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S M E A D®
KEEPING YOU ORGANIZED
No. 12534
OINITLATIVE
2-153LORNAILE
FOR AESfRYWMIN.RECYCLED
CONTENTIO%®
oCert asr1pr morSooroiag POST-CONSUMER
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MADE IN USA
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TOWN OF BARNSTABLE
LOCATION yCi�` vi e. SEWAGE # ~'
VILLAGE � L�� '% j ASSESSOR'S MAP Cz LOTZO2'_`4,`B�
INSTALLER'S NAME PHONE NO.
SEPTIC TANK CAPACITY &60 66i L.
'
LEACHING FACILITY:(type) Pi (size) L
NO. OF BEDROOMS P R PUBLIC WATER Put
BUILDER OR OWNER
DATE PERMIT PERMIT ISSUED: L
DATE COMPLIANCE ISSUED: dd
VARIANCE GRANTED: Yes No : G
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' ..t��'..APPROVED THE COMMONWEALTH OF MASSACHUSETTS
Barnstable onservation Oepattmen2 BOARD OF HEALTH
:yTOWN OF BARNSTABLE
si � lirtt# �t for Di-tipuuttl Wor1w Tomitrnrtiun Permit j
Application is hereby made for a Permit to Construct ( ) or Repair (V) an Individual Sewage Disposal
Zystem at:
i ,
S --------------------------- ------ 4. .
Location-!\ddress or t No.
Owner - ddre s,
.`'. ' c%� �f. Q Vic, sLtc ,. c..�...
Installer Address
UType of Building Size Lot............................Sq. feet
t-, Dwelling— No. of Bedrooms.._..- a......................_..._..._Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons-_-.__.-_.-_____--____.-:--- Showers ( ) — Cafeteria ( )
0.' 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........................................
a
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........................
9 ....-----•----------•...-------•-----------------------------------•----------------•.
0 Description of Soil-----------;- ------------------------------•-----•---•--------------------------------------------•------------------------------•----------------
x
U .-----------------------------------------------•-•------------------------------------------------------•-----------------------------------------------------•--------------...---•-------•-•--........
w
x
U Nature of Re airs or A rations—Answer hen �pplicable.,__ _. plc-2._ a c�L ... ...►:.
Agreement: t ,
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 CompliAQce has been iss e »I o d of health.
Signed �' ...................................................
. .......................... . .D..lt .`..I
Date
Application Approved By ...... ..... ............ ..a- -.-..�`...
JDate
Application Disapproved for the follow' reasons: .........
....................... ........................................................................................---...................... ------------- ----------------
Dare
`-. Permit No. ........ .' ................... Issued ------.....................---------------------------------------
Date
—=——— - -
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Trrtifutt#e of GraplianrE
THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired
by ------ r c? '�_. r-.c-z� - - -- -
--------- .... ----------------------
----------------------------------- --------------------------------------------------
----- Ins[-nll-e-r
at ............... :..... -------._ ---------_----------------------------------------------.....-------------------------------------..............................................
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. ----- '/------------ dated ..................-...._----------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTI UED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE ........!�- - / Inspector „^ ." /
---_-----------------------------------------—----------------------------------�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
c� TOWN OF BARNSTABLE
No......! FEE..,—.3U...........
%postt1 Works Tuns#rudion rlerntit
Permission is hereby granted._.__._cJC --.....".......................................
to Construct ( ) or Repair (V) an Individual Sewage Disposal System
atNo..... \ Q \C�. .S�!M.--•• '------••-----•----•-------------- ---------- ------......------------------------------------------•---.............
:r=
Street /
as shown on the application for Disposal Works Construction Permit No._ ___:-(�._�y__.. Dated...........................................
= /
............................... ( Board of Health
DATE.................-�1.--'=--�-�----c�--.
FORM 36508 HOBBS&WARREN-INC..PUBLISHERS
3.
FE$... .C��.....-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
2 _� _5 TOWN OF BARNSTABLE
Xpli iratiou for Diupuutti Work.6 C vastrurtiun ramit
Application is hereby made for a Permit to Construct ( ) or Repair ('�/) an Individual Sewage Disposal
System at:
-----------------------------=---- Z
Location-Address or t No.
,Wa _.C> Mr— .vncr ....1 ����_ adre�sS'1 C.3-
Installer Address '
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms....-- .t.................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures .-_---------- ------------- •-----..... -e---------...------------------------. ---------•---•--......-•-•---••----••----•••-•-•.............
W Design Flow..................................--------gallons per person�per•d'ay:..Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity.....; .gallons` `" Length_______________f 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
Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
Gi, Test Pit No. 2................minutes per inch Depth I of'Test Pit.................... Depth to ground water........................
-.--------•---------------------- ------------
0 Description of Soil..........�.c,. J-
x
U --••---•---------------------------------------------------------------------------------------. ---------------------------------...----------......--------------------••----`--------------------
W
-------------------------
U Nature of Repairs or A.t.qrations—Answer when applicable.-._.___ _ `Ca.� �_...__C V. .._. .....
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 ce has been iss - of health.
Signed - — -----------....... ...................... ..... a..� .�...� ..` �. ..
Dace
Application Approved By .............. .. ` ........ ....� ..
Application Disapproved for the followan� reasons:
........ . .................................................................... . ...................................... . ...........-----------------------------
Date
Permit No. ........9 -------6------------------------------------ Issued ........................
Dace.. ....................
No...•/ (IL'" —3 OQ 66— �76
,^,Ff' 15VED
6arnstable Conservation DepartmenjHE COMMONWEALTH OF MASSACHUSETTS
,9y BOARD OF HEALTH
igned Da OWN OF BARNSTABLE
te
Alip ration for Diripoonl Wi orbi Tonotrnrtion rantif
Application is hereby made for a Permit to Construct ( ) or Repair (4< an Individual Sewage Disposal
System at:
....... �............... .. �Gy�.
............
Location-Address or It No.
` f�� c�idL�/�.J� /J
C .
O:cngr .�� o� Address
W 1 '= Gi'B!1!J``% 7 6 J L��?.�cci`� � . /_��. i �1 t GZ .� ./1�1'
---• ................... .��----••---•-......__._...._..•.............................. .........................................- ---' ._- -- ---.._........_.......
Installer Address
UType of Building Size Lot............................Sq. feet
1--4 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---------- .P...................gallons.
WSeptic Tank—Liquid capacity400_...eallons Length--.-_- __--__-- Width--------------- Diameter._...-.-..-_.__ Depth................
x Disposal Trench—No. .................... Width_.................. Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No------- - Diameter......1�=P.---
Depth below inlet------- '._._--- Total leaching area.................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by-------- -------------•-•---•••-----•--•-•---•-•--•--•-----•--•---•-•..... Date........................................
Test Pit No. ]................minutes per inch Depth of Test Pit.................... Depth to ground water........................
fZ Test Pit No. 2................minutes per inch Depth of Test Pit..----.._.______-._. Depth to ground water........................
0+ --------------------------------- ----- .........................................................................................................
0 Description of Soil..................... - ..........................
--...... c +,r L-----------------------------------------------•--- -----
x ------f,, ------- --- -----------------------------
U Nature of Repairs or Alter tions—Answer when applicable.____. - 14 0---_-.-tea®
�,,, �.
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 Complianc ha bee is ed b the board of health.
Signed ......� s/
Dare
Application Approved By ................ ................ ...... ..._, .a.. .�
Application Disapproved for the following rearons: ............ ................ -- ........ --......... .... . ............................... ---. .
............ ..................................q.................. . ........ ......-------........................................... ........ . . . . ........................................
PermitNo. .........1.... ..�`S�..................... Issued ............... ........ ..............................te......
