HomeMy WebLinkAbout0067 GLENEAGLE DRIVE - Health A - M -t57 �
(y - ���./� //1 � -. n� •� /� � q 1.1 r \� -�-. �
-
i
r t
..............
THE COMMONWEALTH OF MASSACHUSETTS
,.a
BOARD O HEALTH
---------.OF...:.... ... ... .........
Apphratinn -for Ditipuiitt1 Workii Tomitrnrttnn Vrrnin
Application is hereby made for a Permit to Construct (" ) or Repair ( ) an Individual Sewage Disposal
System at:
------------------------------------- --------------------------------- ------------------------------- ............................................................
;,efation-Ad ,. o of Nop
- = �---°�--------- ... .------ .
w , Address
w ... ...... C�
Insta ler Address
Ty e of Building Size Lot—
. feet
.. Dwelling—No. of Bedrooms-.-_--`3---------------------------------Expansion Attic ( ) Garbage Grinder ( )
p, Other—Type of Building _______________ No. of persons...------------------- .Showers (ooq — Cafeteria ( )
Q' Other fixtures ..__ ______-_ -------------
W Design Flow.. ..................... 111ons per person per day. Total daily flow.........
gallons.
WSeptic Tank Liquid capacity allons Length---------------- Width--- lli eter-------- ------ Depth------------.
x Disposal Trench o_____________________ �Vidtl __..____ __ al e t /_ .__ _ .__ al leaching area._._.._...__...____.sq. ft.
Seepage Pit No----- ______________ Diameter.../ _. b o in le! .. .......... tal lea i g area...... . ._____sq. ft.
Z Other Distribution ox ( ) Dosing tank ( ) - �
I, a Percolation Test Results Performed by..................................................................�.. ate-_---------------------.-------------7
a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water...._.--_-_--.-.-.--_--
f4 Test Pit No. 2_______________minutes per inch Depth of Test Pit-------------------- Depth to ground water._. ._---..-_.-.-__----
------- --------- ----
O Description of Soil--------- .................................--••-=. -------- ------. - V------ ---- - -------------------.-
U /----- -- - - -.a
- ----------- - - - -
----------- - ----
x1 - e a- ----- - - - ----- ---------- - ------ -- ------------
U Nature of Repairs or A terations—Answer when applicable............................................................................. __...
---
Agreement:
r
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article NI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of,Compliance has been issued by the bo d,of heap .
Date
Application Approved By----- - --- -- .. .
to
Apglicatio Disapproved for the following reasons: __
Date
/ 7
PermitNo.-------- •-------------------------- Issued.----/-—--- -----T1...•---------------
Date
\C�a
e �,
� � u.
`�
` J
c ' � '
o
� �
` \ � � _-
r
I .
' �f„ �� o
e , r
1
',
I
� v
r1 _M\
1 � \ /
1
J
e
ie �
` V
\ � R
e �
''�
y ��
i
o
� ` �.
� .!
� '
b
o � J pF
f�'
P � t_
g � ;;",
FE
No..ft.( ', E �!�i/.....'�......"'_
THE COMMONWEALTH, F.,MASSACHUSETTS y
BOARD O ; HEALTH
_OF ------_---------- --------------- ---
;. �irtt ��r fura1: rk Cntrt��n rr�� $
Application his hereby`made for 'a Permit to Construct.,('' ) or Repair, ( ) an Individual Sewage•-Disposal. .; ,
` System at
ataon�Ad
0 of No i'at
--------------- ---- -
drl a �
w Address
`.
-----------------
1 / Insta}e a. Address r J
r' .0 Ty e of'Buildi4g s Size Lot. -- --Sq; feet � a
D`tzelling No.: o BedroomsA..__ -_ ------ - t' Attr ( ) ~•.• Gbage Grinder ( ) •f. I F �`"
r' Other=T e of 13uildin "s Noy of" ei 5 n5.... ................... Showers —.'Cafeteria `
fi - d -tlier fixtures : .. :. t
--•
t Design Flow_� 1I1 ns per ei son er da Total d1i1', flow._..:._._.__
W g � T '"' P P P P Y Y gallons.
