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LOCATION A91 077' > SEWAGE #
VILLAGE �9*f �-s ASSESSOR'S MAP & LOTS ,O 1,3
INSTALLER'S NAME & PHONE NO. yLDH
SEPTIC TANK CAPACITY ,Q00 a
LEACHING FACILITY:(type) /� /'� �% (size)
NO. OF BEDROOMS � PRIVATE WELL OR LIC WATER "
BUILDER O NER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratilan for Diripagal Workii Tomitrnrtinn Vilmit
Application is hereby made for a Permit to Construct ( ) or Repair (oQ an Individual Sewage Disposal
System at:
o•.. -------------- Lcion.Adde < ..........................................
Location Address / r Lot No. N+J
Owner
a� '��✓L-� GC-a l -- �7(0� rnL�r1-1�`f Address
..
-•-••-.-----••----�.... •. -Lcstaller -Atess
�....
d Type of Building Size Lot............................Sq. feet
U Dwelling— No. of Bedrooms.___.___. --------------__-__-. ---Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............................ No. of persons_---_---__---__-_----.---- Showers ( ) — Cafeteria ( )
a Other fixtures -----------------------
W Design Flow............... ..............gallons per person per day. Total daily flow..--------- ..................gallons.
WSeptic Tank—Liquid capacity-1 _-gallons Length---------------- Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Width------- .____._.___ Total Length..................... Total leaching area....................sq. ft.
3 Seepage Pit No..._._......I........ Diameter------?�4-.------ 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__.-_.._.-_-_--------._.
Test Pit No. 2................minutes per inch Depth of Test Pit-_.-_---.-_-_---__-- Depth to ground water........................
G4 ---•--••-•••----••----------••••••••----••----•--•----••--------•-------------------••------.....---.........................................................
0 Description of Soil........................................................................................................................................................................
x ••--••--------------- --------------------------------------------------------------------------------------------------------------- -------------
-
U Nature of Repairs or Alterations—Answer when applica le..../._!f 5%�� ----------------ZUD .... -----------------
-Answer �_�?'1�.....
[S' Q y----------1,0Q2- ---- -•------fP----�-------1'`��a'tT'...... ......................
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 Compliant as en 'ssu d b e board of health.
Signed ....... .. . ... ..... .... .......... f..-... ...`
Date
Application Approved B ........... t ......
Application Disapproved for the following reason : ....-- ............. ................... .........................................
------------------- ----------------------.....-...........--------------------------------------------------....._..----------------------------------------..------- ----------- -------------- ------------------
Permit No. ..... U" 4`/ Issued --------------------------------------------------------Da e ...
T 7 /.
Dace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiun for Di-npuual lVarlai Tontitrnrtiun rrrntit
Application is hereby made for a Permit to Construct ( ) or Repair (c>6 an Individual Sewage Disposal
System at:
---"""---"""""•----""---"....-•-------------•-._........ ---•--._._......---........••----•-----......._---.___...----•----•-------------------•-•-----•---
Location-Address or Lot No.
--------------------•---.....
�— Owner Address
Wai C L(gip ! Cam(.Q I G L.t j1 �"-""""""""""•--""""""-"----------••-•.................... ........•-•-------....`.__....' .......:...r .....................................`
14 Installer
� A'ddress
UType of Building Size Lot............................Sq. feet
04 Dwelling—No. of Bedrooms----------I&
---------------------------- Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Q' Other fixtures ..._--------------------------------------------------
W Design Flow..................`a ...............gallons per person per day. Total daily flow......_.._. .0........_.._._.___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....4............. 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_.___-_"-._-____--___.-.
ri Test Pit No. 2................minutes per inch Depth of Test Pit__.____._-_-____.._- Depth to ground water..-__:_.___-___"-.___..-
P4 ................. --•---------••---•---•-••---------•-•--------••-••-- .............................................................................
0 Description of Soil........................................................................................................................................................................
x
V ..................•••---.........._.._........_............-----•---•-•--•--•-----••............---------...._........_...............---•------...-•---•......-••--.........._...._...._...._...........
W
U Nature of Repairs or Alterations—Answer when ¢
..
