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S ME ADO
No.H163OR
UPC 10259
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AMWEd THE COMMONWEALTH OF MASSACHUSETTS
4ns "� BOARD OF HEALTH
q, 7 5 TOWN OF BARNSTABLE
Appliraolmiatt for Dirripw3al lVarkii Tomitrurtiun rumit
Application is hereby made for a Permit to Construct ( ) or Repair (\_e/an Individual Sewage Disposal
System at
Location-,Address I or Lot No.
---_---------------- -------_---------'��`-�.c..........................................................own
6A (. ,(� 7 re5s
Installer Address
Type of Building Size Lot............................Sq. feet
►.,l Dwelling—No. of Bedrooms---��,2______________________________________Expansion Attic ( ) Garbage Grinder ( )
C14 Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) Cafeteria ( )
a' Other fixtures _______________________________ _ _
W Design Flow............__ .P ......................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---1.c'�---.----- Depth below inlet..._W........... 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__--_-.-.-------_---._..
fi Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
---------------------------
----------------------------------------------------------------------------------------------------•------------•-••-•-•-•-•-----
0 Description of Soil...........................................--------------•-------•-------------------------------------------------------------------------------------...........•----
x -
U .............................................. --•----•--------------•--•---------•---------...--------------------------•----------•------•---------------------------------.........------•--•-••-•---.
w
--------------------------------------------------------------------- ----------------------------------------------------------------------------- -- -----------------------------------------------
UNature of pairs or Alterations—Answer wpen ap licable.___ 4 Z.+ .��----._k'J.00- a..*.. .__.
-----------------
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 rther agrees not to place the
system in operation until a Certificate of Compliance_h s and f ealth.
Si ne
g t: . �........ ....
Dace
Application Approved BY -------V U 1 7.. - /
Darele
Application Disapproved for the following rearonr: . ............ ............... .....--................ .............. --- . .......
---------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- ........................................
Permit No. ........ `/ ..g. ....................... Issued -.--------...._.--- ------------.-------- ice......
Date
No.. 1 FEB....:: .. ..........
THE COMMONWEALTH OF MASSACHUSETTS
f BOARD OF HEALTH
6;�-
711,15'VTOWN OF BARNSTABLE
of Appliratioit for Diripotittl Work.6 Tonitrtirtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ("-�an Individual Sewage Disposal
System at:
fj,, I Location-Address r or Lot No.
1"� � ✓-- ---- St � 57 , E C�QV��4.....
{ Owner C a _ c,W� `�Q 1 (L aU
v Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling— No. of Bedrooms.71` -------------------------------------Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ---------------------------- No. of persons.......--.................-- Showers ( ) — Cafeteria ( )
a' Other fixtures ............................... . .
W Design Flow........ 6----------------------------gallons per person per day. Total daily flow.........................................---gallons.
G: Septic Tank /-Liquid capacity .gallons Length--..-f— Width-- k--..--- Diameter................ Depth................
Disposal Trench—No. .................... Width.................... Total Length-------------------- Total leaching area....................sq. ft.
Seepage Pit No-------/....-_----- Diameter....1.c4--------- Depth below inlet.---4............. 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.......-.--.---.-.-.----
(i Test Pit No. 2................minutes per inch Depth of Test Pit...--.......----.... Depth to ground water........................
p4 --------------------------------------------------------------------•••-•-•..........--------•...-•---•-----•••--•=•--••---•-•-......-•---------•-----_•----
DDescription of Soil.......................................................................................................................:.I-
xOf",U ..........................................................-.............................................................................................................................................
W
U Nature of Repairs or Alterations
ns—Answer when ap licable.--� `>k-01- �__:-_ r2U S?` .rL..-` �`_rt�
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 ftirther agrees not to place the
system in operation until a Certificate of Compliance.has-been-issued th _board,of ealth.
\
Sign�d----� \ `
Date y
Application Approved BY .... ........ +� c - -' --"e�-7- V
Application Disapproved for the following reasons- ----------- -----------------------------------------------------------------------------------------------------------------------
.................................................................................................................................. ............................................................................ ...........:....Date..................
PermitNo. ----.-. ..`.�....� -�' �� /......................... f Issued --------------------------------------------------------
p Date !
-------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
(IlErtifirate of %Q11omplianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( �-
a Y7S� luC
by ............................................. - .- .. ------------------ -�1--`-------_------------------------- -------_------------------------------.-........._.....------..-.------------------------------
/� ! , cadet
at.............................................`� U------..1.— �--K- a rat .. A-- 1�..-... -
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. ----- --J.- ....... dated -----------------------_---------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE . - -------------------- ------- Inspector --------- ... .. -----------....---------------------------------------------
----------------------- --------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
`/ TOWN OF BARNSTABLE r
No..._.....�........g. FEE.- :;�................
Dispo,ott1 Worho Tonitrurtilan rrmit
Permission is hereby granted-------- ------- `t � ---`fi t L-----------------------.........----------.........-•----............---
to Construct ( ) or Repair ( Gr-atrIndividual Sewage Disposal System '
atNo................................................ 1 Sa....... ��i N-
Street � ��� �+
as shown on the application for Disposal Works Construction Permit No..,.-.-___\-•...---- Dated--..--�......
tBoard of Health
DATE— — � � �L�------•-------------------- �
FORM 36308 HOBBS 6 WARREN.INC..PUBLISHERS