HomeMy WebLinkAbout0148 BRACKEN FERN ROAD - Health ���` - Do?� I`1o�x-5�.5 YY���S
��
r
UA TOWN OF BARNSTABLE
LOCATION Gaj LiT SEWAGE #
VILLAGE �i9✓,r{xj 6 �i/�S ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY 11 GCO
j LEACHING FACILITY:(type) (size) r, oao
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER ,,,�� ;
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
3r 9 c(tc., ,�.,l
N 2
ti
r.
�g �No.-. s..
F= --� Fim . J..................
THE COMMONWEALTH OF MASSACHUSETTS Z
BOAR® OF HEALTH
... c. e7...............OF.....04--CilsAnk,64........................................................
ApplirFatinn for %gpos al Works Tonstrnrtiun ramit
Application is hereby made for a Permit to Construct (K) or Repair ( ) an Individual Sewage Disposal
System at:
Location-Address or Lot No.
......................_... CAW.P.0...K...5vlrL_�'%................................. ........4g.. .� �....)CEr..n...dzQ r... ...................
Owner Address
a .� r� icy / r.�� -e6r�s a g...................................................
------•. ......••------•---•-----• ---••-.......--•....... .••••.
Installer Address
U Type of Building Size Lot....
1.,�. .......Sq. feet
Dwelling—No. of Bedrooms...."lhr.c ........................Expansion Attic (A/'o) Garbage Grinder
Other—T e of Building No. of persons............................ Showers — Cafeteria
Q' Other fixtures ---•--......-••••-•--•••--••••-• -
W Design Flow...................................: _gallons per person per day. Total daily flow------------------------- O........gallons.
WSeptic Tank—Liquid capacity.1.06 1.gallons Length Diameter-"__—_._. Depth. �-R
x Disposal Trench—No. .................... Width_...e__..._._._._.. Total Length_______._..o....... Total leachingarea___. ._....s . ft.
Seepage Pit No....c>rj,,...... Diameter......1.6._._..... Depth below inlet.....4P...........
Total leaching area...... °.f^-....sq. ft.
Other Distribution box (`)r,) Dosing tank ( )
Percolation Test Results Performed b fix. rsc�.S�A.................................... (3f L5/8'�
Y Date
Test Pit No. 1......Z.......minutes per inch Depth of Test Pit-----f........... Depth to ground water------t_._.....__...
(z, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground wat CFAr.-
---•------------------------------••------......-----•--....---.....------------•---•-....--•--••............................. .............
0 Description of Soil....O.:n iJ�s411.----•----------•---------•-------•-------------•----•-......-••--•--•---• �ALLYN N gG
�eNsl... ---------------••-••
U
W WILSON
x ••--••••••-•----------------••---••-...•-----........-•••••-------------•-------•-----•-•-••••••••-•-...•-••--••---....-----•••-------••-------•---••......-•-•••••••• NS:3021� "
V Nature of Repairs or Alterations—Answer when applicable.................................................................. -
--•- •--•-•-••--••••••••••••--•----•••••••-•••--•••---•••-•---•-•---•--••---•••---•....--•--•--••••••••••••••••••••••------•••---•--•••----•-••. ........................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in ccordance with
the provisions of TITLE 5 of the State Environmental Code The undersigned further agrees not to place the "'A07
system in operation until a Certificate of Compliance has een issued by the board of health
Signed _................ ..-------------- ------ ------- -----� ......
Date
Application Approved By ... -•.�--�. - -i)05�..,-� roA �+ e
- .7V
Application Disapproved for the following reasons- ----------------------------------------------------------------- --------------------------------------
..................... .............I......I...........................
........------.--....... ...................................
--................ --...................---................------------------........------------------------------------------ --------------------------------
*.......
Uate
Permit No. ..�j- �-S�
------------------------------------- Issued ...-------...--------------------------------------------..---------
Daze
No... :.�7. F>m.... '.......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........ ca+...,.................OF......
d....F..J..G......
Appliration for Disposal Works Tonstruriion Pprutit
Application is hereby made for a Permit to Construct (A) or Repair ( ) an Individual Sewage Disposal
System at:
..... _.. ----------------�'.���v ........ 0.17--Z-------------------------•...................-•-•-•---•------------
----------------------------- -------------
Location-Address or Lot No.
......................»...�lf.�t?'..p:�.._l ._. l Lla f !!. rC' !?--- QL................................._.....
Owner Address
Installer Address
Q Type of Building Size Lot.... .......Sq. feet
Dwelling—No. of Bedrooms...___l E'�ni;��........................Expansion Attic (Alo) Garbage Grinder (AA
`4 Other—T e of Building No. of persons............................ Showers — Cafeteria
Other fixtures ........................................-•••--•-• .....
Design Flow...................................:V.'-5.gallons per person per day. Total daily flow.......................3.a4?........gallons.
WSeptic Tank—Liquid*capacity.1060.gallons Length_5'_4_._._ Width--•-..--.j(5.,. Diameter_----....... Depth.5.--!!.....
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No._-,n-rue------- Diameter......k.0........ Depth below inlet......''_®..`......... Total leaching area..°4+7...sq. ft.
