cc�T.z.✓NF� U.S�p Ay' ,ice . �in/�G� �M/L 3 �J7,Qocra-J io3. /03• q 105. 7 r Az USE' /Gby �4-L_ 5, TA,/!c 8 �\ . 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