Weptic�-Tank ,. Liquid capacity -__ allons Length-_---__ -__ Widfli._--..:.. :._...Di eter--------. ._-- De>th,-.A ---
al ein
al leaEhin area-.-.. - _-. ._ s' ft.D5osa1,Trench- o•----------- Widt --- g 9See a e Pit No Diameter '. b ot"' tal lea ire t scPg1f
Other Distributio .11 c ( ) Dosing tank`
Percolation.Test Results' Performed by---------_.. -.-_ -=_: . .......... ate----------
� ' Test Pit No. 1.................minutes per inch Depth of. "lest Pit ----- Depth to ground wlter.....__ ...... ^�
L; LLa -Test Pit.Ako. 2_...............minutes per inch Depth of Test Pit. :_-__.._ Depth to ound water-- �.._ --
„ , ------- --
D Description of Soil ---- . --• ---" -- -----
x
V --- -------------------•-------' --' -•---. J -•------ __---....__ --_.........................................- ..-.
y
_._..
M �-=------------ - ---------- --- ----------- --- / ;t-- ------. .__- --_. --------------- ------.--- _- --_--- -----------•••-•--•_
W
U Nature of'Repairs or Alterations—Answer when applicable --------- - --- ._...-.---.-.--------------_.-- ..-..-----. _--- -.--.-.....
, r
Agreement
he£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 furthei agrees not to"place the system in '•;
";- operation until a Certificate, of Compliance has been issued byahe boardibf health.`
D y
i `/`r++'rYI` ate
Application °Approved By i -
._.. -- rrr���ate
Application Disapproved for the f ollowing reasons:. .---
Date
}
PermitNo---------------- �. ;._., Issued........................................................
°i Date
THE COM-MONWEALTH OF MASSACHUSETTS
BOARD HEALTH ,,,,�g
^' I ..... ....�......:....OF...... .........44. t,•:........................ ................
"TrrtifirdtP of Tomphaure
IS I O FY, That the Ind' idual Syge Disposal System cons ted ' or Repaired ( )
,.
Ins ler ,N .__ ^t______. 4
e at _. -------- -- -a-4
----------------
a hcation.for Dis ,osal Works Construction Perms of Article of The State Sanitary Code des ribed m the
has been installed P�accotdance with the proyisio it No.--:` - __ __ :,-_ . dated .-1-�' ,-_- .��.�--.._.-�_-
{
THE ISSUANCE OF-THIS,'CERTIFlCATE..SHALL NOT, BE CONST E® AS A ARANTEE THAT/THE
- SYST,E�iA Vd1 L, PDCTIO SATISFACTORY., : �'
eDAIL-. r
•Inspector
'� � 7 sf, � THE COMMONWEALTH�OF MASSACHUSETTS •' ` '• . ;
BOARD <HEA.LTH � ��� • � 3`;�'
� C�' �, . ...... ...; . ...... OFF .. ......^..-• . ............. �
4' a / .a. .
No. .. FEE w
w. y. ittrrtig rr i#
Permission s ereby granted. =` �� � --.. ..
to Constru or epa r; Ind>,v�id al Sewa , D' l tem ', V
-A
at No.-
-------� h 01 '�'
. ,b• ,, - ... Street l
as shown on the applicat}on for Disposal.Works oiistructioii. P o- _ . ..-.' __,__ .Dated--r2 �✓ ...... #}
M.
t t�
• •''/ r Board of .eat" -•---•--.._..
R
DATE "
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS'
�.�. .-..,....,i.. _ -... _.- .. _....- ,.-:, .J_ _.. .. .•..iffy ..-•. di.. .. -. ... .' ... , .. ..,r•
( '' r /►
� t
-.00
OOV
i
ez
Y
r
—Q�lv�v�ze��,. a;70�/f�-�-" _5c1�{ J
I �
1
` � I
i
' I I I � I� I � I I I � , i �
I I i I ( � t r � I � � ' 1 I
i I I � � I
t
� r � � ��
' i � � I 1 1 I I � � � + � n ^
ttt t � }
I I � I � ( + ' � � i ' � � ,.
