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TOWN OF BARNSTABLE
LOCATION / S :9 / y!4e 1� SEWAGE # ! 1- 5��6
VILLAGE /4/7 h/'f ASSESSOR'S MAP 6: LOT �✓
INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 ;
SEPTIC TANK CAPACITY /060
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LEACHING FACILITY:(type) J— P %U00 (size) � l®
NO. OF BEDROOMS a PRIVATE WELL O PUBLIC ATER
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BUILDER OR OWNER �C C��Dii�Sd
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED--.
VARIANCE GRANTED: Yes No
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE (ornstable ConservauesDaparunent
Appliration for Big anal Works To;;
Application is hereby made for a Permit to Construct ( ) or Repair (man Individual Sewage Disposal
System at:
........l.. = ... •N............................................ .......... .y .NN S ........................................................
• •Lpr,ation-Address or Lot No.
---•----•--------•---- •••--••----••••--•.................• •...•••....................-............---•••---•••
Owner ...Mess ,
a ............. �..__ .1 ---•-------•-•-------••---------•------------ = = fit? ....... �i r�1� ono to i f�....
Installer Address
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 ( )
Ct, Other fixtures ..........•-•-•••......-•---•--• -
d -------•---••------------------••----•----
WDesign 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 ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
rZ4 Test Pit No. 2................minutes per inch Depth of.Test Pit...:................ Depth to ground water........................
P4 ---•-•--•--•-----------•-----•-••••-•-•••-•••--•••-•••••••••-----••-••••.....--••--•--------------•................................................
•---_-----
0 Description of Soil........................................................................................................................................................................
x
x ....................... .•-•---------------•----------••-------•---•-------------•--......••---•-----
-----------
U Nat re of Repairs or Alterations—Answer when applicable.__ �--� �B�?a____$_
!3- --------------- z --
14—
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Env' ental Code—The ndersigned further agrees not to place the
system in operation until a Certificate of Co pliance been issued t e board of health.
Signed...... - ---- ----...- -- ----------- ------------------ ----------- -- 2-- -- ---,)
Date
Application Approved By ..................... .....�D-11114,,,1,,,,. --s
. .................-................................................. ................Date......-..-........
Application Disapproved for the following reasons- ------------------------------------------------------------------- ------------- ...........................------..........
..............--------------.---------------------------------...---'------............................................................................................................................'------- ..............-- ..................
Date
PermitNo. ........... ........................................... ... Issued .----------------------....------.--- ---------- ------ --
Date
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34
No. j: � ?�.�.{. FEB......ale................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiun for Dispuuaf Works Tom itrurtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair (p-)^''an Individual Sewage Disposal
System at:
........ ......... ........ .tom.,...................... la N 1 5.-----•----••_•----------••--••...............................
Location-Address 7 or Lot No.
........./.!. t cQ.02 IJ C O 1.�
Owner Address
,Wa ••-•-•-- ` ...... ............................................. tom= = !�!�`� 9 f'±1..W.V7:J4
Installer Address
Type of Building Size Lot............................Sq. feet
�-t Dwelling—No. of Bedrooms.._...2L..................................Expansion Attic ( ) Garbage Grinder ( ' )
a e� Other—T yp of Building ____________________________ No. of persons......................:..... Showers ( ) — Cafeteria ( )
d Other 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........................................
Test Pit No. I................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........................
ODescription of Soil.......................................................................................................................................................................
------------- a
-------------------------------
U Nat re of Repairs or Alterations—Answer when applicable a____..-__..�--I?__.toc A_....420.._CZt.�t...._42-__.
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 Compliance as been issued Cy the board of health.
_ - Signed - \ -�C *'-- -�.-- ;:.. - 9
Date
Application Approved By ---------------------- 'V
Irate
Application Disapproved for the following reasons- ---------- -- ------------------------ - ---- ---------------- -------- ------------------ -------- ------------------
......................... ............ ............ .............. ................. ..... ............ .................................................. ...................." =-------- ................ ....................
Date
PermitNo- -------- --------------- ---------------- ---------------- Issued .....---------------------------...----------- --......----. --
`----�" Date
THE COMMONWEALTH OF MASSACHUSETTS 1
BOARD OF HEALTH
TOWN OF BARNSTABLE
CLPrtifira e jof (11->ampliana
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( J�
by `� -A. ................................ ----- ------------- -------------------------------------------------------------- ----------------- --------------- -----------
. .. ..... ... .......
