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TOWN OF BARNSTAB�E
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LOCATION Omc)a tdaA) _SEWAGE #/49
VILLAGE ���, , .-. ASSESSOR'S MAP & LOT 9 4, �
INSTALLER'S NAME & PHONE NO. �
SEPTIC TANK CAPACITY I ®V
LEACHING FACILITY:(type) ( Xx L,c,"` (size) p-3/.5,}o•.c.
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED: �" <
DATE COMPLIANCE ISSUED: '��✓ `mom
VARIANCE GRANTED: Yes No
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la, 4 -�:- ILO<�- I-�' F(-,,
'ATION SEWAGE PERMIT NO.
VILLAGE I
1 �— l
ug 0-5
INSTA LLER'S NAME a ADDRESS
S U I L D E R OR OWNER
40
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED
J
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No...._.. ✓'� FRs.......-............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Di-npinial Works Tomitriirtiun remit
Application is hereby made for a Permit to Construct ( ) or Repair ( (J—.an Individual Sewage Disposal
System at:
d,��C�QC.�S (-------- ------ -------------..
Locatio Addr s �_ Lod o �Q J
' •.._ .................................................
161"X _j ( f_0 6AZILP �-e
I — � s :
Installe Address
Type of Building Size Lot............................Sq. feet
Dwelling— No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons--------------------------- Showers ( ) — Cafeteria ( )
Otherfixtures -------------------------------------------•----•-------------------------------------
W Design Flow------`�5 7...........................gallons per person per day. Total daily flow...? _ .......................
WSeptic Tank—Liquid capacitv............gallons Length---------------- Width---------------- Diameter---------------- Depth..............
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No......I.------------- Diameter.._..1.0-1...... Depth below inlet--- Total 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-.___-.------__--.--
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
fx ..............................................•------•----•----------......-----••---•----••----•--•.........................................................
0 Description of Soil........................................................................................................................................................................
W
U ...................................................-•---------------------•-------------••---•------------•---------•-------••-----•------•------•--•••-•-----------••-----•---•-•---••......--•----•---
W
UNature of Repairs or Alterati s—Answer when applicable. :: ... 060 ��T 0 4,5
......Z3�--••••---------•--•----•ezca s T.--�c
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 furth r agrees not to place the
system in operation until a Certificate of Complia d by the board of lth.
Application Approved .. -----...�...- --------........... ..._......_....._.. - "......... iL
Dace ��7
Application Disapproved for the following rea,rons: ........._..._...............................................:
................ . . ..............................................................------------ ------------- ---------------------------------------------------------------- ........................................
Dace
Permit No. ................... Issued------------------------------------------- ----
ace
- I (oq o( If) t vV
No.................. Fims....... ...... J
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
A liration for Uhn wia�� }� 1 Wurltii Cnowitrurtton Vrruttt
Application is hereby made for a Permit to Construct ( ) or Repair ( _an Individual Sewage Disposal
System at: / „
............Iq.....j .: Q.r�,-cO
��i ,!. �Locatio�l�i\dds t �Mo��ior
......................_.....--------- ------- ._.._.._..-------•••-•......--•----------•------ •-•--------------------•-----.._..._.........A ...............................................
Q I /� �Oavner ,r7/. Ad'ress -----••�-•-�----_--
W aj) Ct► t J' \ t�C----c..-- ---- -(/Z--v Address
��•-- -
................ ,
Installs
UType of Building .z Size Lot............................Sq. feet
Dwelling—No. of Bedrooms-----=f?: .................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Otherfixtures ---------------- -------•----...---..__._....---•-----------.....----------------------..._...........----••••----•---•-----•---••••----...._..
w Design Flow.......5_,�_>
------------------------------ per person per day. Total daily flow---.`M_�-7___0.......................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......I-------------- Diameter---_.�_(�.�.__.__ Depth below inlet... t.............. 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........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
Q,' ...................... .......................... -•----•-•-----•-•------•------------•--------••••-........................................................
0 Description of Soil.......................................................................................................................................................................
x
�.,
w
VNature of Rep irs or Alterati ns—Answer when applicable.:�1AG?7aA_��_..-1 OCR �`� �: 06
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_hes+een- sued by the board of dlth.
Signed ...........
... `�..-----..... Dare
Application Approved CBy..............�--- --- .-..... - ..........._... - - ........
� Dare
Application Disapproved for the following reasons- -------------------------------------------1...........................................................................................
........................---------------.............---...---------...--------------...-----...------.....---------------------------.._................._.---------------------------------....-....---. ...----..-------------------------------
/� Dare
Permit No. .G,�...--a .................1./ Issued "'.. .'.�" ---------��.�
Dare
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
T.Ertifiratle IIf Tontlatiance
THIS IS TOl CE TIFY, Th t thvl'ndividual Sewage Di pposal System constructed ( ) or Repaired ( 4--j__._...
by ----------------------- -Q-.,f l�- r'---- C _ ---`----------- - .-----------...'--------------------------------------------
at ................... - -�........ ...�,u_C�(�C':� -'_.�l f�c` ,{ C `�/�..-1.1-- _----------------------------------------------------
has been installed in accordajcce with the provisions of TITI_E_5 of The St at Environmental Coe as described in
the application for Disposal Works Construction Permit No. _. dated
J
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
,/�'
DATE....... """....,/��"/....................................... Inspector ---- f. /" .. /Z- -�
-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
No.. FEE .....................
/�>aa�����r#'. n �erutit
Permission is hereby granted................. �.. .....-E... �-- G - -_] - G�
to Construct ( ) or Repair ( ) an Indivi..a Sewage Disposal System /
_....__...............................r...._ ....._....____ .._..t..........................
Street
as shown on the application for Disposal titTorls Construction Permit Nd.' Dated___ .... r--r..✓�' --
...•--•-----------rC.= --- ..--•-
Board of Health
DATE......... -------�------------------------
FORM 36508 HOBBS&WARREN.INC..PUBLISHERS
Fxs.. .........
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
....773�✓iv.....................0 F.. � s r�9 B_�o
App iration for Dhipaiial Warkii Toutitrurtiou ramit
Application is hereby made for a Permit to Construct �_l or Repair ( ) an Individual Sewage Disposal
System at:
................C G c1...... �'�:� QQ ................................... ......... T �y. ......T:�.....................................
__....
Location-Address / or Lot No.
//A Owner Address
Installer Address
Type of Building Size Lot.._/�.cl/�.._.._...Sq. feet
Dwelling—No. of Bedrooms___..._.....................................Expansion Attic Garbage Grinder k-01)
04 Other—Type of Building ............ No. of persons---------- Showers ( ) — Cafeteria ( )
Other fixtures --------------------------------__
W Design Flow..........................Z1�...........gallons per person per day. Total daily flow--------------- .a
........................
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------ %C __._..t3. .......................................... Date.......�.-ls-...........................
Test Pit No. I........_-2_....minutes per inch Depth of Test Pit----_/__;--........ Depth to ground water.._.�._.ti011-P
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-.-_-______-____--____-.
R+ ----------------------------------------------------------------------------•---------------------------------------
--------------------------
-----•---
O Description of Soil-----------------.0..'�........_Go 9:,"? __3` .5'0-,0ZU/L.__.-__---
--- .....-•------ --------••----•••---••••-••••--•----......--••••-----------------
ti
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 provisio of TITL: 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation it a Certificate of Compliance has been issued by the board of health.
................................ -�-��.-.�:�........
/Datee
)cation Approved BY -•---• --- ...................................................... l `�-�� '
Date
Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------------
..........................................---•------•---•-••-------------•••---•------------••............----•---•:•-•--••----•--•-•---•-•-----•-•-------•-----------••-•-•---••-----------------------
Date
Lg
n rmit No............ ..�� Issued...
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...7G.......'v...................._OF...�-�7/i.
Appliratiou for Uhgpaiia1 Murkfi Tamitrurtiun Kermit
Application is hereby made for a Permit to Construct (__) or Repair ( ) an Individual Sewage Disposal
System at:
...... PP C...... (a ('57
.-•-•---------------------••-------••----------------...............
Location-Address or Lot No.
Z147
62"
�. .. act.c</�:..........T!.....r------------•.......... ..........._-...........:7 P�::'....�-----..............................................
--- -
/ Owner ...Addr457 ess......................••---•--.............
Installer Address
d Type of Building Size Lot----.. .........Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic (,'15 Garbage Grinder (Nd
C14 Other—Type of Building ............ No. of persons.._..._..3.............. Showers ( ) — Cafeteria ( )
a Other fixtures -----------••-••-•-•--••......•.
W Design Flow........................... ...........gallons per person per day. Total daily flow................33 c 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.....:Z.n<A......0 lI/?�'t............................... Date....... s:..._....
W
a Test Pit No. 1........�--.-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........................
a •••••••••--•----••---•••-----•-----------•-••••.............•--- ----------=---•-----.--.---..-----------------------------------••---------------.-----
O Description of Soil..................62..-0.......... .li--'-9 ' S 4e so I e-
........................ --------------------•---••••••••-•---•--------•---•---•••-•--••••----..........•••---
'r�i o7-%_�- &lPA , S--2-L-_-)
U --•••-••-•-••••••---•--•••-•------•-•--•--••-•-•-•-••-••---•--•-•--•-•--•-•--•-•----••..............••---•-••---------••••••----•••-•-•••---•---•-•----•••--••••............-••----•---...
W •
UNature of Repairs or Alterations—Answer when applicable..............................................................................................
..............
Agreement:
The unde agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions iL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
gpe on un > a ertificate of Compliance has been issued by the board of health.
----.— .. .. .........................................................
\ /
.. ................................
� Date
Application Approved By. ....y- ... _ ........... . .` ��
Date
Application Disapproved for the following reasons:--•-------------•-••--•---•--------------••------...-------------•--------------------•-----••............--....
------•----------------------•-•-•-------•--•------•---•-•--•-------------------------......---------------•--••--------•--•----•---•---•-------•-----------------------••-•---•-•---..................
No-------------------- '... - Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.............................OF.....................................................................................
�rrtif iratr of Tampliana
THJS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( )
by........... -•--1.g�:(......- ---------------------------------------- -------------------------------------------------•---•------------------------------.........--------..........--
at. L\ I taller '
o j !j .... �n�v_..L<
has been installed in accordance with the provisions of 11_m E j of The State Sanitary Code d scribed in the
application for Disposal Works Construction Permit No... :�_�G �' �
•---------- dated__- -/ _- --
THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONST UEID AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.............. ---------•-2---..... ................................. , Inspector.................e------- •- �--.�......._......_._....._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.............:....
NO.....:.................. FEE........................
Permissionis hereby granted. ............................................................ ....................................................
to Construct 0/1 or Repair ( ) Indi idual S wage Dispos System
at No. -I ?� � ..........................................Q- ....S _,
` y�-••-------••----------• --------------------
reet ----- r
as shown on the application for Disposal Works Construction Permit_N ___________________ Dated-_____ _:_:`��....................
•-"`"-""' '• Board of Health
l " � -- �
DATE. ------•••••• < ,
--"FORM 1255 HOBBS & WARREN,'INC.. PUBLISHERS 4S.
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IJo ,GatZgAGE- GwNDE1Z. --- ..._ ,
?/>IL�(, P L o W z I10 X 3 = 7306.R»
SEPTIC TANK = 33Ox15C>% =,4956.P.
U$E- 1000 64lEzT 2 .
ot5Po5Esva
W PI ARG 5C '1 0o GAL. �I 3� oV: 5�'cm �
,;' '7vTA1- .17E51GN = '���' ' G.PD•
-TdTAL pA l LY FLOW = 330 G,Pt)
Pa ZGOLATtOu RATE: I"IN 2MIN o�L>✓55
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