I t I t � ! , I t t � ,
I � t ,
' I ' � ' � I ` i ' � I t
, � -# t .
I � P ; I I
I , r , , I t I ''
1 ' I � ; F � {
I i I � t
I I , 1 t I ( � I I t i
I , I � , � � t I t I I � I �
I t � �
I I I I t � ' � ' � I ' i
� I I i I i t � I I
t j � 1 � t 1 t
' I �
t 1
' � i ' � I
t i 1 f � . � � I I t
I t I � � V � I I
i I i + ( t � � � ( t I
� I I I � � � I- � � � � � � � � � � ��
I , � I I � ,
I I , t , ; � � I I � ; � I � � I I
t f ! I
' I I I I - i
I I � t � t � r � i
t � � �
f
t
I ? ; � I � I I I ' � I � I
' � � � � � t ,
I
I I i I I � I � � � ,
} I � i
j I ( t i f t I � � I h
j � � I � I
I � � tR �
I � � I ,
t i I I I
t I i
t � I I i I j I t � , � r
a I I I � � I I I i I I
I I
� � t � I � ! I � � �
� t t �
t i
_ �" � ! I '
l
a�
lc�
! a�Y} 4i. 9 i:wz # n _ 4 ki-,:. �v '1:"1.M}� r . , , p 4 - S I.+�, i w '} x. '"
>7 .A ik i !r: t."i r _.'�,*fix €r.-}Y. }�r i�, rw t',:av 1. � it '�. _?}N. !j ,�µ ° ,F.t Y N fl+*r h! Ci, a-. M '. a �, 'S- +
w ,:n' .:✓.rC'..r ' r t s•,: ;� w; §d a ,i.,*, "r+! t:;'4� i .. A. q Y t � r i i. .:
T % { S �'
Y �, j.
w.
�" i t• t7 �' ': i+A ,r L ",IL. 3 ,'} N of : y t-i'A T If,
y I. r?•_.- �tr Y F, } F,, 4#1. } ii ,. 3 �� - f S',•; t,�_ q i y +,
f
r,}, t•.yr "` S Ih ,L'Y a '7 _.; .} r V i
- y• 3 4 x
fl}'iY b wtt. t' 1 •�. •] M - 'yl{' i L f t .} ,z` � ` .
4 '+ ? ;, ..i , •] , '.er .a" l .'rr, •._�MVvi��,>:.IVGY ,�.�fe �' r w5 I.s
h
-
2 N + . r a '-�t wjr x 4r _� _ `t,- _ t_ ,.; ,oi t.
"�. zy „ s �` .t`"` Y of :;€ B r j - 'a. i. `
�111 I"
IL �i rl = SV 1I. �, 4 a t' �i f t f y•�' 's l $f' T', r.
i '4♦ -a. .`�p�s�y �y« �1.tre tef,�: t # yr � t � _ N' a•
•t+. 1•G$.,PN T3s3r✓�} ' qd 4- cT r 1. f'• 4; x ; _.J..
1.` = tit ' Y_ , - 1 4, ,
. ir�r nv , �l'+•is_daAc3iu..8e ;S'. r" r � r �•.
F
r
. Y 1, 1irista,, . anh.- spoon? q. a .6ept�c P'.1�St4jn 3�Gy ,
a
„.i� t: 1Ct,. }14''. 3 �' . ,, 'b.�Ya`�4�.�.f36� ;€t3 j hbti .2'k `�
r r i is 'I` �'f�Y3tt alf: fir Al C?b �`i.. °+.'� ..a cf�*i ' } '�."tzil 0.c .v t -I
� Q:
d _ !ea, ((Y.yi+�Ny.x yryK ,€ p�-p_�{ }'$y. p� /� •; y�{�yrlyt, �'-® }�'gy.,..i. ,X �h} f 'j+
'It i - d; {'./� Vai \,Ii �•WAi3 1 .m.? \�/ 1:}r Z i4 hi4A i I t1s,i- t'fir Lc!�7f, Y9
r
r." — . .y� +' -.byj ycbix--i/��y�y;Dece-�e"I°. S_� ?3? ' 'is not prc . �..a.