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 Compliance47as been issued by1he board of health.
Signed ------f -Vim:.--�-- ------ ---------
Applicatlon Approved B r �• R- r -------------------------------------------------------- .
Application Disapproved for the following reasons: . ....... . ..... . .......... . ............................................................
... .......... . ............................................. . ........................
Permit No. ---------T-- - - ./( - Issued ............................... ...........D te......
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
C�er#ifi ate, of C�omplianve
THIS IS TO CERTIFY_,Th.a he Individual Sewage Disposal System constructed ( ) or Repaired'( )
Y ............. ----------------------------------------- - - .......................................................
Installer---
has been installed in accordance with the provisions of TITLE 5 of he State Environmental Code as described in
the application for Disposal Works Construction Permit No. ------_.. ............. ��.._' dated .._...__..__------ ---------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE 0 STRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE---- --------------------/. - �� -- - Inspector __P
------- .P--------------------------------------------- _-----------
2 THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE ®_
7 .�
FEE........................
DisposalVia-r-,hp Tunotrudiun rrrntit
,�S ✓G.Lug""---" � ...J�..../c:..�lr�l
Permission is hereby granted......................-------------•--- ----•--------------•--•--------•-----..._..--•--•---
to Construct ( ) or Repair (/��an Individual Sewage Disposal System
at No. / / i_./. AytJ _. ._... FrJ.�..t..-•--------------""--"""""--""-.......
Street � --•�� /^
as shown on the application for Disposal Works Construction Permit No.1-�.1__,y�__ Dated_____��-_-
•-""...-"""""-"......................... J —-- ----------------------------------------"--
� rd of Health
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DATE J. a� l � a
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FORM 36508 HOBBS A WARREN.INC..PUBLISHERS
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ASSESSOR'S MAP N0. 2- `t PARCEL �3
LO CAT ION SEWAGE PERMIT NO.
VILLAGE
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INS LLER'S , NA E i ADDRESS
B U I L D E R OR OWNER
DATE PtR MIT . ISSUED
DATE COMPLIANCE ISSUED
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Lu-CA I ION SEWAGE PERMIT NO.
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INSTA LLER'S NAME i ADDRESS
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DATE PERMIT ISSUED
D..ATE COMPLIANCE ISSUED
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HYANNIS
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LOT 11 sT
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ASSESSORS LOT 5
LOT 289-012 `' ASSESSORS
_ ARBOR
LOT 289-009
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C.B. �v4
(FND) N88 40'10"E 136. 46' SYDNEY
i PROPOSED41 ,, i o o SIMMON s
DECK Is
^ - - 77 IP � oN
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o LOCUS MAP
/ ♦♦ �0�',�jj PLAN REF 164-57
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0 0 / ♦ ,,,, - - - - - - - - - -,,,,,, DEED REF 09507-0025
41♦ "'-EXISTING"""' ZONING: "RB"
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""'HOUSE"""" SETBSETBACKS: 20'-10'-10'
/PROPOSED I """""""""' �� FLOOD ZONE.•
y PANEL NUMBER., 2500010008 D
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it 3 GARAGE--� DATED: 07-02-92
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♦♦ PLOT PLAN OF LAND
LOCATED AT
1.01 FROST LANE'
PROPOSED `°��v°"
` C.B HYANNIS, MA
PORCH ASSESSORs .
(FND) ��
O LOT 1 04� LOT 289-008
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'C-� q' ASSESSORS PREPARED FOR:
LOT 289-013 ®®®®�A®OF S BRIAN. & THOMAS LADNER
�GS-c,qF� ,yam
C.B. F �� SEPTEMBER 10, 2007
(FND) o STEJ. v
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(FND)-
K J� YANKE'E LAND SURVEYORS
& CONSULTANTS
GRAPHIC SCALE PO. BOX 265
20 0 +0 20 40 UNIT 11 40 INDUSTRY ROAD
MARSTONS MILLS, MA 02648
r TEL.- 508-428-0055 FAX 508-420-5553
1 inch = 20 ft. SHEET 1 OF 1 JOB /!' 54268 JF
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