Dace
THE COMMONWEALTH OF MASSACHUSE17S
BOARD OF HEALTH
TOWN OF BARNSTABLE
. (
ertifirate of
gornplianre
THIS IS TO CERTIFY_That the Individual Sewage Disposal System constructed ( ) or Repaired ( N<-')
-------------------- ---------- ------- ..........................................
h,:u« - - --00
at ....................................... ....... /n
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. .....�.Lr/--.6..�......... dated ...
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
i. SYSTEM WILL FUNCTION SATISFACTORY.
DATE... .'-'.....__._.... '�'".__. .. ....._. Inspector^..G ..........._.......... ............ ..............._
--.-.__,---------------.--_----------------_,__----------_,---_-----_
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE -36--
No...1l7..7: - FEE........................
t n tt1 �ork,5 Tonotrurtion Wrnttt
Permission is hereby granted------------ .--e-.'�_-.-.----C '�.---$--! --G'��1
---------------------------------------•---
to Construct ( ) or Repair (� an Individual Sewage Disposal System
at No..............-------------- �1 �5,�..Z o.i ;�G /ii..�F- f /!L....�.J. ��z w?'f.�J/ct
Street
as shown on the application for Disposal Works Construction Permit No.- -.y.66---- Dated......1-4, ------ a.7. ......
Board of Health
DATE.................. ----
/ --------------------------
FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS
t9� -�S i 3 - ooy o�- ,�G
No.._! .._....... c� Fss.......
THE COMMONWEALTH OF MASSACHUSETTS
e2 )�2 9y/ BOARD OF HEALTH
TOWN OF BARNSTABLE
Xp4ifirativit for Diri inial Worlw C owitriartion tIrrmit
Application is hereby made for a Permit to Construct ( ) or Repair 0< an Individual Sewage Disposal
System at:
....... .. ....-- ..........I I- ... --
----------------
Location-Address or Lot No.
66
•-•-•--•---••------------•-----••........................................................ -••-----.. ..................................................................................
_ 0. ncr Address
...7.. c e�Ti 7 C!.....l i9 6G.
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 ( )
Otherfixtures -------------------------------------------------------------------------•---•--------- ---...........--------------------•----•••------••---------•-
Desi n Flow.................. �_---_.___---.gallons per person per day. Total daily flow.._-____-__,.
W g g< P P P Y Y -��v-------------------gallons.
. W Septic Tank—Liquid capacityZ�4....gallons Length---------------- Width---------------- Diameter...-_-.-.--_-_- Depth.................
x Disposal Trench--No. .................... Width-------------------- Total Length-------------------- Total leaching area....................sq. ft.
Seepage Pit No......... Diameter-----Z .t_..._ Depth below inlet....... -........ Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed b ................... Date..........._............................
Test Pit No. I................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........................
.................•---------....-•---••-•-•--•-••-•---.......-•----•-•-----•------•---•------•-....••.........................................................
0 Description of Soil..................--�� .........S-U�Ja �, C•G_A-,!i-j__.... -'
t
j ti,S ,.l�...�........
x -
Cs £.1.-----•-----------------------------------------------------•---•-------•---------------•-------•-•-----•---------------.....----•-••-•----..........---
U �..:
W
x -•-•-•-•-•• ....................•---...----------•----------------------------...........---•----•-----••••. ...._... =•. ----•- /
U Nature of Repairs or Alter tions—Answer when applicable �_.--__-- 9�a.-----.tf!. d-�.....!._* !nl -__._ ....
...............!elll.............W ........ T17! ..L......._7�...._.. IJ"T/�v ........ �G,4Vx
............................................
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/h beeeta isssstied bbby2 the board of health.
Signed ----- _(-L...2 ✓1-.........L<.........................................................} .�. '//�/.....���...
Dace
ApplicationApproved By ................. �... .............................................................:----------
Application Disapproved for the following reasons: ..................... .............. . . . .........................-- .........................
...................................................................... ........................................ . ... ..... ........ .....-.. .- . . .... .. ........................................
q� Dace
Permit'No. .... 1...y.........�...may............................ Issued - ..............----.: .........---......... . ....
Dare i
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VIL•LA6E
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IN;ST A 'LLER's NAME i AbbittS'
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