Installer
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. .........�/-----..J��� ........... dated ................................................
THE ISSUANCE OF THIS CERTIFICATESHALL NOT BE CONSTRUE_D AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. 1A
DATE...................................... l a j� I. _ . , . 1 4
---
Inspector -....... .......................................... ....................
i
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
CC��/ ^ ff FEE....
No._..,1......._.J..��� o••.........
Disposal Works %TUunutrnrtiun rrmit
Permission is hereby granted......_r^_)__`!1.7?....... ILi C Q....................
-------------------------------------••--..............._....
to Construct ( ) or Repair (`+ an Individual Sewage Disposal System
at No.....Jr---..Z3 ?^. 1 +�)..... 2a�-=--.......A").4&I yk I r
Street
as shown on the application for Disposal Works Construction Permit No..��-5_y(_�_ Dated..........................................
.................................\=
� Board of Health
DATE................ ? ........................................................�
FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS
TOWN OF BARNSTABLE
LOCATION �S Me /J 1�6�7 SEWAGE #
VILLAGE tt4 h 1 f ASSESSOR'S MAP & LOT (I �•'
INSTALLER'S NAME &.PHONE NO. A & B CANCO 775-6264
SEPTIC TANK CAPACITY /ppd
LEACHING FACILITY:(type) „Z- P /UDO (size) el- ,KID
NO. OF BEDROOMS PRIVATE WELL O PUBLIC ATER
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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THE oommomvvsAcr* or MAssAo*ussrrs
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ApplirationBh
IV&
Application is hereby ade for a Permit to Construct or Repair an Individual Sewage Disposal
S stem
....... .... - ------4 W- --::------ ...... -- ----- ..........................................................................
0 tion- dress or Lot No.
. ��-- - ......................................... ---------------------------------.................................................................
nstal'� Address
_ Type of BuildingSize I.ot--.----.---'Sq. feet
I)wellioc . of Bedrooms-------__--_----Expansion Attic ( ) Garbage Grinder ( )
Other--Type of Building ---------- No. of persons---.----.--' Showers ( ) -- Cafeteria ( )
~~ Other fixtures �
Septic / ���
Design �
��n�d � --
~� ^ � � ��� _---~ area_----_---sq. _
Seepage P� lNu--..+c--- 'total leaching area--------------sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
~~ Percolation Test Results Performed by------ ------------ ----------------------------------------------------- Date--------------- ---.----'
� Test Pit No. l----------------minutes per inch Depth of Test Pit.--_-_.. Depth to ground =ater-------'
�Xq Test fit No. per inch Depth of Test Pit-- D��
0m �o�d «��
Description of SoJ-....... �6�. ---
-_-_----------'---
.
---'--------```---'--'--- --------------`-----`------------'----
~�
------------- -''—_--'-_--'-_.--_--_---__----'-.--------_-_-'_--_-'---.___-_-
U Nature of Repairs or Alterations—Answer when applicable-'--.-------------------------------------------------------------- ------------------
----------------------------------------------'-'-_'--'_---__---_.__---__--_---_------.------_ �
Agrrcoeu,:
The undersigned agrees to install the uforcdcocriboJ Individual Sewage Disposal System in accordance with
the provisions of Article %I of the State Sanitary (odc—Tkeondersigoed further agrees not to place the system in
operation until u Certificate of Compliance has been issued by the board of health.
.----- ---_----___-
-I-Stgned Z--------
ate
/\ppl�xdou Approved Dy'-- --2�_
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te ate
Agp�cadnuDisapproved for the ƒo�vxu��/ reasons:----'---.-.------'-------_------_-_-_------......
—`----------'-------'--`--`------'`------'-------`--`--------'-'-----------
Date
��roit �o�_--___-____.__'._____ Ioou�l__--_-_
- Date
THE COMMONWEALTH OF MAssAo*ussTre. BOARD OF
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THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANT E THAT THE
SYSTEM WI
LL \
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THE COMMONWEALTH or MxssAc*ussrra
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Permissioby grantTd--- -------------------- ------- - ----------- ----- ------- ............................................
at
Str
-- ay.s6ov000 the application for vrko
Board o'f Health
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