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THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: C
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PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Jv/
Application for Migooar *raem Congtruction Permit
Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) ❑Complete System r! Individual Components
Location Address or Lot No. 13 (#2 6) F etn b t o o h L n Owner's Name,Address and Tel.No.
Cente,,vitte Bob S.itk (508) 778-4783
Assessor'sMap/Parcel 208-85-10 26 Fennb/took Lane, Centetvitte, MA 02632
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Nwtthenn Sea.2coat ng 9 Paving, Inc. Same Nokthvtn
Box 995, Venn.i M 0 639
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building Hou,5 e No. of Persons Showers(2 ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date 12122199 Number of sheets 1 Revision Date
Title
Size of Septic Tank 1000 Gatton Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) Pump 9 n emo v e existing
1000 aatton teach pit and .inztatt new SAS
(3 Cuttec 3301z with 31 .5tone) - .see 5ketch
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been i d by ealth.
Signed Date 12122199 Qq
Application Approved by_ Date
Application Disapproved for the following reasons
a
Permit No. Date Issued
' 4 No. / / ` 50.00 /Z
THE COMMONWEALTH OF MASSACHUSETTS Entered inlcomputer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
2pprication for Migpool *pgtem Construction permit
Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) ❑Complete System Individual Components
Location Address or Lot No. 13 (#2 6) P e)tn bno o k L n Owner's Name,Address and Tel.No.
Cenxenvitte Bob S.t,Ch (508) 778-4783
Assessor'sMap/Parcel 208-85-70 26 Pennbtook Lane, Centetvitte, MA 02632
Installer's Name,Address,and Te1;-N6' Designer's Name,Address and Tel.No.
No,%thenn Seatcoat.i.ng 9 Paving, Inc. Same Notthenn
Box 995, Denn.i 9$ ,3M8- 4 439
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size I sq.ft. Garbage Grinder( )
Other Type of Building Houd e No.of Persons Showers(2 ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date 12122199 Number of sheets 1 Revision Date
Title
Size of Septic Tank 1000 Gatton Type of S.A.S.
Description of Soil
-Nature of Repairs or Alterations(Answer when applicable)t Pump 9 n emo y e ®x.i,6 t.i,nq
1000 oatton teach o t and .i.natatt new SAS -
(3 Cattec 33014 with 3' atone) - zee z ketch
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been isgmd by of Health.
i, Signed Date 12/22199 q
Application Approved by_ d1. Date �? - Z 7-/9 .I
Application Disapproved for the following reasons
Permit No. Ffc Date Issued 17 - 7
---------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS ,
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( )
Abandoned( )by _,e c, ,V-4R,, `.- f, ,wt
at L-a-// 3. >- d Fe r n 6 'F II . 1 n l 44 Al� I/�-V has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. 9- a'/ildated
Installer Designer
The issuanqeo,f this pe t shall not be construed as a guarantee that the ssysp,0will function as designe�d/`
Date Z �"' Inspector
---------------------------------------
No. !/ O /6 Fee 'SVt
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS
lwigpogal *pgtem Construction Permit
Permission is hereby granted to Construct( )Repair( )Upgrade( L-)-Alandon( )
System located at L o`f 13
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this ermit.
�y
Date: Approved by
l �
1/6/99
NOTICE: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only.
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS)
I, T ^� '^ ' , hereby certify that the application for disposal works
construction permit signed by me dated 12- a� 95 concerning the
property located at meets all of the
following criteria:
• The failed system is connected to a residential dwelling only. There are no commercial or business
uses associated with the dwelling.
• The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch.
• There are no wetlands within 100 feet of the proposed septic system
• There are no private wells within 150 feet of the proposed septic system
• There is no increase in flow and/or change in use proposed
• There are no variances requested or needed.
• The bottom of the proposed leaching facility will not be located less than five feet above the
ma..dmum adjusted groundwater table elevation. [Adjust the ;oundwater table using the Frimptor
method when applicable]
• If the S.A.S. will be located with 250 feet of anv vegetated wetlands, the bottom of the proposed
leaching facility will not be located less than fourteen(14) feet above the maximum adjusted
groundwater table elevation,
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information) "7
B) G.W. Elevation Z Z _the High G.W. Adjustment .3• = 2
DE rrRENCE BETWEEN A and B 2 f
SIGNED DATE.
(Sketch proposed plan of system on back]. (�5;KLI-7 W .-
q:health folder.cert
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TOWN OF BARNSTABLE
LOCATIONI 9r,f-� e�°p4/ �y SEWAGE #
VILLAGE_2,e- ASSESSOR'S MAP & LOT D ^d G
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY g5
LEACHING FACU.ITY: (type) (size)
NO.OF BEDROOMS
1 BUILDER OR OWNER
j PERMTTDATE: �'� COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and 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 cility) Feet
Furnished by
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No.!IZzll� y Fxa...v.s.v... ..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
... .. . ............
