HomeMy WebLinkAbout0024 GLENWOOD AVENUE - Health 24 Glenwood Ave. , Centerville
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No. 42101/3 ORA
ESSELTE
10%
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No. ^ Feet-
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS
01ppYtcation for Diopooal *pztem Com5truction j3ermtt
Application is hereby made for a Permit to Construct( )or Repair(✓)an On-site Sewage Disposal System at:
Location Address or Lot No. / A/DOGJ�� Owner's Name Address and Tel.No.
Assessor's Map/Parcel Cee
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
, vl'�alofflGa � 77/-939l
Type of Building:
Dwelling No.of Bedrooms `� Garbage Grinder(_1W
Other Type of Building :_ eW e No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow Ile gallons per day. Calculated daily flow 331?1 gallons.
Plan Date Number of sheets Revision Date
Title
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) 6 7ef/ �✓��® ��� �� ��� ""
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by o f H Ph.
Signed Date
Application Approved b Date
Application Disapproved for the following reasons
Permit No. l :?,:2� z Date Issued ��,��
No. " Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Z(pprication for Oiopooar bpMem Construction Permit
Application is hereby made for a Permit to Construct( )or Repair( ✓)an On-site Sewage Disposal System at:
Location Address or Lot No. / i��OQ//�Cj° Owner's Name,Address and Tel.Noo..
p Z G CC% �I'j�l//L� /I/ N -_J'491-
Assessor's Ma /Parcel
—
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms 3 Garbage Grinder(__W
Other Type of Building ILe3% PeCY No. of Persons —Showers( ) Cafeteria( )
Other Fixtures
Design Flow Ile gallons per day. Calculated daily flow 33D gallons.
Plan Date Number of sheets Revision Date
Title
Description of Soil
Nature of Repairs or Alterations(Answer when ap licable rg 5 7��/1
/
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by o d-of yH th.
Signed f' Date
Application Approved b _ r Date /-",w ,
Application Disapproved for the following reasons
Permit No. % l Date Issued
THE COMMONWEALTH OF MASSACHUSETTS r
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System 1}1stalled( or repaired/replaced( P-ron
by S y/��' Installers
at Z y ee $/OGp C!614-9 er 1ye141 - has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. �� dated f—147 '
Date 1+ , . Inspector
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE-OONSTRUED''AS A GUARANTEE THAT THE SYS-
TEM WILL FUNCTION SATISFACTORY.
------/----------------------
No. o �l � Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Miooar */p_fte/m Construction Permit
Permission is hereby granted o
to construct( )repair( Kn On-site Sewage System located at No.#
7 Street
and as described in the above Application for Disposal System Construction Permit.
No. Date
The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions.
All construction must becompleted within three years of the date below.
Date: Approved b
Board of Health /
TOWN OF BARNSTABLE
LOCATION Z layr4 �U`� SEWAGE #
VILLAGE �i f�lz' ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS
BUILDER OR OWNE
PERMTI DATE: I"�C� "9 7 COMPLIANCE DATE: / `'�f� ''f Z
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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