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Home My WebLink About0050 GLENEAGLE DRIVE - Health (2) 50 Gleneagle A = 191 -162 Centerville SMEAD No.2-153LOR UPC 12534 smead.com • Made In USA Yoe NMS� SFIii9115®SOURCING N1iKWi001KT!!E � ' i No.....73=,!_.i11 Fas.....-..- .Q..r� THE COMMONWEALTH OF MASSACHUSETTS ® BOAR® OF HEALTH OWN OF BARNSTABLE AI ie IT ' l r � , iiivwial Wnr1w Tomitrnrtinn Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ........ � —------------------------------------ ---- -•-•• ... ....................................... .--.•.---•-Locsti--.---\ddress ._.........or.Lot-No:. .......... ...........--............ -•----•-------------------- ----•---------------------- .-...-......................:........... O cr ress Installer Address ype of Building Size Lot_.........................Sq. feet U DwellingNo. of Bedrooms............................................Expansion Attic Garbage Grinder aOther—Type of Building ............................ No. of persons_---__-__--___-__-..__------ Showers ( ) — Cafeteria ( ) a' Other fixtures ---------------------------------- W Design Flow____________________________________________gallons per person per day. Total daily flow----------..................................gallons. WSeptic Tank—Liquid capacity-_------___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..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test.Results Performed by-------- -----•---.....••-•••--------•--------•--------•-------••......... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.--___-_____---.--- Depth to ground water........................ L% Test Pit No. 2................minutes per inch Depth of Test Pit----------.......... Depth to ground water........................ a ------••--••-----------------•------•--•-----•--------••-•---••---..••••--------•---.........................-•---•---•-......-------•----.....--------....-- 0 Description of Soil........................................................................................................................................................................ �4 1 U ---------------•------- ... ----------------------------------------------------------------------------------------------•---------------•------•-•-••-----••-------•----•-----•---••-•-- W ---••-•--------------------------------•---------•....---•---•-------•----------•.........----------------------- ... UNature of Repairs or Alterations—Answer when applicable--------------- --- -- OOO•� ....... ••------------------------------•---•-------------------••-•------------•---------------------------------------------------------.....-----•---------------------------------..............---....----- 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 Complian has been issued by the bo rd of health. Signed ..... . ..l�f , ------- - ------------------------------------ ,,y Dare Application Approved By ------------ .. ......L/e1...:.0 r. ..�........................................ Dace Application Disapproved for the following asonr: Dme Permit No. ............ ... ...-..��..�. - .............. Issued ....................................................... ...... Date �✓'t'-•-..+tom---.•"r^_.-,r"^'�`^�.r"�.i��-'....1•_-.s..---2.-�.s..r.—•-- ✓`�`ti^--:�.,s�ly.•�:Yw'�C+es..-�r�r'"...��.r^"'^.-�Jv.-._...r.r.^'a......t,,:^'..++.�„v_�.='r•d...-+�....�....,.,. _ .r.....�t..rr'. .._. -..�. {(/y�-� Fizz ' THE BOARD AOF LTH F HEALTH, MASSACHUSETTS �) TOWN OF BARNSTABLE ' /Appliration for-Diripniul Wnrk,5 Tomitrurtiun lirrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at, . � �------------------••--•-............. - ........: .._.T�...._...._�_.__......_.:. �� y�,l , Locati Address or Lot No. Or�ev`ncr Gry/_� �)a./7lKdress �� Installer Address L U T,4e of Building Size Lot.................... .....Sq. feet ..� Dwelling— No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) a4 Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 4" Other fixtures ---------------------------------- ------------------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------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..................sq. ft. Z Other Distribution box ( ) Dosing tank (, ) Percolation Test Results Performed b '' Date........................................ - Test Pit No..I................minutes per inch Dept} of Test Pit.................... Depth to ground water................... 44 Test Pit No. 2................minutes per inch Depti?of Test Pit-------------------- Depth to ground water........................ ODescription of Soil........................................................................................................................................................................ Z ........................................................................ . '-----.... ... ........�'. �1...........�a - U Nature of Repairs or Alterations—Answer when applicable............... ------..�d � .��. W11 •-•-•-----•--------•---------------------------------------•------...---------------................----•--•----._...---......--••••-•-••••-••... ...................................................... 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 .. �/a ��w-.. ................... ... . ` ......-"./F V ..f ..........._.. / Date Application Approved BY U .: A ........../.. - ..� _.,, t„,..........._........ .......... n-� s.....�.... /� Date Application Disapproved for the following r asons- .....................----------------------------------------------------------------------------------------------------------------- ... .................. .................................... ........ ..........------ ..... ................................................................................... ............. .......... .................. ...:..... Date PermitNo. ............ ...�...�...r../ . - Issued -------- -----------------------------------I.................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Grapliartre 1, THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by e•-<------ lr -----...----........ ...------------------..---..------.....................................---------- ....................... ` Insr.Jlcr p n at fir' _x s----------------------------------------------------------------------------------------------- :z, r ......... --- .ern has been installed in accordance withJthe provisions of TITLE 5 of The_State Environmental Code as described in the application for Disposal Works Construction Permit No. ..{�. fie_ .�........... dated ................................ ....._..... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. i U DATE....._...........................�. / :. .. Inspector ... f 1.f(:1�- f. �L.... +==U: THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH qq TOWN OF BARNSTABLE Dwposat Works Tonutrurtiun "rrmit Permission is hereby granted-•---------�o? r�..+ w ^�...........................................--------•---••---•-•-•-....-•-•-•---•--. to Construct ( ) or Repair (k) an In lividual Sewage Dis osal/System atNo............ ----- --------- --------------------•----------------------------------•--•---------...- 1;�� street � �� as shown on the application for Disposal Works Construction Permit No. ._._.-:_..�____. Dated--_-__--_��.'.;�-�.."__�-,�� ----.....--•...--•--•----------•t. �"�----------------------------------------•----........... DATE. - ------••--------------------- Board of Health FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS cJ TOWN OF BARNSTABLE LOCATION All SEWAGE # 7,3- .S6,2. . � J l VILLAGE chide ttd- ASSESSOR'S MAP & LOT l �W� INSTALLER'S NAME Gz PHONE NO. SEPTIC TANK CAPACITY p /o0O V B� o� LEACHING FACILITY:(type) e� A' (size) rOGU NO. OF BEDROOMS 3 PRIVATE WELL O PUBLIC WATE BUILDER OR OWNER DATE PERMIT ISSUED: 3 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No C �o use ��` ae V l TOWN OF BARNSTABLE .4 f7. LOCATION &xf_ SEWAGE # VILLAGE -� ASSESSOR'S MAP & LOT 7- INSTALLER'S NAME & PHONE NO. Al SEPTIC TANK CAPACITY ��/GP✓ ,den. t P LEACHING FACILITY:(type) rr- G-c..S (size) ,A writ NO. OF BEDROOMS Z PRIVATE WELL OR PUBLIC WATER Ala t-ce BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No z._ . a �� ._ � (j `� � � a ��, �� ,. �, �- �( z�l ��S /2 — - .