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Home My WebLink About0017 GLENWOOD AVENUE - Health 17 Glenwood Avenue Centerville A = 190 124 ¢_ i UPC 12534 ' No.2 53LO HASTINGS,MN THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' TOWN OF BARNSTABLE Ter#ificttte of C ontyliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by .. r at _... ......... - /`t ` � lofi`i ....- .0-..""+ -------------...._..--.�`�--�`'�r-------------------------------------------- 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. ..... .. 6 dated ----------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS RUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION . - S7ATISFACOY... Inspect rDATE ..6 .... is%J i I t!f 4 ?, � 1 _ J Ape- ASSPSSORS MAP NO•. e.�r—C, 1W PARCEL NO: FEE.... 0.............. r. THE COMMONWEALTH OF MASSACHUSETTS.✓�' 2 BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiutt for Utti—pa tl Wor1w Tomitrurtiuu Urratit Application is hereby made for a Permit to Construct ( ) or Repair (tP an Individual Sewage Disposal System at: ..... ---------------- . ,44- Loc t�ion-Address or Jot No. 1 s l vv SsC(n ....................................... O er ( ^ , 2 Address W tl f{f 1 J �ir��` •.......... ---------•-------.•--••.........................•• Installer Address d Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms________________•_.-__-_._-__--.__-..-_.--_Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of -Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 44 Other fixtures ------------------------------ - - W Design Flow........... ...................gallons per-person per day. Total daily flow.- .........................gallons. R; Septic Tank Liquid caacity_p p (000galIons Length--. ..... WidthS5........- Diameter.---_-.----_--- Depth---------------- Disposal Trench— N . .................... Width-------------------- Total Length._-_-_•_—-.._-__ Total leaching area....................sq. ft. Seepage Pit No........ ............ Diameter----1,d_1......... Depth below inlet---- Total leaching area..................sq; ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by--------------------------------------------------------------------------- Date........................................ a Test Pit No. 1----------------minutes per inch Depth of Test Pit.--_-----_________ Depth to gr wator......t.... . Gz, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water......--_.....,.,.. --------------PARC._` - \ � " ODescription of Soil............................................................................................................................. �I .. ••-----•------------ ---------------------------------------------- ----------------------------------------------- ----------------- - / ............ ....... ... U Nature of Repair or Alterations—Answer when a plicable._-.. �a"�{ 6000e �✓`, �, 1 +�, -------------r --------- ..........•-- 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 Com fiance has been issued by t e board of aft Signed . . ............................ .................................. Date Application.Approved By ---------- '�- �...-.9v��. Application Disapproved for the following reasons: ...._......_...................__------...._...._._--------- --------------------------------------------..........---..........-..------------------...._._..........----_......_.....--------------------............--------------------------------------- ------------------------------------ Date Permit No. .....�Is-----16.6--- ----------------------- Issued -------------5.•-... J Date_ tom- No.. -�hS -' ! a _ FIms.......��- e.?............. THE COMMONWEALTH OF MASSACHUSETTS.✓'� �+ �'76— 7� BOARD OF HEALTHY ea? 4 TOWN OF BARNSTABLE Appliratilan for Dia5pw l Workii Towitrnrtiun Primit Application is hereby made for a Permit to Construct ( ) or Repair (1C) an Individual Sewage Disposal System at ................... ...... -•--------•---- - ------------------------------------------------------- Location-Address � or Lot No. _...._.. .. t =� - y — Owner Address Installer Address UType of Building ; tf Size Lot............................Sq. feet Dwelling—No. of Bedrooms------------------------------------"" -__} xpansion Attic- Garbage Grinder ( ) .' a Other—Type of Building ............................ No. of persons.....__...._I............. Showers ( ) — Cafeteria ( ) .,.a Other fixtures . ------------------------ ------------------------------------------------------------- W Design Flow......... +.��.....................gallons per person per day. Total daily flow._,, -?.(- _-___.____.___------•---_gallons. WSeptic Tank-Liquid capacity-I(() gallons Length---�.------ Width_.__...------- Diameter..-------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.---------_......... Total leaching area....................sq. ft. Seepage Pit No-------/.......... Diameter----4_;_�.._------ Depth below inlet...V'......... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date....................................... Test Pit No. 1----------------minutes per inch Depth of Test Pit___-..--.-_---.___ Depth to ground water-..-_.-._.._-____._--.-. (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_--_.-..-__.__.-.___--. a •--•----•--•----•-----....-•--------•---....•-•--•••••---•••---•-----•--•---•---•--•......-••--------•--------------•-------------•-••-••------...------.... Descriptionof Soil..........................................---------------•------••---------------------.-------•------•----•••••-•••-------------------•-----•-----------•------..-•-•• x w --•----------------------------------•------------•--.._.............................................................................................................................................. V• Nature of Repairs or,Alterations—Answer when applicable,_._ '�.`._L'41_f....oon___S_nT ---- = ----- ----•--- -------- - - --------- --------- --------- 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 - -... -------------- .-..... .. . Dace Application Approved By ----------- _........ - -..... 1 .,7.2.5....... Dace Application Disapproved for the following rearons- -------------------------------------------------.............._...------_----------.-..._.. ...................... ..._-----------------------------------------------------------------------...............-------------------------------------------..........----------------------------.........._.------- ----------............................ Date -Vo)-.J�.......................... Issued ��..—. Permit No. --- -.- - ..�.f�... . ------------------ Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE U ertifi atr of TIImpliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (SG) by ...........................- -� ,_ �..: .....: <:. , .%( -- --------------------- -------......------ / -7 / i m.,tauet - .... - ------- at ............. \ /• l.----..1 ./'7"..... ...'`�...r....z- � r��------ -----...._.. '-G'" ;;;— 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. .._-... ."`.... _ __.. dated . .........- ----------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 4-11 DATE---- ��K-- -------------------------------- Inspect r - - v THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEE_ ... ...... Rapooa1 Workii Tomitrurtion Vamit Permission is hereby granted------------C �� C `r ' '�r`j?/i -----------------------------------------------•---.... to Construct ( ) or Repair) an Individual Sewage Disposal System Street _ q� T 7. as shown on the application for Disposal Works Construction Permit Not_ ._-.�` /:�__ __ Dated_.�.�_ ..�25.._._._.... -----------------------� Board of Health DATE. •- ------- FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS TOWN OF BARNSTABLE LOCATION / -,07 twn a D SEWAGE # � VILLAGE � �� v/�y�'� ASSESSOR'S MAP & LOT/7tl w/ ,-- INSTALLER'S NAME & PHONE NO. �- SEPTIC TANK CAPACITY 4-04L iv gvv- LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: ^�� •�', DATE COMPLIANCE ISSUED: VARIANCE:GRANTEO ,Y— No i 3 � �A�K �� 7� � ��- -- -- �: j9 gas �.p �� r