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PER IT NO.
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VILLAGE
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INS.LA l ER'S NAME A DO Rp S
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e U I L D E R OR OWNER
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED
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THE COMMONWEALTH OF MASSACHUSE77S
BOARD OF HEALTH
...............TOW-17....0 F.. 0 0 2.�5 .�)c.............................
Appliration for Bisposal Marks Tonstrurtion jinmit
Application is hereby made for a Permit to Construct or Repair (><) an Individual Sewage Disposal
System at: 0,
............... ..................................................................................................
/L r.e) ...........C=Jln�bi O
Owner
C c......................................
rw .er e............6.
_ .b
...........................................
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder
P4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria
Otherfixtures ............................................................................................................................
Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
1:4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter.--............. Depth..............--
W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area----_-------------sq. f t.
ZI
Seepage Pit No..................... Diameter.--.........---..--. Depth below inlet............._...... Total leaching area..................sq. f t.
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.--....--.....--.....--.
f3. Test Pit No. 2................minutes per inch Depth of Test Pit---....._......._... Depth to ground water..--....................
...........C.'�. ..........d............................. I--------**----------------------------"..................................................
..................... ... .... . ........................................................................................
0 Description of Soil.
.........................................................................................................................................................................................................
............................................................................................................... ............. .......
U Nature of Repairs or Alterations—Answer when applicable-------- ............ 3?
.......................................................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'THE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
A.-I
operation until a Certificate of Compliance ha been issued by the board of health.
Signed.--NU4(3&Vjq�..... >...\\%U%_S.L4MtjkA L
Date
ApplicationApproved By.................................................................................................. ........................................
Date
Application Disapproved for the following reasons:................................................................................................................
.........................................................................................................I........................................................I.....................................
Date
Permit.No......................................................... Issued.......................................................
Date
No.. 'Syf.... Fps.:............. . .....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
&s I/ ...OF......i ,,F�a`.'py%°� �h ..............................
Apphratiou for Bigpos al Workii Tonstrnrtion rumit
Application is hereby made for a Permit to Construct ( ) or Repair (A an Individual Sewage Disposal
System at:
......... :% '....�..�.'2,?' &"a .......................................... ----------- ............ ....-----.........................------.
Location A�ldresaf or Lot N
■r f ,t�f* /j1 C ` /' �+ yam,! � °t l am } •� '� .
.._._4. ✓ eA. ..K�:ewGJ. .... ... ............ 4 ._P .. _F.,.py.�.d.. ..... y............_......._....................
--..._. h r '` 2!'r O'nX ,yl � �+F � A d'ess
6-6_I l_FFrEA�f�" tsx ��1...:�+� �...yJ '
_.....d.. ......... +.............................................
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No., of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
aOther 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.....................................
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.....................
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.......................-------------------------
.
---------------
----------
----------------------
--------------------------------------
O Description of Soil...................... - , 1 a = ``= y =' '=-
x
W -•-----------------------•----------------------•-•-•---------------------------------.............•---••------...
U Nature of Repairs or Alterations—Answer when applicable........y!�. :___. _____.. _1 ________________L ✓.c' _ ` ° ..
Agreemenu`n"d'_
:
The ersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Ti :'ITE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has,bee)n issued by the board of�health.
�£ . . ...� 5 4/- R 4 r f i$_L f wf It 1 e 6 a
Signed ._.:>_
l Date
ApplicationApproved By.................................................................................................. ........................................
Date
Application Disapproved for the following reasons---------------------------=------•--------------------------•-•-------------•--•-----------------------------_..
............................................................................................................................................................ ...................
11 Date
PermitNo.................................................... Issued.-------------------------.............................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
gee
..............v"%--v-)'4�'./ OF....... .........................
............................ .............
Tertifiratr of Tompliaurr
THIS-IS. TO CERTIFY, That the Individpal'5ewage D4psal System constructed or Repaired (k+
\ J2 '
by----------- "...................................................
Installer
at........r. Xz........... .... ................... .. ...............................................
has been installed in accordance with the pr Ir f,
ovisions of I 'LE of The State Sanitary Code
I rribed in the
---------------------
application for Disposal Works Construction Permit--NoT�lr....!;N. ................. dated----
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
......................
............ ........OF......... 5'
-Y FEE........................
No... .............
DispaiiaLMorkg Tonstr ion , r Writ
Permission is hereby granted----- ---------------------------------------------
to Construct-k., ) or. Repair (, stem,�' -an jpdividual--,S. ewagq Disposal
........................... ..... ......at No......... Street
-.
as shown on the application for Disposal Works Construction Permit No....8.. ......J.....y----/Dated.1 r/...............
-------------------------------------------- ----------------------.................. ............
Board of Health
DATE...............................................................................
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
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ANTHONY D. CORTESE Sc. D IT 01A////
Commissioner oLc�Y,evr�le �Gad'u�c� oLa.�rQ,rrc��e, .�Llad�ac�ii�4e�4 (�2�1rG
PAUL T. ANDERSON
Regional Environmental Engineer
cupy October 15, 1981
Joseph P. Macomber & Sons, Inc. RE: BARNSTABLE--Subsurface Sewage Disposal--
Box 66 Pumping Prior to Septic Tank for Mrs.
Centerville, Massachusetts 02632 Heyworth Backus, Connors Rd. , Centerville
Gentlemen:
The Department of Environmental Quality Engineering is in receipt of your
letter dated 24 September 1981 requesting prior approval to pump the entire
downstairs flow generated from a one bedroom apartment at the subject site.
The flow would be pumped into a recently constructed septic tank located approx-
imately 9 feet above a proposed pump chamber and pump.
The flow from the upstairs portion of w the dwelling flows b gravity
P P g y g ty into an
existing subsurface sewage disposal system.
The Department does not recommend pumping into the septic tank but whereas
the subject dwelling is reportedly in a location which would be difficult or
impossible to service, the Department hereby approves the proposal in accordance
with 310 CMR 15.06(18) with the provision that the installation meets the require-
ments of all other State and local agencies.
Very truly yours,
For the Commissioner
Paul T. Anderson, P.E.
Regional Environmental Engineer
A/kd/JH
cc: Board of Health
South St.
Hyannis, Mass. 02601
Plumbing Inspector
South St.
Hyannis, Mass. 02601
Mrs. Heyworth Backus
Connors Road
Centerville, Mass. 02632