....1.f-'.f.4 ........ .. .. ...........................................
.).. .. .......
Appliration for Visposal Works Towitrurtion runfit
Application is hereby made for a Permit to Construct (L4 or -Repair Repair an Individual Sewage Disposal
System at:
mon................ F.. .........6:i&4. ......................................... ..............................................
Location-Address or Lot No.
...........
............... jj.�$.J.Ib.__e-------------------------------------- ..........
----- ..... ..............................................
,,owner Address
............ ......P_lLi, ....... I . _r
W sc&-U .............................N. ....
.................. Installer ................................ Address----------- -------
Type of Building Size Lot feet
U
Dwelling—No. of .... No. of persons...... -----_----------- Shower
Bedrooms___-----_.. Expansion Attic (IVO Garbage Grinder QJZ
a
er—Type o �
Other f Building _WO.a2 s (A) — Cafeteria (40
r i t
Otherfixtures ------------------------------------------------------------------------------------------------------------------- ....;.,.................. ...........
Design Flow............el'.3-a..................gallons per person p day. Total daily flow.._..._...._,..J.........................gallons.
WSeptic Tank—Liquid capacity.I.OV.*allons Length__....3 --
......
.......... Width......&...... Diameter-------4...... Depth.....9 .
Disposal Trench—No. Width.................... Total Length.................... Total leaching area-_Z.44...sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. f t.
Z Other Distribution box (YI) Dosing ( ) I
�4 Percolation Test Results Performed by._64_�e .... -U, C.......................... Date....//—All/�;U------
1.4 Test Pit No. I....... ..).L.-minutes per inch Depth of Test Pit.................... Depth to ground water------
P-4
Test Pit No. 2................minutes per inch Depth of Test Pit..._..........__.... Depth to ground water-.-_--_--__------__-___.
(lj ............................I......................,. ............................0............I................... - -----:-- ----------------
0 Description of Soil... ...... -- ---------------a--......1_;X_ r,�
...............7.............5 .... ..
--------------------------*------------------ ------------------------------**-------------------------------------*---------*-------------------------------------------------------------------
........................................................................................................................................................................................................
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 TLITLIZ4 5 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.... ......... .�Z...................... .......................... .......... .... ............
Da -
ApplicationApproved By........... ................ ..... ............................................•..... -------- ----------
ate
S gn d----
i e -------e--------------------- ------
a
ate
ApplicationDisapproved f WS re ................................................................................................................
.......................................................................... .. .........................................................................................................................
Date
PermitNo.......................................................... Issued.......................................................
Date
FES.........................
THE COMMONWEALTH OF MASSACHUSETTS
_ BOARD OF HEALTH
- -�2rt ................OF..: ...An.-v.t `f XJ.. � -----.-.--..-.-------.---.--.--.-------•----
Appliration for Disposal Works Tonstrnrtiun rrrmit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at:
Location-AAd,�L drress or Lot No.
_... _ -a->.4.i;L-- ...................................... (.!IeZA
Owner Address
+
a � ..,,{.... ?�215. ........ ..........•--•..._...... �t__r--. -----------------
Installer Address d �-
Type of Building Size Lot.......t ._-.2!2 Sq. feet
U Dwelling No. of Bedrooms-•_------. Expansion Attic
� g— --------------------•------- P �,IU) Garbage Grinder �v)
aOther—Type of Building _ dLt- -.lob%..... No. of persons___. -_--------------_ Showers (,� ) — Cafeteria
Otherfixtures --------------------------•---------•--•---•----------•••--••-••••••-••-----•-----•-----••-•••••............--
WDesign Flow............ ...................gallons per person per day. Total daily flow-__------.,._.J..........................gallons.
WSeptic Tank—Liquid capacity.40".gallons Length................ Width..... ........ Diameter......4------- Depth....!._...._.
x Disposal Trench—No. Width.................... Total Length.................... Total leaching area...,'2. -4. q. t.
....s f
Seepage Pit No..................... Diameter.................... Depth below inlet_................. Total leaching area..................sq. ft.
Z Other Distribution box Dosing_ank
'~ Percolation Test Results Performed by.. .!'. _ ...... .. � _.�.........................
,-7
Test Pit No. I....�--__ _- minutes per inch Depth of Test.Pit.................... Depth to ground water.....
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
._.................
-------- -----
x Description of Soil Q ._....�. .-c '. ...-- ?. . : �.,r • . .......
r $s° t ui
V -----------------------------------
•------------------------------------------------------------------------------------------------
W
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 TITI.j 5 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. q `
Signed _ ---- �� •-•---....-•----•---............ ---t- .
te / ... .D f.-
Application Approved BY ._�""".....---•----------•---------------•-- ----;r!�----..7----Y--- --------
Application Disapproved f 8gca{e- v owl..re
-•-•-•-•-•-•-•...._..---•--•-----•-•--••------•-•----•---•--------•-•.... .. "--•-••------....-•-------'------••------•----••••--•-•--•-......-•-•-•...........................•--.Date
PermitNo....................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........... ..li".'` ...........OF........ �t.��vf..5.?`:�z : :..............................
Mardifirtt#r of Tnntplianrr
THIS IS TO RTIFY, Tha e Individual Sewage Disposal System constructed ( or-Repaired ( )
/ '' C
__3......... ............
.....l11_. �t� '�y r'�r
at.............. ....:---•-------------------------------•----•-•------------------•-----------------------•-
has been installed in accordance with the provisions of TI7/ �5 / The
State Sanitary 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............................l..r� ......................... Inspector---
.........................•-----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
1- t........OF......./' : !x a.......................
No. ... ......... 7 FEE.. ....
Disposal sal Work (tons ' n permit
Permission is hereby granted......_..._ti .. � ..._. � Ef. r_....
to Construct 1 or Re air ( ) n Indivi ual Sewage Disposal System
-
at No............l•--••• `tit .............................
-------------------------------------------------
Street
as shown on the application for Disposal Works Construction Permit No.___-.,:• .... Dated..........................................
---
Board of Health
DATE.............................................................................
}
FORM 1255 A. M. SULKIN, INC., BOSTON
<�1►JGlL— F.AMI►-Y - .3 BCORooM �oN i1
►,Jo GARBAGE (�QJ1.1DE�iZ. I� IpQ
p/s►Ly y o w a 11 o x 3 -- 33 0 G.P O 15'd�3.. ' n
SEPTIC. TANK a a3Oxl5o�. =•495G,P. o
►000 �A�. \�1� � 99.9 t12,�.g ..
0►SPo5AL P►T SSE 1000 GA1-• ` Thl•
5�c�wA�L AQca. * I,os.F •o�. �, � ,qg ., �.
BOTTOM laREAj j�c S,F. I \ � "
t 50 5.F x 1• o s' 5o G.Po lLl �' /�z- ._.,� \ ' -g� ;
'T COT A�. D r&51F.N * 42�j G.P P. /'
S f z.
} -roTAL DAIt�%( FLOWI 3306,P0,
P�R,Go�t►TIoN 9ZATE.t.,l''IN ZAN 0P_L�55
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y.^ �p DAVID �yG sl
r� AluHARD G� 3 C. .0 /v
A. .. o THULIN y 3
j;- P.Ax'f ER No. "9976 y , j
240M 9 �(/4� I DDT lot o O 11 `
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loco Iw- fyw sy.^
SvI pL d BST' INS' bCPT►C _ PETER
.L 1 aoo IN r uK �{9'!o TANK c^ suar%Il"� �� f
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No, 2'1'7J3
LE.AG41
PIT INV. INV. P� �s Tr
WITH q8.2 �4 t�'•`�1�lpNAmob
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CEtZTIPIG0 PLOT PLAID
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31 i WATTRE F E BEN C E ;
► C E RT F Y T H AT T N'i= t�flvSE 51do 1rYN ( i
' �AER6oN COMPL�(5 y�IITN'THE SI V�LIN E 13 !I
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DATE G SAATEee WYE INC•
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►,Iot a,.rG u5E0To RETE.R1!\I►�� LcT -II.1E`j APP%_1C �T' ' I "•j '
0 C A T 10N SEWAGE PERMIT NO.
Loi #/3cr�,., h<ao k ��' ?9 7
VILLAGE
C-�4-cr u !f,
"'ANSTA LLER'S NAME i ADDRESS-
S-S�
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B U I L D E R OR OWN ER
FDA T E P ERMIT ISSU E D _ G -
DAT E COMPLIANCE ISSUED
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LOCATION-
�� ZfY _ SEWAGE #
VILLAGE !icerz/Li ASSESSOR'S MAP &
INSTALLER'S NAME&PHONE NO.
EPTIC TANK CAPACITY / 6Csz1
liTEACHING FACILITY: (type) �/ •�.�''i (size)
NO.OF BEDROOMS_
P,
BUILDER OR OWNERS * L �
PERMITDATE: I '� f COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and 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 cility) Feet
IL—Furnished by L
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