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OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER ��? DATE PERMIT ISSUED: 3I up IQ DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No,, FP 3 1 / I .a . ASSESSORS PARCEL No. No.... ......... Fas..... ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Mu.pn ial W urku Tomitrnr#inn rrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System.at fA --- C....................... ---- M-P.-A........................................... �c �Lo do - s or Lot No. _....... ..... ....... ....... ...... ................ •-----------•------------•------------------------------......---......._..................---•--. caner Address ............................................ � Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms---------- ----------------------_--_-Expansion Attic ( ) Garbage Grinder (: 9 aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Otherfixtures -=------------------------------------------------------------------------------------- ------------------------------------------------------------- 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........................................ 1..1 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........................ R,' ----------------------------------------------------------------------------------------------------......................................................... 0 Description of Soil....................................................................................................................................................................... x U ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•••------...--•------- W -------------------------- -------------------------------------------------------- ------------------------- U Nature of Repairs or Alterations—Answer when applicable.---1. J4Sl.r.___ ..______ ..___.... -------------------------------------••••....-- 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 Comp 'ante a been is he board of health. - Dare Application.Approved By ... . ----- ------------- 0...... —...... ............. ............—" --'---'-------- Dace Application Disapproved for the following reasons: ---------------------------- - - -...... .... ............ ..................._.................. / a Permit No. ------- Issued -------- /- ---------'--Dace...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Gertifirate of (fantylizince TO CERT—TF'Y,—,That the Individual Sewage Disposal System constructed or Repaired by ............—r-----P—.\ --------------- ---- ---------- ------) ---------------------------------------- Cn at ........(31--------------------------- N ---------------------C.....! ........ has been installed in accordance with the provisions of TITLE 5 of De Stgse Environmental_Code as described in the application for Disposal Works Construction Permit No. ----Q—A) dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE/CONSTRUZD?AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ✓ --------------------------------------------------------------------------------------------- Inspector.............................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.-- �).......... FEE---- ......... ut-stp"d Var 121 ............... ............................................................. ----- 4 Permission is hereby grante� �-� to Construct or Re air (Vf an Indvvid# Sewage Dis OSM, System % osl�. .�. ...... at No. 12)i 0— ................. ---- ---- -- -- ---------- ---------------- ------ ................... Street as shown on the application for Disposal Works Constructi Be--rmit No. .......3- 1.4,-0. 12 ............ . . ......... oard of kd'it DATE......... -2..................................... FORM 36508 HOBBS&WARREN.INC..PUBLISHERS No.. .......J--�- �. F>�$....._..................... I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Biij-p l Sal Workii (foutitrurtiun Farm# Application is hereby made for a Permit to Construct ( ) or Repair ( (/)Xan Individual Sewage Disposal System at: _ - - � m �`2-.---.......-••-----•-- y � -------� -�=----------------------------------------------- Locatiotr ss or Lot No. ; y c 1�- c --------------- caner ........................................... Address Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms____.______ Expansion Attic ( ) Garbage Grinder (()f-) --- - - aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Q' 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..------------------------------------. r-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........................ a ---------------------------------------------------------------------------------•------•-•--------......................................................... 0 Description of Soil----------------------------------------------------------------------------------------------------------------------------------------------......................... W U ---------------- --------- ---------------------------------------------------------------------------------- r -------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable_-_- -__.._ _. _.9'&Nk,-�......._,� ____________� �C1' ......... 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 further agrees not to place the system in operation until a Certificate of CompCance a been issrred--bNhe board of health. j Si ned - �� Iq� g - o -e - - ---.�..,------R ---- Application.Approved BY - !1/l C -------- -- .................. Application Disapproved for the following reasons: ..... . . -- .. ... ....... .... ....................................°-----------..------------------------------ ------------------ -- ------------------------------------ ---...--...--.....-....---------..-.-..---------------------------------------------- -.-------- /�� L' Dare Permit No. ..... 1-... 7 .. ....... ....... Issued -..- =� ------------------- f Dare j