Z Other Distribution box (7C) Dosing tank ( )
Percolation Test Results Performed b ..._ ..............:-_-_._._-_-__.___ Date...
.�_'_�?
Test Pit No. 1------- ------minutes per inch Depth of Test Pit......_`�l_-.......... Depth to ground water_____________
f= Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground _--water_
---------------------------------------.................................................................................... ....
Description of Soil_._-b.��'-----1 > -;_.�aao'_,r -���__..._- ---5tEMEN
V --------•....•---•----------------A�.- .....fit :_.5 ryNr�°....------......-•---------•-•-•--•----•-•---•-•--------•----••-• ALLYN
WILSAN
--------------------------------------------------------------------------------------------------------------------------------------------------•••••••••.........---•-•. 1io' It2T6�Q c�i
V Nature of Repairs or Alterations—Answer when applicable.--------------------------------------------------------------------- a .......
---• -------•......-----•--•.............: .•-•----------••-•-------------•--•-•--.......---......--•--------•------------•-•--•-•----•-•-•---...---•-•-••--•-•--------••-•--•- -AV
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in ac ord ce wit 'Cesov&_
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the ��•�•r�
system in operation until a Certificate of Compliance has.been issued by the board of health.
Signed
f .................-�. - -- -- ----------------------------------------
A >f1/D�ace
N`
-
Plication APProved BYP ..... ' ----�-cf
Dare
Application Disapproved for the following reasons: ................................. ......................... ..... .....-.....................................................
-
----------------------------------------------------------------------- ---------- -- ---- ------------- --- - ----------------------------------------------- .............................. ----------------------------------------
•.- Dace
Permit No. --------- -� & ................ Issued ..........................................................
----------
Dace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
- •rs,�'.............. OF -----` '"' � . . --- --- ----
Certifirate of C�omytinure
THIS IS TO CERTIFY, That the Indivldual Sewage Dis sal Sy_tem)ccrost -ted ,or Rep Ired ( )r
�,.� \
by ......... r -- .............. /l.f' -
Installer
t
has been installed in accordance with the provisions of TITLE 5 oj=cT-he State Environmental Code as described in
the application for Disposal Works Construction Permit No. ........ '�------- dated ................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
IA L� r e {.ply __/'
DATE.--------........................5pe C&
-------------...... Inspector ....................�................... ......................................
- ---...--------............ ---
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No.... FEE ..
Disposal, or_ko Tonutr ' n ami .�
Permission is eby granted.------ � - ------_----....................._ ............................
..........
or Repair arir
to Construct ( dividual Sewage Disposal Sy em [:
at No, 07"..f' t _ .r!. c`9iC-` `� 'i� � r = /l, %�,jd ------------------------------------------------------
Street
as shown on the application for Disposal Works Construction Permit `? Dated_._.
-----•-------- _- - --•-- ----------------
DATE _
� Board of Health
---- ----------'�••---•-••------ -----•---------..........................
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
{
-i t I r i ' r - r t .i •.t � ..j
_CUES/G/V 0.47".4
,c'?p try/ /lcn�X 3 = 3 3D G,P/,�, ��oce I
Usk /cea 6.44 . 5.TAAAe- o •c sp4 cr
f�/5fzr5. P1r--uf�T&) /coo �4L,L IPir
SipEWvtL, .4 z /7g
�at/ •�Z G /'� � ' o
3
•Tara oEs✓ y .�o. , . � �, �y
7b72V-.D4/4- Low = 330
or _ yg
"
STEPHE �G �o OF
RIC►ARD
ALLYN cis A.
., FTER
WILSON y No.24®48At
.�No.36216 o �' s✓
STE
s�0 l
WILSa�/- C-r/G 6 , U /n/Sr4LL_�G G,2/S S-_-_...
O 7-0 Wlr/fi^/ OF
.�
KL.� s I /.ii✓. ��.U
i - 8oX /.v✓. Gam-. f� �•
GEACk . g p 82, s�'PryG �'2
•�
,, �� �' �?7 G'.E.2T/F/EO PGOT PL4�✓
M*2�:-/2/4L TO PC- 30
�E�rovEp Foe/o' •• pl.�t:S/ .�FE,2E.Vc�
3
%w ,e o w,�r�,e pry s ,. l�T-.. L17
./ C�.er/,C•y T//.4T TNT' FoJ�/o,4rya/SHaW.c/ ��.4+✓�_ ��8 �6.' �7
,2 �•'r(/j��
.4iV4.��'y°'Y�AGI% .e�dlJ/�'�'NI�i�ir..S. O.c Th'� /�C�2E6isr�.ec=O.l-�Lvo.Sli,2riEYo,Ps
Tossiv oF�A2✓y.�B�E Avw /,.S it/or-
�OC.cr.Eco Ft//Tf1/�/ 7;v,-a �Le�dooLQ/1V, t
• i i 4/t�,
.
• •sh�cY.�/yE.C'Eoit/,s.�v'avGO r�
r • . . . � To E.S.T.�G/Sy,CoT..G/N y�T� USEo