HomeMy WebLinkAbout0128 GLENEAGLE DRIVE - Health (4) a s Uw or-i cam
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
Town----..OF..Barnstable
-------- ...................................................
Appliratilan for Bispniittl Works Tnnitrnrtinn thrmit
Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal
System at:
128 Glen Eagle-Drives Centerville. MA „026 2
.....•--•--.....--- -........... ...---•--. ten Eagle gr-i ............................•---..---•-•-----•--
-• Location:Address or { No
Nicholas_—Tavano „-,-„--•................................... 128.. ..... ............................................Centerville...MA,-...... 2
Owner Address
a A & B„Cesspool Service 128 Bishops Terrace. H�rannisi_MA 02601
Installer Address
UType of Building Size Lot----------------------------Sq. feet
�., Dwelling—No. of Bedrooms.._........................................Expansion Attic ( ) Garbage Grinder ( )
p, Other—Type of Building ............................ No. of persons.......5................... Showers ( ) — Cafeteria ( )
Q' 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........................
r= Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
9 •-•---•--•---------------------------•-...-----••-••••.....----------........---•----------••....---.........................................................
0 Description of Soil------._._..Sand........................
x
U
w
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable.....installation__of__a__1_t000__�llon,___pre-cast
stone.__-Dacked--leach_-fit•_•(overflow _____________________________________
-----------------------------------------------------
Agreement:
.The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE: 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance s b n ' su d by the oar f altl�:
ApplicationApproved By-_....••-•--- -•------•-•------------•------••.........................................•------- ........................e-- .....
/D�t S<
Application Disapproved th ollowing reasons: ---�I ...-
------••------------------------------•-•----•--------------...--•••-------------...•--•---•---••--•--...._...............-----•--------------------------•--•----------...----------------••-•----------
ate
Permit No............�:.-......... Issued :. Date ..�..7. y
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�.................. ...-.T.wn......OFTeozumtalAa............................................................
�.��
���' ��� �����]�� ��
" " '� - " ' -- -----------'� nra-~---
Application is hereby made for o Permit to Construct ( ) or Repair (o ) an Individual Sewage Disposal
System at:
�� ~ -~_
Owner Address
&
Type of Building Size feet
"""^ -- ^yp= of B"�"�g ............................ No. of persons......~/................... Showers \ / -- Cafeteria \ )
w Other fixtures '
^� . -----_--_--_--_-----_---.---_-----_---.--------------.-------'-'---
Deo�gn Flow............................................gallons per person per day. Total daily flow............................................gallons. �
� ScpdcIaok--Liqoii' ............gallons Length................ Width................ Diameter---------------- Depth................ �
Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. `
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total area..................og f t. �
Z Other Distribution box ( ) Dosing tank ( )
� ~~ Percolation Test Reoo8u Performed 6y.......................................................................... Date........................................ �
' Test Pit No l yerinc6 Depth of Teo Depth tn ground water �
� 9 .................................'........................................................................................................................... `
0 Description c6 Soil..........Sand........................................................................-------.-----'---------------�-----'--' \
__---__-'-_--_-__.__'-----___.____-_----_-_-----__'__--_-'---__--------___-__'--�- � \
^ ' ' )
� '-------------'---'-------------'----------------'-'----------'-''-----'____-.. ' \
[] Nature of Repairs or Alterations—Answerwhen -inateuIlecti oo..ccf-.o.'l'.0[0-.gaIIon,-
ot���. ..Iaaah.. .---------'-'------------------'---------'--'''---------- - \ �
Agreement: �
The undersigned ugrcco to install the uforcdescribol Individual Sewage Disposal System inaccordance with
the provisions of TITLE 5 of the State Sanitary Code—The m1 to place the system in \
operation until u Certificate of Compliance 6u
~'o----~--/^----~-^--~--''�--'~-'~~~�~�~'_ =---' -' °p°^ ---
;;;�
Application Approved
8y'-----------.-----------------_______._____________ ______
Application Disapproved for the
Permit^,"` ` Date
' THE COMMONWEALTH OF MAssmcnu � .-
BOARD OF HEALTH
....................%{Wn'--..OF......... .................................................
THIS IS
TO CERTIFY That tht Individual Sewage Disposal System con�truqed or Repaired (X
128 Glen Eagle Drive, Centerville, 1,,A1ns'&ff632 - Nicholas Tavano
has been installed in accordance with the provisions of T TLE 5 of The State Sanitary4ido
application for Disposal Works Construction Permit No*7 . .....9 �d,scribed in the
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTrR A GUARANTEE THAT THE
SYSTEM Wl" F14NCTION SATISFACTORY.
� .............................................................. Inspecto �
� � \
THE COMMONWEALTH orwAssxo*ussrrS
BOARD OF HEALTH
Tt��-............ �
��u--'��,ft-'>-'�' ' ..����....�..���.....�..... Fmz-#.'�-5,Z�--
xm wsposal Works *u��nstrurtmon panfit ^
Permission is hereby granted-------.-_-'&_� B C 8 __________________________ `
or;-Repair_}
n Eagle Drive, Centerville, VIA 0263Z - Nicholas Tavano
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