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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Uhipatial Works Timitrurtiun Frrutit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
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Installer Address
Type of Building Size Lot.p��1,1.7 ---Sq. feet
U Dwelling—No. of Bedrooms___----_ .____Expansion Attic ( ) Garbage'Grinder ( )
Other—T e of Building No. of persons------6................. Showers — Cafeteria
Pa Other fi tures .................................................. �^�
w Design Flow............ ........................gallons per person per day. Total daily flow......5 . ......................gallons.
WSeptic Tank—Liquid capacity/�M..gallons Length------F-•_• Width.../j........ Diameter................ Depth................
x Disposal Trench—No_____________________ Width.................... Total Length......... .. Total leaching area--___ ------ __.sq. ft.
Seepage Pit No--------1_....... Diameter..... -- Depth below inlet...... Total leaching area..oW___sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
a Percolation Test Results Performed by.............................. � aV ................ Date___
Test Pit No. 1__ a-_-minutes per inch Depth of Test Pit---- ..... Depth to ground water_•___-_______•_-______-.
�T4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Description of Soil......
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UNature 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certifica f Complian as e n issued b the board of ltlth.
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Signed .... ... d :. .... ........... . ... ....(..�......
r Dare�p
ApplicationApproved By --------- -- -------------------- ..................................... . ............ ---,... --_---------------1`--------
Date
Application Disapproved for the following reasons- ---------- ---=----- -- --------------------- --------- ----- ------------------------------------------------------
-- . ---------------------------------------------------------------------------------------------- ----------------------------------------
Date
Permit No. � ------------------------------- Issued ....... --- 0.....9 ..................
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
,c pplirati n for Disposal Works Tonstrurtion Prrmit
` Application is hereby made for a Permit to Construct ( V) or Repair ( ) an Individual Sewage Disposal
System atl
Loc lion- ti ess
f 7 / ' l�rc�a°,e, UC� !/ l. °r e1111,
ess
�� � ../J /'J'!N-�r....................... .._......_.......
Installer Address /
Type of Building Size Lot_- ...Sq. feet
1 4 Dwelling—No. of Bedrooms.._..._e.��.___._•_-_-_..._--_•--•__..-_Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons......6................. Showers ( ) — Cafeteria ( )
Otherfi lures - ---------------------------------•-----------------------------------------------------------------------------------•-•----------------------
W Design Flow.......... ...................gallons per person per day. Total daily flow-----. ___....,__....._.....gallons.
1:4 Septic Tank—Liquid capacity/.gallons Length......9.... Width....L_....... Diameter---------------
_'Depth................
Disposal Trench—Not................. Width.................... Total Length.................... Total leaching area....................sq. ft.
� Seepage Pit No--------/------- Diameter...../.��_ ..__ Depth below inlet_________ ________ Total leaching area_-e-;2.6 ._sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
'�' Percolation Test Results Performed by................................!!": ._._......_._.._... Date...Z,—. _ ...-
a
Test Pit No. 1__4 ._..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 ------------------.........................................................................
O Description of Soil------ ... /�-� SL�� �S/ 5. _ ........
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U -� t�:.�.�r� '� ,�,Y; --_-��' =--_-•--••--------------•-•--------------_-__-_______-•---•-----•-----------
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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 TITLE 5 of the State Environmental Code—The undersigned further agrees'`not to place the
system in operati6nuntil a Certificate-of Compliance ,gas been,issued b nthe board of hlth.
Signed ......:.../...��Yl�►-.��---- -_.�� Y... .---------�"'-........ ...:�"_�:L�.'�/.----
�„� Daze
Application Approved By ....... ?1��9�
-_ Date
Application Disapproved for the following reasons- -------------------- ----------------------------------------------------------------------------------- ---------------------
----------------------------------------------------------------------- ----- ............. ------------------------------------...--------------------------------------------------- ...............................
/ Date _
PermitNo. --------------------.------------------------------------------- Issued ------------�`---------------------------------=------ --...--
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Cer#ifi ate of Gntj#ianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by 6./ ,`i.t� tt ---------
om.: ---------------------
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-,�g..�....�`X......................... dated ................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOTJBc'f CONSTRUED AS A GUARANTEE TWAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................ . ...�t-�•-.'...7/
------------------------------ Inspector .........................
V'
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
_ TOWN OF BARNSTABLE
No. //.�... ;?. FEEIUU. ..
Displasttl or g To �tnu#' n Vr�"mt#
_. ;/
Permission is�l ereby granted..... r /1J. ._/�,/� ,.... ...:
to Construct (!/) or Repair ( ) an Individual Sewage Disposal System
at No........ ...___�l.......r�,•)AG Z . .� .... _�.. < .--------------------------------------•---••---'•-----...------------------...---•--.........
�may-/ r - ,✓'�-----•
�� " Street
as shown on the application for Disposal Works Construction Permit No�l. P_..... Dated.�..��. ��...............
..........................-•-------•--....••--•-•--------------------............=---•---...._...----_....
Board of Health
DATE................................................................................
FORM 36508 HOBBS&WARREN,INC..PUBLISHERS
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LEGEND
EXISTING SPOT ELEVATION Ox0r
EXISTING CONTOUR ---- 0 - -- CERTIFIED PLOT PLAN
FINISHED SPOT ELEVATION �.or'
FINISHED CONTOUR 0
N(YH..: 'Che location of any existing underground`.sewerage, .. ;
Wells, or other utilities shown on this plan is approxT IN
imate only as determined. from records and/or verbal:.:: Imo,\� .� •\ !� `-1 -` +
information. 'I'he contractor is responsible. for. tre ' di S. J� S) ♦�9ASS ,r
verification of the existing locations in the .field. ii , 'eN/Stir
b 5'.-2o-�d
SCALE' / -`� DATE a /�l4 06 .,
LDREDGE ENGINEERING CO. IN
_ C L.I E N T.
I' CERTIFY THAT THE PROPOSEDIP:
EGI§H E FREGISTEAED JOB NO. BUILDING SHOWN ON THIS PL AN _;
CIVIL LAND CONFORMS TO THE ZONING LAWS' '►
ENO N E E R U R V Y R DR.BY
L_ Q OF': BARNSTApLE MAWSS
712 MAIM ST Es i CH. 91 ' �f �
HYANNIS$ MASS. SHEET OF DATE EG. LAND SURVEYOR `1