• Y .♦ 6 Y. 'Wl3 i.i is�ii -3. iRJ 4.Ad6GFW •!• 9 i. _ e
:t __"ZU ..!- a d:C.�}� 7' ��m�ss..}i Se-& i�r.7r,'tar ..�. 7e b e r t �� +.
�.�d ibig.'Deartrierit �N, ., - P� .�1, on' ecmtb,6r 54 '1�'7 r � .
1.
Z , r r-!� , A , a r
- il
L.
it
Yam;_ _ �,� ay F E i ►` 11 F �, •
u #��� � .a z � i is IN'+7S 4 BOARD : 1. a
�r -yne r P r.* ..$s It. d'', .+• - s F b �! i.
�. r r 4 i.
r {4 {.kj1�yy k A ,F
s s� :t� �V, ;ii i , } ` f +y„ Y- r1f;i4. ra V Nil ri�• t R { _
r v r!t i P' 1%11.y�x�.,C.6r-, t. ray
i -1. iay Aks,bJ{"\v LebY.ii',ra .a' A -,f` "t.+
2¢ap y�
-; .. t .a. :
f Z C F 1 i ! �ryy ' k Y 1 J 'Y
1. y # i } d
'F r } '"t ; -.1 w r r 'r'., .N' - -4+f k s r ...,.
1.
r ri I 3�3 Y. ,V,},g, ...I !f k �, .2r 4 g r t .p r r b tt .r rh y
! z-.r- t r} a V ', F .n: � I r s t• ,�" ,z d
d r^{t a - a '.t.: -i'^ €
fi r_'}y .a 3. r r a:. -' '''' 4, !- }, r.
4 �• k i:7 b i :j �x ji Y 7 ! r f Sy is
ti 4r'r„^t�lrh.,,t ra rNr l[e L i{. +, �. a s' r y` Y . f � , }`�
a n R -'4It �' a -"!' t} t; r :� ¢; a I. T J '' t 'r£ L .
y u
5 ! 5".. 7
t..- g ,r t � __ { 'R. ' t:$ a ^M1 r yNrl, 'r;€: . '� e a _... t .'y�'r
`a
' r _ k ' r. e
�`^' L..'-` '+ z .i a a '! �",h' Z '!c ..:y ¢yt K 4- i ,, sv y.,m > r q, k € {
f
,.... = 5,<:., _ tics �' ,, F '�,. tv .' ._a .n" t, ?:'!. t•.. ... r �' .V.7 . t tk .-
SENDER: Be sure to follow instructions on other side
PLEASE FURNISH SERVICE(S) INDICATED BY CHECKED BLOCK(S)
(Additional charges required for these services)
❑ Show to-whom,date and address Deliver ONLY
where delivered 11 to addressee
' RECEIPT
Received the numbered article described below
REGISTERED NO. SIGNATURE OR NAIVE OF ADDRESSEE(Must always be 'led in)
CERTIFIED NO.
825433 2 SI ATURE OFADDRESSEE'S AGENV IF,ANY ,
INSURED NO.
I
DATE DELIVERED SHOW WHEEE,-[IELIVERED(Only if requested,and include ZIP Code)
i 2- l ����
U.S.POSTAL SERVICE
OFFICIAL BUSINESS
Q J i I F PENALTY
DEC 14 USE TOOT V �
I` 0 1973
ozs55 `
Pafmark of DefNerIng Office
SENDER INSTRUCTIONS
Print in the space below Your name,address.including ZIP Code. EMM RETURN
I • If special services are desired.check block(s)on other side. MONT�
z vW• Moisten gummed ends and attach to back of article.
. Town of Barnstable
Board of Health
397 Main St.
HYANNIS MASSACHUSETTS 02601
i