HomeMy WebLinkAbout0089 BRENTWOOD LANE - Health 89 BRENTWOOD L#NC-
Barnstable
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TOW v O; B RNSTABLE
LOCATIONo'� � ✓dd Lui� SEWAGE # 4 j- ` 7
VILLAGE CJ�, cam, ,� ASSESSOR'S MAP & LOT _U
INSTALLER'S NAME S& PHONE NO. 1 3 cy\� '77 1— I 0`I 0;
SEPTIC TANK CAPACITY l 6d y �� ��av►S
L
LEACHING FACILITY:(type) L-ea.&b. (Size) 1,660 �a tl6h, S
,NO. OF BEDROOMS 3 PRIVATE WELL O PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED: `7-S" 4
DATE COMPLIANCE ISSUED: N 2-A-3 a
VARIANCE GRANTED: Yes No
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No. f..... ® FEED............._
� V11 ) THE COMMONWEALTH OF MASSACHUSETTS
V BOAR® OF HEALTH 9
TOWN OF BARNSTABLE
b� Appliattilan for Uiipnatt1 Vorko Tomitrnrtinn Vamit
�v Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal
Sys at:
.. 3... . .. ..................... .....-- ............................
- - .-•-oc on Address/
_.......••.. ^......•.. ...........�.......................... .ddre so..................••---^.................
caner A�
II -------------•--................._..._..........---......_..__..._......_.......__.
Installer Address
d Type of Building Size Lot____ feet
Dwelling—No. of Bedrooms........ ____________________________Expansion Attic ( ) Garbage Grinder (A/d)
aOther—Type of Buildingf ____,1Gi No. of persons____________________________ Showers ( ) — Cafeteria ( )
d Other fixtures .....................................
�- ------------------------------------------
W Design Flow..............U0.....................gallons per ��er day. Total daily flow...........���Q_....................gallons.
WSeptic Tank—Liquid capacity D.gallons Length_ ________.`.`._ Width_.`r./0___ Diameter_�._y_..__ Depth................
x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No....../--------------Diameter__._._�®..__..__ Depth below inlet..... _........... Total leaching areaa l.....sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed bY-------------------------------------•-----------•-----•---------•......•• Date........................................
-�
Test Pit No. 1._..�_a____minutes per inch Depth of Test Pit______1_3_._..___ Depth to ground water_____Nd NIE
44 Test Pit No. 2................minutes per inch Depth of.Test Pit---:................ Depth to ground water________________________
•---•-•. --- ---------- - -••------- -- -•••--•-••------•-•-•-••-•... --------•••----•-------.....
0 Description of Soil---•J' y( ZZ P',_.....,..... ?�.I y r_��-�- --��L10 .....................................
x / ----- •. r
v •.............•--•--•-••--•••••......-•-•-•---•--•--••---•---•-•-••-•--•••-•-------•••••-•...•--------•-••------------••-•-------•-•-•--•-•----•-•-----•-----•••---••--•-••----••......•--•••-••••••••.
W
----••---------------------------------------------------------------------------------•-----------•-------------------------------------------........................................................
U Nature 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 Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Complianc has bbe�en, issued by the board of health. p
Signed ... t...`''v I. ...`- .......-................ ----rJ -----
N�y I Y o
Application Approved BY - ... ----- - --- ---.. ..- .............. .-......: -- ---... _.. --- - - . .- - - --� U
Application Disapproved for the following reasons: .. .............................. ...---- ........----. --..... .....-----..-.--..--....---------------- ----------- ------
------------- ---------- ----- --------- ---......................................... --------- - Date
----..--...--..-.--
.....--Permit N Issued
o.
Date
No---- r Fps L
_t.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Mira#ion for Uiopooa 1 loorks Tonstrurtion eruti
t Application is hereby made for a Permit to Construct QK) or Repair ( ) an Individual Sewage Disposal
Sys tpm at
oc` n i Address/+_
A`�
//Awn Address
_. .. --• - - `............................•-•--------..---------•- l dC 1 t�L�C J
ddres-------------------------------------------
Type \ Installer Address nn
of Building 3 Size Lot-.__`I_._.(_�- s��.Sq. feet
P Dwelling—No. of Bedrooms-------------------------------------------- Attic ( ) Garbage Grinder (Alv)
1.4 e of Building a Other—T yp g No. of persons____________________________ Showers ( ) — Cafeteria ( )
Other fixtures ....................................
Design Flow..............4Q-----------._._------gallons per er day. Total daily flow----------- J�3;d--------------------gallons.
WW -Y 6"._ Width__`"/O"- Diameter_�.........• Depth................
Septic Tank—Liquid capacity_f�p.(�_gallons Length. .....__-_
x Disposal Trench—No..................... Width......-............. Total Length-------------•...... Total leaching area--------------------sq. ft.
Seepage Pit No------ ------------- Diameter.......ID-------- Depth below inlet.....k........... Total leaching area.�...__....sq. ft.
z Other Distribution box ( ) Dosing tank ( )
IH Percolation Test Results Performed by-------------------------------------------------------------------------- Date------------------
...
Test Pit No. 1....CA----minutes per inch Depth of Test Pit-------1 3_------_ Depth to ground water.. .N�_`!�r__.
(_, Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water-----------------------
- -------------------------------
O Description of Soil---- L�r..._ �3 - ........ —'----Y = r• f __%t
x
W ------------------------------------------------------------------------------------------------------------
------------------- _
U Nature of Repairs or Alterations—Answer when applicable-------------__:___-----_--_ -___ s'• .
--------------------------------•----------------------------------------------•------------------------•-----------------------------•----------------•---------------------------------------------•--
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 been issued by the board of health.
Signed - -= -"- f sip e
Application Approved BY - ° 1 2.i ..........
/�/.Yt
Date
Application Disapproved for the following reasons- -------------------------_--- ---------------------------- ------------------------------------- --------------------
------------------------ - ----------------------------------------------------------------------------------------_- -------------------------------------------------------------------
' � 1 Date
PermitNo. -----t-- ------ --- --.-------------------------_--- � _ Issued' . - - ------------------------------------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Cger#ifirate of Cgottyliance
T I§JS TO CERTIFY, That the Individual Sewage Disposal System constructed ( x) or Repaired ( )
by--- -U-----------------------
Inst let ,,,/
has been installed in accordance with the provisions of TITLE o Thy y8Sx � Environmental Code as described in
the application for Disposal Works Construction Permit.No. .... .................... ................. dated ........._..___._._......._.....__.._..._.__..__
THE ISSUANCE OF THIS CERT)FICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATIS f T� pY.. . ,/]
DATE............................................... �.✓ 1. -------------- Inspector --- U Y
f t
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Q /,- �C TOWN OF BARNSTABLE No.....(................... F ....................._.
Disposal_ rko Tontrudion fermit
Permission is hereby granted v--� --------•-•----•------------------------------------------------------------------•--------•---------............____
to Construct ( )Q or Repair ( )_an Individual Sewage ,isposal System . j
at No.. �° �J� `e= -------------------Gi�4t-�- = �f'' I -
D..o >! -
Streetq/----A v
as shown on the applicati/or Disp sai ti3�orks Construction P Dated ...�
/ --
IBoar�of Health
DATE...........Z....• �• •--••••---•-
FORM 36508 HOODS♦!e WARREN.INC..PURL HERS
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