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Home My WebLink About0049 GLEN ROAD - Health t gyp' r r q l � l a , 1 u • TOWN OF BARNSTABLE LOCATION y �lth /I�( SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY.(type) (size) NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: separation Distance Between the: Maximum Adjusted Groundwater"Table to the 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 L I Lam( ,_ J } �:� , i '. ;'" i �� C - , �� h� 0., / � �, , ��' �Z ' -� No:.--....•....-ud-- --• -... . Fxs. ..... THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF E-1EAL OF......... . Z Apphration for Disposal Works Tonstrurtioaa Vaftfit., Application is hereby made for a Permit to Construct ( ) or Repair ,(, ' ) an Individual:;Sewage Disposal System at: .............Y /?. ........ ............ ........................... .....�: ..��..: Locatio'ZcAs�./1......-................... ..........................................or-Lot .No. ......................................_._. n r Address .........4.44 fj. .......... ............:................. ................... Installer Address UType of Buildi Size Lot............................Sq. feet Dwellin No. of Bedrooms...... .....______ ...................Expansion Attic ( ) 5 Garbage Grinder ( ) 04 Other—Type of Building .............:.............. No. of persons............................ 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 ( ) aPercolation Test Results Performed by......................................................................... Date............................................ . Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.............:........... O Description of Soil........ ...... _ .. r............... V v ._...-•----•--------------------•-----•-------•---•--•-•--...---._._...--•••--•...-•-----•--••••----•--•----•---------•--•••••-•-•-•----•-•---•--•-------•---.'-•---------••••-••-•-••-•-•-•-•---••-•--- -------------------------------•---------------------------------------------------- ,, .a..: U Nature of Repairs or Alterations—Answer when ppjicable,_-------L-L�.u� .1� � . _z --•--------------------------------------------------------••---•---- 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 C;op,.,nc,e has`be issu by e board •f health. gne --- - U �- ------ ------ ---------------••••--••----------•-------- ................................ D e 1 Application Approved By..---•--• - - ---•-- -_._ ..... •--G[/l . -_ ------ �/� ,�i��7----------- Application. r Application Disapproved for the following reasons:..................................... ......................................................................... ------------------------------------------------------------------------•----•---------------------....---•-------•------•----------------•-----•-••-----•--•----------•-•-•-------•--•------._..._..... Date Permit No......................................................... Issued.._.._.�,� _� 2 .... r - Date ........... / Fiz ...:................... THE COMMONWEALTH OF MASSACHUSETTS \ BOARD�YF HM-rp Appl$uatinit for Bigiosal lVarkB Ton0rurtion Permit Application is hereby made for a Permit to Construct ( ). or Repair ( ) an Individual Sewage Disposal System at: �� ... ° .. ,i• b 1ifo on•T4u.� � r ir��yit!✓ ry �f' ........................or Lot No................... ........7 r :; .. ;. t �..................... ................................................................ •� j �Qttez Address ......... ..` ...�, ,.. In alla ............................ ............................................Address......... .............................. Type of Buildin Size Lot............................Sq. feet ►-, Dwelling No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons.........................:. Showers — Cafeteria Q' Other fixtures ................. r Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid capacity............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 ( ) a Percolation Test Results Performed by....................... ----------------- Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water---._____-.--_--_-_--. f.Tq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_-_____________-----_-. 9 ..................................... xDescription of Soil-------- ;------ ""r ----•-•--------•---------------------------------------------------------------------------------------------------- UW ----•----•--------•.......................••---•--•----------•----------------•---........... -----•-•----••---------------•--- •--- ------------------------ ----- Nature of Repairs or Ellterations—Answer when applicable.-- -Z- ..� t �._...-��t..W'"Cs"A.0-�•---•----1'7Jl�iaL�,'�.� .. --... ...-•.................................................."�"+."-•------ ---- .......--------._ - Agreement: !/ The undersigned agrees to install the aforedescri e /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 been issued by the board of health. Signed...................... --------------------------- •••... Date Application Approved By............. {t[..� f.. .. _ ..�.. E y... /N'/JQ 8 Y f Date Application Disapproved for the jollowastg reasons:....................�...: �� ------------------------------------------------------------------------------•----------------------------•••-•--•-•-••--------••-•----•--•---•--••--------•-•••-•-•-••--••--•-•----••-•-••-•---...... Date Permit No. Issued. Da ; ,........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......O F......4.. , :....... � #L�L Tntifirgte �f Tomplianre TH S IS TO CERTIFY, That the Individual ev,age Disposal System constructed ( ) or Repaired ( ' f� V, 1 Insta10 lle, at.......... . . ...... . . -=------ - -- has been installed in accordance wit�l the prod'. s of Article X 16f he State Sanitary Code as described in the dated..._ •_application for.Disposal Works Con traction Permit No................. 41.., :"".`:'�.... vzov�il� �=�''.........THE ISSUANCE OF THIS;CAR IFICATE SHALL NOT BE C NSTRUED AS A GU THAT THE SYSTEM WILL FUNCTION SATISMCTORY. DATE............ .. ..... --------------------- ......0402-vA ... A'4Z14V .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ".' '°" OF . ...... ...................... FEE..... . .... fff i rn �l n�°k� C n it rtilin rumit Permission is hereby granted......:... .... _... ........ -------------•----•--•----.....---.................••-••.............. to Construct '( ) or Repair ( ndi idiial"S'ewag: Disps Syst atNo.. . . f .................................... .. .......................... as shown on the application for Disposal Worl: Coiistruciion Iermit No.............. .... Dated----- X ;�,,,,...... ��i�i� � ..................... DATE.......... //SI /_X 1----- -----------------------•------- FORM 1255 HOBB & WARREN, INC.. PUBLISHERS