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Home My WebLink About0183 BRAGG'S LANE - Health /Y � _ \ .. / � ! / I .. _ � � / 1 � -..._.._.._.._._._.__.____._,_i O TOWN OF B.ARNSTABLE LOCATION CueAM AS U( Q SEWAGE # VILLAGE 193 BlaO�j r'S ASSESSOR'S MAP & LOT U U-0 INSTALLER'S NAME & PHONE NO. At J3 CgtJ(o ? 7 SEPTIC TANK CAPACITY I Gov LEACHING FACILITY:(type) 60 S JoNE n )ize) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER of a riCF �j5Mw Y\) DATE PERMIT ISSUED: rl ALF-2 DATE .COMPLIANCE ISSUED- 7�F•7 VARIANCE GRANTED: Yes No c� f o r e ASSESSORS MAP N0: No... ?-'YS PARCEL NO. Fms...-2.�'.............. THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH ........... ...................OF.... M1.4. 1p.....---------------------------------.._.............. Appliratiou for Eliivooal 10ork.6 Toostrurtioo ramit Application is hereby made for a Permit to Construct ( ) or Repair (.4.) an Individual Sewage Disposal System at: - .....1.83...!,�/.OPQ.. -du 1t.a a id-•------------ ---------------------------------•---------------------------------------------------------------- - a1�jr .. ,-. eL.o_c ation-Address _ o - t o. ............................................... J.:.................. Owner , Add ess a --•AAA ��c.�.ca.. 3 6--��__`..... ' i-------- Installer Address UType of Building Size Lot............................Sq..feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ...................................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity------------gallons Length................ Width................ Diameter---------------- Depth................ Disposal Trench—\To. .................... 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 tank ( ) '-� Percolation Test Results Performed bY...............................................:.......................... Date....................................... aTest Pit No. 1----------------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_____-_____•_•_-__-_____ P4 --••-•---•-•-------------•--••---•••--•-•---••--•-••---.....•-----------•-----•------•----......-•--......................................................... 0 Description of Soil........................................................................................................................................................................ W ------------------------ --------------- --------------------------------------------•••--•••----•----------------- --------------- ----------------- U Nature of Repairs or Alterations—Answer when applicable.- n.S- ce-..__ "0i�___�iu _cS__4h�e.-_a's................ r-.e e .cArA .---•--------------------------------------------------------------------•--------------------------------------------------------------------------------------------------. Agree nt: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iTT _ . p 5 of the State Sanitary 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........... �?-�et,..)t s� .CeLn- n..----------••------•-•--- ••-?--a.67-•----•-• Date Application Approved By......... .................. —._---------- - ---�•-�"`"'-=^*,��..........................•------ Date Application Disapproved for the following reasons:-----••---------------------------------------------•--------------------------•---------------..............__ ---------------------------------•-------••-----....--------------------------------•--•------------.....-------------•--•-•--••------•-•---•--------•----------•-•-•---••----••----•---------•••------ L Date Permit No........ ` .{ `5 ----------------- Issued....................................................... Date :_. ........._ THE COMMONWEALTH OF MASSACHUSETTS • BOARD OF HEALTH OF.. aC+N qua. 1 ------ .........................I....................... Appliration for Uhipoii al Works Corm ratrtiun Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: IP,3 13P0�ra.. �nci� . lc s?��tG�[�lc� -------------•---------..........._ ---------------- ------ .. --- tt � t"r Location-Address or Lot N b(4 YY a I I r t E, rcq �r>ntic. �[[�axr,r%r rr t -___. ._....---•------••--•-•---------•................... -•-•.....•---•-•-----•...._.......----.......••----------......--•--•. .. �} r r Owner r.l - I( Address l rj oQ 11 C :a b t I C�t1k V4'rt.e.t..t , C.LtP,,, -•-----. ........ Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building -• No. of persons............................ Showers — Cafeteria G" Other fixtures ------------•------------------- . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ xDisposal 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 tank ( ) a Percolation Test Results Performed by------------------------------------ ---------•-•-------------•-----•_.... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit..................__ Depth to ground water_-_____-_-___--_---_---- G%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..................... a •-•-•------•--------••--•-•--•--•••-•-•-------------•----------.._......---•--•----•---•--•--_---•••......................................................... 0 Description of Soil........................................................................................................................................................................ x U -----•••----•••--------------------•----•-----------------------•-•---•--•-•---•••----••-•-•---•-•------•-------.....----••••-••-••-----•-•----------•--------------•---•----•----•--•--•-•-•----------- W ------------------------ --- ---------•--•-•••-•••••-......--•---•-••••-•-••--••••••••-•--•...------------••-•-----------------••-----.....--------------•-•--------- ............................... UNature of Repairs or Alterations—Answer when applicable :`: "In(. -----4..�-5 f►? --rc .................. _ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITHE 7 of the State Sanitary Code—The undersigned •further agrees not to place the system in operation until a Certificate of Compliance has been issued /�)b[y( the board of health. Signed .................. ..�--- •---- ''..._.. ------•. --.... � Datee Application Approved By........a -- "' -------------- Date Application Disapproved for the following reasons---------------••---....--------------------------------•----•------------------•------------------------•------- ----------•--------------------------•---....------------•-•-•---•-----.......--------------------.....--••------------••-------•------•---•••--------•--•-----•--•--------....... ------•-------------- ,, ` . Date PermitNo.......�. 7 r._Y_ .1-------------•-•- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS l011 BOARD OF HEAL TH � s .clau.�X� _"� / ..................................._................................• ..................oFG �.. ........... ? ..... (9rdifiratr of TompliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired�) by---__-•_--__---_A;....h,3------- --------------------------------------------------------------------------------------------------------------------------------------- _------------I nstal ler at. 1... - - ---- has been installed in accordance -t1i the provisions of TITI L 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.___d -"__Y s__3..._. dated...............__--_-.___------_-------___-•-- TFIE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............. ._ ................................ Inspector..... _-_ ...._..... -_---•--•----•--_------ THE COMMONWEALTH OF MASSACHUSETTS UVULA BOARD OF: HE [ALTH. "o._. ._ ....' Disposal Workii Tonstr Uan rrntit Permission is hereby granted.......A.-.6..__... "z: . ......................•......-. to Constructor Repair X) an ndividu Sewage Disposal SysteVi r ---------------•----•-----------•------•--•----------------------•-- at i�0. - _._.... --. reet as shown on the application for Disposal Works Construction Per t Nd�_ - [�5_ Dated.......................................... ----•-•--........ �1 -` . ...-----•---------•-•---•--- of Health DATE............ •-^•-• /.............................. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS