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THE COMMONWEALTH.OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE
ApplirFatiou for Uh4posFal Works Tomitrur -#
Application is hereby made for a Permit to Construct ( ) or Repair an ndividual Sewa eg 9
System at: �
Location- ress or Lot No.
.. ......... ..........
owner Address
= P .. ... ........••------•--.............---•-----
Installer Address
d Type of Building Size Lot............................Sq. feet
V Dwelling—No. of Bedrooms-----8...................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers
a YP ,g ---------------------------- P ( )--- 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........................................
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........................
P4 -------------------------------------------------------------------------•--------------------------------------------------------------------------------
0 Description of Soil........................................................................................................................................................................
UW -------------------------------------------------------------------------------------------------------- ------- ----------- -----------....................
Nature of Repairs•� Alterations—A saver hen applicable_ __ _. _._I _. _[ __} ._ 6 ...;. ..-a>� .._..:
..........................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State En ntal Code—T dersigned further agrees not to place the
system in operation until a Certificate of Co liance h been issued the board of health.
Signed ----- --�----------- ---------- ----------- -------- ----------------------- ........... ---1-t-`oZS7_19 ........
.Dace—- — -
ApplicationApproved BY ------=---------- � ��.�,.-,�,.�...7 ....---...................------------......----------------------------- 1i~ Dare=
Application Disapproved for the following reasons- ---------------------- ------------------------------------------------------------ --------.......................................
----------------------------------------------------- . .-- --- . .................-..to...
Permit No. .....74.--...J��j Issued
,� Dare
t i 90
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE _.
Appltration for Disposal Works Tonstrurtio7ndividual
° it
A lication is hereb made for a Permit to Construct or Re air 'an Sewa e D s o al
PP Y ( ) P (t.�) g P
System at:
......1.�. __...ro.X. ........................... --.. _ .h�'_ .12 v1�-L - .............................................
Location- dress or Lot No.
....- a - i-��....... ........`�'+.__.i__H_L_........------------•-•--- ..........
-_...........................................-..........................................
Owner Address
Installer
Address � --___--••-•------------- -- -
UType of Building Size Lot............................Sq. feet
I—� Dwelling—No. of Bedrooms__-__1___________________________________Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Buildin
a Other—Type g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
d Other fixtures .
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
W 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 ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water.......................
1-4
44 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................
P4 •-•--•-••••---_......•••-•-•••--'----•--•-•--•-•....--••--•--••....•----•--•---•--•----•----•--__---'----...'-------•.....................•••'•'•'------•--•-
0 Description of Soil........................................................................................................................................................................
W
U ............................... •-•-----......-•------••-•-•-•--••••._...-•------••-••---------•--•-•--•--••-•--•--•-•-••-•••---•---•---•--'--••-'•••...................................................
x - ..................................y------
Nature of Repairs or Alterations—Answer hen a licable._ •, - -r �r e.1 - --- L - two al _
f l l -fi A Cva ................t, -'
Agreement: v
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 has been issue(Ny the board of health.
Signed. --` `-----_~- \NV
`a l
Date
Application Approved By .................... ..
Date
Application Disapproved for the following reasons- ............................. --------------------f---------------------....--.-.....-------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------------------------....................................................... ................ ..................
Date
PermitNo. - �-.. �� �� ------------------------- Issued ----...------........------------...--.......------.-. ----
Dace
f
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Tex#ifirate of Taraptianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed',( ) or Repaired ( Lfj
by ........F"1 !4' t�v.........f'- -tom b-------------------------------------
Installer
at ......).l..-$---------r.o.X.-j4---/. --4 ..........fZ..7r -:-� C.e-1j.T•-P..2..v.../. -------------------------------------------------------------------- -----------
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. --.......?/------- 3..5y...- dated ................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A•GUARANTEE�THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. io),
DATE.. - - ------ JInspector = `.......r---.... .-...11-- { !'�.� /.•
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
NO-3/1-1-.......... FEE....21),%:"......
Disposal Works Talustrudivit rrutit
Permission is hereby granted-•••- °r" ------C J.q.N C 0----------------------------••-----------------......---•-----._....._._.._..__........_._..
to Construct ( ) or Repair ( y�,an Individual Sewage Disposal System
at No..•••••)•1Q•-•:... p-�! �--------R,:j ,r ,---•-•-•-Ir•E-•N=r-�ra `r I '
Street i
as shown on the application for Disposal Works Construction Permit No---- J_•• •S Dated..........................................
- -- ---------------------
•--------------
...--------
-•.......
... -
Board of Health
DATE �' = --•---•••••----
FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS `