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No. 4210 1/3 YEL
Pendalflex '
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1000 ..
TOWN OF BARNSTABLE
LOCATION l SEWAGE # !��'— L/1�
VILLAGE ��—A K s�,� „ ASSESSOR'S MAP & LOT 2 L7-6 gr
LNSTALLER'S NAME & PHONE NO. 0"?
V
SEPTIC TANK CAPACITY X,c r l—h Q Igoe) Qr 11C—t G' N�'ai
LEACHING FACILITY:(type)
NO: OF BEDROOMS PRIVATE WELL OR PUBLIC WATER�j
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BUILDER OR OWNER
DATE PERMIT ISSUED: J--—=00
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DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No _
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No---- :..._.L110 Fizz _...._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
,�vAration for Biopooal Works Tonotrurtion lirrnti#
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at:
...................1_......A.L ?-b-•`-L---•-•.... I `C S ..............
Location-Address or Lot No.
........►'`_n `r.`.... ! -?'w - ....................................... ---....� (--•--....4 LO b:'�..... %.........................
Owner Add
ss
ti ,'`
Installer Address
Type of Building Size Lot............................Sq. feet
aDwelling—No. of Bedrooms-_,,.,3, ....._..................___.......Expansion.Attic ( ) Garbage Grinder ( )
pa Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ............._.........................................................................................................................................
W Design Flow.........;a__� ...................gallons per person per day. Total daily flow.......... 3.f ...................gallons.
WSeptic Tank—Liquid'capacity___..._.__..gallons Length................ Width................ Diameter................ Depth.................
x Disposal Trench—No..................... Width.................... Total Length........... _ Total leaching area...................sq. ft.
3 Seepage Pit No......./_............ Diameter...J_6. ....... 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........................
G� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 ...
--------------------------------
__-________....
_-------------
_....
_-...
_-___....
__......
_............
.................
_____------
------
-...................
ODescription of-Soil-••--...--••--•••-•--••-•••--•-•.._....-•••--•.._...-•..............•--•------•••-•••••--•-••--•••-•----••---•-•••••--•--•---••••••-•-• ••-•-•-......-•------•..__..
V -------------
--------.............
=
......... ......... --------------------------------------.._..--- - -
U Nature of ReT.W
r,or Alterations—Answer when applicable...........�.1Q,�,�_____.__,arn--________ i...�r. . ............
................//►l. ....•• '{ •• ti.� ti ........��y.. ........... -------------------------•---------------------•--._._....................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITLi; •5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by th oard of health.
Signed 1 • = -
-•••- -•••--• ----
Date
Application Approved By.... ................................. .............
1 Date
Application Disapproved for the following reasons________________________________________________________________________________________________________________
Date
Permit No.......
�0_::...t./Z.—--------------•--__. Issued......................................................-
Date
..._....... a Fas... -.......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH .
-�:v. .w...... � A (Z,KS �b�
O F..... ................................................•-.................................
i Appliration for Disposal Works Tonstrurtion Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ("Y-Iln Individual Sewage Disposal
System at:
Location-Address or Lot No.
...... -- .....! .�"!` ... ... ......................... .. _._... .................................. f.--................_.....
Owner Address
r i
a ...._........�..._.._..+...... r........^ r
Installer Address
Type of Building Size Lot............................Sq. feet
�..� Dwelling—No. of Bedrooms__._..................................Expansion Attic ( ) Garbage Grinder ( )
`4 Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria
a
Other fixtures ____________________________ ' ' _a -----•--=-=------------ ----------------------------------•-----._..._..........
W Design Flow......... __e....................gallons per person per day: Total daily flow.......- __J_ ...................gallons.
WSeptic Tank—Liquid'capacity............gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length..........._....... Total leaching area....................sq. ft.
r
3 Seepage'Pit, No......./............ Diameter....),I)......... Depth below inlet....... ......... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... 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........................
a •---•....................................................................•--•---••--••••••-•--•----...........-••-....-•--...------•....-•-••-•-•-••-•-•••--•
ODescription of,Soil........................................................................................................................................................................
...................
0 Nature of Repaicsf or Alterations—Answer when applicable.__.__.... _....._0__i^..e......._ (w._.. �?....................
/ r � 1�- ;" v Z't '` !.5 7
v --.--- --- I
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by thesboard of health.
Signed..._._.. ............
Date
Application Approved By..............A v.. .................................. .............
r Date
Application Disapproved for the following reasons:_........-•---•---•-•------------•-•------•---------•--•--••----•-••------------------------••-•--............_
........-•-•--•--•--•---....-•-----•--------•---•----•-•.........:.......................•-•-----•------ --•••.----•------------------.----------.......----------•-------...---...--------•---•---••---
oo Date
PermitNo....... ... Lo.................... Issued.......................................................
Daw
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Trrtifiratr of faoutplittnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )'�
by.............. .2-' _= ",-�`' -----•- 'l 1 InsZ..... -•---------------------...........-•---•------._..................•...=
nstaller
at............C.;..(----•---P� .Z.�'�-- --- ................. ----------- ---•-------• • ---------- •--....--•--.................---------
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No....... ,615 f-r't_......... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
DATE.................................. ............................................. Inspector-•-•--------------- .i: ...., '
SYSTEM WILL FUNCTION SATISFACTORY.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
c �+�-�.......OF...�. Q��..� ���r�t,�.- 9............. C�
No.-6...�1.n -. FEE........................
Disposal Works Tonstrttrtion "prrmit
Permission is hereby granted C .. �4-ud�l.....=�`�r....- -C'"--------•..................•--------------....................
to Construct ( ) or Repair ( ti)an Individual Sewage Disposal System
atNo.--------•.................e:..'A..._p_r:.._I_L4 I p....5�� r 1 r .............................................
Street
as shown on the application for Disposal Works Construction Permit No._Z.LL 2.. Dated..........................................
......................................... .........................................................
Board of Health
DATE....................7.......................................................