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Centerville MA
Tel: 508 737 7014
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16 Clipper Lane
Centerville MA
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Page 5
8 Clipper Lane
Centerville MA
Tel: 508 737 7014
Rough Sawn Spruce
HIM 11 Asphalt Shingles
Garage
16 Clipper Lane
Centerville MA
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Page 6
Back Elevation
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Centerville MA
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Left Side
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• 1111■I1111■I1111■I1111■I1111■I1111■I1111■I1111■I1111■I1111■11111■I1111■I1111■I1111■I1111■11111■I1111■I1111■Iltll■I1111■I11111.
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■I1111■11111■IIIII■I1111■I1111■11111■Ie111■I1111■I1111■I1111■I1111■IIIII■11111■I1111■Ir111■Ir111■I11/I■I1111■I1111■I1111■111,
111■I1111■I1111■11111■I1111■Ir111■I1111■I1111■Ir111■IIIII■I1111■Ir111■11111■I1111■Ir111■IIIII■I11/1■I1111■Ir111:::::�::C::;:1 � -• ��� _
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IIr111■I11/I■I1111■I1111■I1111■I1111■I1111■I1111■11111■IIt11■I1111■11111■Ir111■I1111■I1111■I1111■I1111■I1111■11111■Ie111■I111:
■I1111■I1111■I1111■IIIII■I1111■I1111■111/I■11111■111/I■I1111■I1111■IIIII■I1111■I1111■I1111■I1111■I1111■t1111■IIt11■I1111■I11
III■Illel■IIIII■11111■I1111■Ir111■I1111■IIUI■Ie111■I1111■Ie111■I1111■n111■Ir111■11111■I1111■11111■I1111■Ir111■Ir111■I1111■I; Elevation
IUI■I1111■I1111■n111■I1111■IU11■I1111■I1111■IU11■n111■I1111■IIIIIBI1111■I1111■I1111■I1111■I1111■11111■11111■Ir111■I11111.
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41
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE
Appliration for Diilipo!tl Wor1w Tomitrurtion runfit
Application is hereby made for a Permit to Construct ( ) or Repair (�4) an Individual Sewage Disposal
System at:
IU4�_.q__e L-ta, c �� °�� _ -------------- . .........------------........-----------.....................
nn /� Locaq-Address 1 or Lot No.
Otvncr dressS
Se :Y. BLS------------------------------ -. c.
Installer Address
Type of Building ' f Size Lot........................... q. feet
U Dwelling— No. of Bedrooms--- I-____`_'-�.-----_-•-_--___.Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ---------------------------- No. of persons---_---.------____-------. Showers ( ) — Cafeteria ( )
04 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. 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........................
-----------------• ---• ---....------•--
Descriptionof Soil R---•----t...&�---..... \\---------------------------------------------------------------------------------------------------•-------------
U ---•-----•---•----•---------•••------•---•------•----•----.....••--------•--•-----•-•-•----------------------------------•--------•--•-•---------•------•------------•--•-•-•-•••----••-•---------•••---
--------------- ----------------------------------------------------------------- ............................... ----
U Nature f Repairs or Alter do s—Answer when applicable
pplicable.-.--.-_.-. YY1-�.._ __.__ °.�� b Zvi+�a �,
�s � �.a- 5�...----. � .. . 11. ..---...I.............
�S Cj
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 Complia e has been issued b the board of heath.
Signed ......... Cx .. .................. ...................... .... .-^°�-0- 1
.-- a ....Apphcation Approved By ..... Dace
Application Disapproved for the following reasons: -------------------------------_------- ------------------------------------------------------------- ------ ...
;�
..._ .. .. .................. .. ....... .................... ------------------------------------------------------------- ................... 3_". ..... 5......
Permit No. -----------9 S 9`� � Issued 3-^�r�0..�.R., - D�e...
Dace
4 -
� I
I
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Di-nVuuttl Wor1w Towitrurtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair (4) an Individual Sewage Disposal
System at:
.
o
........ ,
Loca aon-:\ddress 1 or Lot No.
v
1 t Owner ddress
,�
. InQ° ST . V�rtctS�,n .Yt'l�.
Installer� Address
UType of Building Size Lot............................Sq. feet
�.. Dwelling—No. of Bedrooms------------ _-------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type
of Building __-.__-__-___-------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
dOther 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. 1----------------minutes per inch Depth of Test Pit-.-_-------_____-__ Depth to ground water------------------------
fit Test Pit No. 2................minutes per inch Depth of Test Pit-_-----_----_____- Depth to ground water...-___--.-_---_•----_-.
Descriptionof Soil -- ----------•----------------------------------------------------------------------------------------••------.-----
U •-----••••-•--••-••....•••••--••-•--•-•-•••••---•'•-----•---------•--•-----------•-••••••-•••---•-••-•-•--------------•------...--••---•----------••---•-----••-••••-••-•---••--•.....-••••------•--••-
W ....................................................----------------------------------------------------------------------
U Nature of Repairs or Alter tions—Answer when applicable.._____._.��rn.F ��.�J__.__.
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 Compliance has been issued by the board of hgAith.
Signed .....�..0 ..�-Y'. .`�"`' ^°? ^?J.
1
Application.Approved BY .... 'y-'- ....................
Date
Application Disapproved for the following reasons: ....................................... ........ . ................--------------------........-
3_�a 4 -
Date
Permit No. i -23 Issued .. ... . p. C���.........................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
&rtifi atjt of CIImptianu
TV V IS TO C RTIFY, That th'e Individual Sewage Disposal System constructed ( ) or Repaired (�
by -------- -.. _�-- �.±-.1-- ------------_\ ?. ..�.. (I-)LS------- -
J
at ._ ...._`� o :_ e.�^..... e1 ¢ '!'a ---�--;
has been installed in actor ante with the provisions of TITLE 5 Qf The State Environmental Code as described in
the application for Disposal Works Construction Permit No. .----9_..--73_?_......._. dated �..'..��...`r���..
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.- - --- -----. 'lJ......... - _.. Inspector .. --. ... - ... -
--------- --------- - -_- --•-----I- -- ---------•--�-V- -- -----------------
THE COMMONWEALTH OF MASSACHUSETTSy�
BOARD , OF HEALTH t
�°S'_ 3 TOWN OF BARNSTABLE 4"w a d o
No........ FEE
at uxku �uaiut shun Vrrmit
Permission is hereby granted._a.r.`._�..k........_...:-' :`� � C`.:�_ � _.-
to Construes( ) or Reepair`(A an Individual,(Sewage Disposal System
f ` ' L-- ' _at No.••--••-•••--•-•••- ? �' a'' .--:_... _t4 h<..-----......` -:-------��:.................
as shown on the application for Disposal Works Construction Permit it tNo���-73-_-_ Da/ted�f'__�f�___0.___!.S
— v Board of Health —
DATE....... —
�. -- 9S----------------------------------------
FORM 36508 H088S 6 WARREN.INC.,PUBLISHERS
TOWN OF BARNSTABLE
LOCATION l G LO SEWAGE # /5-73
VILLAG ��� ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.Gjj�o Oew1,e,cA , +-7'7--D347
SEPTIC TANK CAPACITY 1 0 n
LEACHING FACILITY:(type) I-- , ` }. (size)
NO. OF BEDROOMS _P L OR PUBLIC WATER_
BUILDER OR OWNER 0
DATE PERMIT ISSUED: Y 4 1000 -6 1 5
DATE COMPLIANCE ISSUED: 9 I
VARIANCE GRANTED: Yes No
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