HomeMy WebLinkAbout0050 GLENEAGLE DRIVE - Health �� �(fin e� C� ��i�z
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THE COMMONWEALTH OF MASSACHUSETTS
BO RD OF HEALTH
o F ............... . ,5j,.►BLE...`A.........
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Appliration -fur Btspouttl Workii Tonstrurtiun Vrrutit
Application is hereby made for a Permit to Construct ( .) or Repair ( ) an Individual Sewage Disposal
` Sys at: •--••----
Location.Address ! or t o...
L�
=-----------
wner ---•-------A ress
a .. ' = =
Installer Address
d Type of Building Size Lot_if�-Z.S(f--._--____Sq. feet
Dwelling l�—'No. of Bedrooms.-.___""_"_-.----------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Q' Other fixtures�...... ____
W Design Flow------------------------- .......gallons per person per day. Total daily flow____"____ ...................... allons.
WSeptic Tank L Liquid capacity B®_®gallons Length................ Width................ Diameter----.--._..._... Depth.__.______......
x Disposal Trench— o."_______________"__- Widt __�_._.j..�_ - o Le gth_ . ..._____ al leaching area.__._.______...____-sq. ft.
Seepage Pit No...... Diameter__ /l_. De �i t a leaching ar a.. .. ..........sq. ft.
Z Other Distribution box ( ) Dosing tank
a Percolation Test Results Performed by.......................................................................... Date--------- ___._______
Test Pit No. 1................minutes per inch Depth of "Pest Pit-------------------- Depth to ground water...."-_.._"__---_.._---.
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_.._...________.___.----
�+ ---------------------- -------- --•-----------• ............................................................................................................
O Description of Soil_________ _________________
U -------••------------------------------ ---------------• --•.•....---•----• . --"--•-•---"----.....---......................_...._...........--•-•--•------------------
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 Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be n issued bit oard of health.
Signed. -- JD—9 7�
----.-•-•• ..................•...-------• --------------------------------
I Date
Application Approved BY !/ ace
Application Disapproved for the following reasons:.........................................
-----------••---•-••--------•----- ........
•-•-------
...................•--._.........-•-•--------•--..........--•---......•........-----•-----------------••-•--""---------------------•-"-•--"---"--•------------"------------------------•-------------
Date
PermitNo......................................................... Issued...................... .................................
Date
No.... ........... Fz�s.... ,.. ....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
e� �• a ...o F.................8 R 1tSTAB1.. ..-...../.... .....
, pphration -for 13itipuiittl Workii Tomitrurtiott Perrot
Application is hereby made,for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at /
P 1' Location-Address / ( /t or Lot`No:
`-.• = ._.... -' - . ....... ----•----------------•---------------------•--••-•--'••----
f ( ` L; 4 Owner Address
. ..1'.... ��_, ✓%'t� ..._.1.1
Installer Address
Q Type of Building `Size ........Sq. feet
Dwelling`=No. of Bedrooms----------:t�-----------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Q' Other fixtures ------------------------------- - -
W Design Flow___________________________________________gallons per person per day. Total daily flow--------------------------------------------gallons.
P4 Septic Tank_/ Liquid capacityA'1-"' 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 ( )
aPercolation Test Results Performed by-------- -------- -------------------------------------------------------- Date--------------- ---_------------------
a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit..................... Depth to ground water...-_.--.-----.--...___-
(i Test Pit No. 2................minutes per inch Depth of Test Pit--____--_..____-__-- Depth to ground water------------------------
----------------------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------••---------------•--•-----•-•------------.-----
O Description of Soil------__.-_--v--------------
U
W ------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------
UNature 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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b n issued by t and of health.
Signed..... ''--- ------------ . ----------•-......_._.._.
Date
ApplicationApproved By----------------------------------------- --'--'•-----• --------_------------- -----------. -------------------
Date
Application Disapproved for the following reasons-------------------------------•-•-------------------------------------------------------------•-----------------
-'----------------'-'----•---•----•---=--.•--------------------•---------••'--•--•-'-------------•------------'-•--------------......--•---•----••..-----
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
_ BOARD OF HEALTH
BARNSTABLE
............... ...........-..........OF.... ................................................................................
Tatifirate of 10kompliaur.e "
THIS. IS TO CE ,,TIFY, hat the Individua e�ivage Disposal System construe ( )for Repaired,,{
-- ------ j- ------------------ -- . f
at----_'-•"/:^_�__- _- "`.. ..............��!--1-rr._ .- - -!� st----- =`:-..._�_-----i --�-�---•------•- --------/----=�----�w- '--
has bV-n,dnstalle in accorda e with the provisions of Article XI f_T e State Sanitary Code as d/escr ble �i.n the
application for Disposal Works Construction Permit No--------------- . .__�... dated---•--... /...
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. , ,�/�,
DATE --� --•--'•---- Inspector-------"..............•---- •-•----•----'-------'---'-'-----...........
-- 7
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH ,
/�.,,.. �........of...............BR_iSTABLE... - ----
............................
No._........_.�,r / FEE.........
%sVwial NorWJI C11mitrurtion Peratif
.< �.,
Permission is hereby-•granted---------- _2_44..- f,....---••--t - '` ' 'fir r ter. >
to Construct ( )``or•Repair ( ) an,,Individual Sewage Dispossal System `
at No...
.` ._ .f .-- ..� = `` ._Jr x ---,,�a� �i'3--`��-------- �', �._''`���`��"'
L: t r�--
,.- Street
as shown on the application for Disposal Works Construction Permit,Now--------------r__�Dated,,--7:: :4: ___.._.-
wY
Board of Health
DATE..................•..... .. ---- ----
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS