HomeMy WebLinkAbout0038 EAGLESTONE WAY - Health 38 Eagleston Way
Cotuit
TOWN OF BARNSTABLE
LOCATION of � �� f��he VI/ri SEWAGE #
VILLAGE
ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO. 9a /-/p
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size) �XG
NO. OF BEDROOMS PRIVATE WELL OR, UBLIC WATE
UILDER OR OWNER a�� �'er ff
DATE PERMIT ISSUED:_
DATE COMPLIANCE ISSUED: f
VARIANCE GRANTED: Yes No J!L
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THE COMMONWEALTH OF MASSACHUSETTS
_ BOAR® 9F HEALTH
.................CA:VltJ.....OF....../.v. ,( rS/w�.�.-.cl..........................----------..
AVVfiraftou for Dispniiaf Works Tnnitrurtinn Vautit
Application is hereby made for a Permit to Construct (A or Repair ( ) an Individual Sewage Disposal
System at
... .....__... : ...ion...A"d ........... .......:.�� � —� ................................ �........... .
Location-Address �• or Lot No.
Address
.......................... •.•
...................... ...... ......................................
---.....-----•.............................
Installer Address _L�
U Type of Buildings Size Lot...416% Y.d_Y_.Sq. feet
Dwelling'�Vo. of Bedrooms__________________••--•—----__•_--_---.Expansion Attic (�.� Garbage Grinder ( 4—�
pa., Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ..................................
d
- ••••••-..•------------------
W Design Flow...........................:��.5...gallons per person per day. Total daily flow......................----�. .._._gallons.
WSeptic Tank—Liquid capacity..-`?l-�g•- allons Length...............:Width---------------- Diameter---------------- Depth................
x Disposal Trench—No. .................... Wid .T-__-----•-__-__-. Total Length.............. Total leaching area....................sq. ft.
Seepage Pit No.........�...... Diameter___________________ Depth below inlet.....G.......... Total leaching area....tetn...sq. ft.
z Other Distribution box (tom Dosing tank ( ) 1 b,
Percolation Test Results Performed by...... ._ ..1~�(,E __� ce_..... Date..Z`__Z _. �_____.... j
aTest Pit No. 1...�__�-minutes per inch Depth of Test Pit-________---15d-------- Depth to ground water-_-GV
(% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
RiI J i --•-•---..... . !f.................
Description of Soil-••-63•`"-1-..... .Y�fL f�l ... � C I
x
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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Complian h been 'ssued by the board of health.
/- �
Signed ------ ---- %"
.--. ................................................'--'--'--- --..............ate c..-......---
✓ L ,�
Application Approved BY -- Ir.... ��......._'_ ... -L �
--------------------------------------------------- Dace
Application Disapproved for the following reasons:
.................................................. .....----..----...---....--..--. ------..............----............----..----..----...... ---- ---. ----..---- -- -- -- .-- ........................................
Permit No. ..... -- .--
.... .... ....... Issued ............ � ...� � ... ._P
Dare
No.................... 1 Fiz$..............................
THE COMMONWEALTH OF MASSACHUSETTS
_ BOARD OF HEALTH
�f."LA1A-) -OF......1✓4I /�J-a/ tr-"t
ApplirFation for Uh4paiiaal Workii Tnnitratrtinn rruti#
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
Location-Address or Lot No.
.......................l $ 1f 1 a � !` / -' 1 1 •................................................•-•---------------------•............---
Owner Address
W .
Installer Address
Type of Building Size Lot__ ��� _5____..Sq. feet
Ex ansion Attic Garbage Grinder Dwelling--!!No. of Bedrooms. P (1)4 g (�")'
'4 Other—T e of Building .............. No. of persons......_.._................__ Showers — Cafeteria
P4 Other fixtures -------------------------------• .
Design Flow............................ gallons per person per day. Total daily flow...................... ......gallons.
W g P P P Y Y
WSeptic Tank—Liquid capacity../..:?gallons Length---------------- Width................ Diameter---------------- Depth................
x Disposal Trench—No. .................... Width.................... Total Length.............i..... Total leaching area....................sq. ft.
Seepage Pit No..........0........ Diameter... ............. Depth below inlet.....G,_.......... Total leaching area.... ...sq. ft.
Z Other Distribution box (i.-)- Dosing-tank ( ) 1 y,
Percolation Test Results Performed by.....aJ�k '�......_d`'`� .j__�. .......... Date............................
a2 1.9 e![� /Test Pit No. 1__!`.-__..__.____minutes per inch Depth of Test Pit_____ _ _________ Depth to ground water.__ ..._._......_.�U
fi Test Pit No. 2................minutes per inch Depth of Test Pit__-___----_________. Depth to ground water........................
a P j ;' -------------•---••--------- �._..
O Description of Soil fJ- ,/ = f?1l-�Z' Ufs %JL `1 A-)7�I cJ•. ? - :
x
x ------------------------••-----------------•------------------.....--•-------•----•--•-•---.-•---••---•-----------------------------•------•--------------••--------•-•----------•-------•-••------•---
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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Complian h been issued by the board of health.
Signed -- U/c �_
----------------------------- -
--- 2�- y
ApplicationApproved By -----------------------------------' -----------------------------------------------------..............---------------------------------- ................. ate -----
Application Disapproved for the following reasons- ------------------------------------------------'-'----............-'----'-'-'--- . ----.......--"----""-----------------------
.. . ................ .........' ....................................--- --- -- --- ---' -- '---------------------------------------.............................................. . -- ..-- ......... ..-------. ----------------
Date
PermitNo- ------------------------------------------------------------------- Issued -------------------------------------------........................
Date
i
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............/ ... -- OF --.._ . T 6&td--------.
(11'e>rtifira e jof (ILTIImylian e
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( A,) or Repaired ( )
by------' -------------------------------------------------------------------- --------------------------------------------------------
I
--------------------------------------------------------------------------
a[ ........ � � . r-- t.... .
...........................................------------- ----..------------------------------
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ................................................ dated ..........................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE... ' ' '' " " ' " "--""--""' -- Inspector :." � � "-- .t% ' I/G
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..................................../L OF.........A /0:,7 �a3.e_. .......
No......................... FEE........................
Riip auaa1 Workii TwilmitrudiattUpamit
Permissionis hereby,granted......................................................................... ---•----•-•-----------------•.....--•--•-••-........................
to Construct (XI) or Repair ( ) an Individual Sewage Disposal System*' j A/
Stet
as shown on the application for Disposal Works Construction Permit No..................... Dated..........................................
_ ...................................................
�4 01 Board of Health
DATE................__�. I ---------------•------------
---
FORM 1255 HOBBS &'WARREN• INC., PUBLISHERS
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TOWN OF BARNSTABLE.
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LOCATION �/pT r �;��� St�;,� L4� SEWAGE #
VILLAGE
Gt�fv f ASSESSOR'S MAP & LOT
INSTALLER'S NAME PHONE NO. 4), �Q ,�o
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) J- (size) X G
NO. OF BEDROOMS Ll PRIVATE WELL OR. UBLIC�WATE
UILDER OR OWNER0:
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED °w
VARIANCE GRANTED: Yes No
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