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�T/OWN OF BARNSTABLE
LOCATION l\ 3 r`X� 4 �` �l � h SEWAGE #J� —W G
VILLAGE- �ASSESSOR'S MAP & LOT ''
INSTALLER'S •NAME 6a PHONE NO. ��wy� 4
SEPTIC TANK CAPACITY e
LEACHING FACILITY:(type) x� /�� (size)
OF BEDROOMS, PRIVATE WELL OR PUBLIC WATER
R OR OWNER �7'0
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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ASSESSORS MAP NO:
�.� _ FARCEL NO:
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH Y y
TOWN OF BARNSTABLE
Appliratiun for Divjivnml Work,i Tomitrur#tun 11amit'
Application is hereby made for a Permit to Coristruct ( ) or Repair (�an Individual Sewage~Disposal
System at
. ..----=----------��-----. �.---- �......-- .................. .. -.:.•-- -=-
Location \ddress or Lot No.
Ow er Addrej
Installer Address
Type of Building Size Lot.....__.•__-_-_--•-__-__-_--Sq. feet
Dwelling—No. of Bedrooms.__�-----•---------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) = Cafeteria ( )
dOther fi t res _.---__..---•---•---------------------•----•-----------__--_-_------------------------- ----------------
W Design Flow........ _ __ ________________________gallons per person er day. Total da•ly flow......ra _____________ gallons.
tx Septic Tank-�Liquid capacityJ�`...�_---gallons Length_ ---------- Width--- -------- Diameter---------------- Depth................
Disposal Trench—No_ ____________________ Width.._1•�...t...._...... Total Length-_:_______�_._____ Total leaching area....................sq. ft.
Seepage Pit No------I------------- Diameter------dam.-_.... 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_---_...._-_-__-_-__----
44 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water----_--..-___________---
p4 -----------------------------•--•-••..._._..._..-•-------•------•••-•-------•-•-•••-----•---•-....--.........................................................
0 Description of Soil......... -------•----•--------•---•-•-••-••-•--------•..................•-••-------•-------•---•--••-----------------•••-..._......••-••----...._..--•-•-••----•-•-----
x
U .___________________•-------...--••-•••••-•-•-----•••----•--•---•••-•••------•••••••--•-••----------•--_.._.__--------------•------._._._.-------•--•----•••••---•----•---•-•-------...._•••----•--•-----
x ------------------------------------------------------------------------------------------------------------------------------------ ------------------•-----•--
V Nature of Repai s or Altera{tioons—Answer whe applicable._ G✓ _?V--� .-\0 . ;5; 'ib�- _►4�
•--b•=---�b�............ �!_�___...�� `SRO!' -2----------•----•-•-•--•-•--....-----
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 fu ther agrees not to place the
system in operation until a Certificate of Compliance has been iss oard
Signed -------------- --------- ------ --.. ................. ...................... --- ..V./�..`
�
Application Approved B
�-4,
Application Disapproved o-r the ollow* reasons: l
PP PP f_ f g .... . ... ... ....... .. --=------------........-----------------------------......----------------------------
.......... ................................... ........................................................................... . ... .................................. ........................................
Permit No. --------V. ---- --'- Z................ ' Issued -------��'.. ...�1_`71_
M..
13—
- ---- ------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
CErtifirate of Cantyliance
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by ............... . ... ......... ��..t 1. �-Wr y(?--�'P i<h<�------- ----__------- ------.-.................--------..------------------------------------------------------
at ------------------------------------------...._ ............ -a f ( -
--------------------------------------------------------------------------------
has been installed in accordance with the provisions of TITLE�fThe State Environmental Code as described in
the application for Disposal Works Construction Permit No. -�.�" __. dated ^
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
.—Af
Inse- cwDATE.. f . ----_ .
———————————————————————————————————————————— ———————————,_-—— •———————
i
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH`
TOWN OF BARNSTABLE
No.. FEE........................�\
Uiopnoa1 Workg Tunitrurtuan "rrntit
Permission is hereby granted *-----C.`----------------•------------------------------------------------•----•-•---
to Construct ( ) or Repair Individual Sewage Dispos System r
atNo...............................................................:-�..-------A.) .................1' 1 `
Street ,�?^9 �,..� � / ,gyp
:37-
as shown on the application for Disposal Works Construction Permit Nq„-r"�` Dated._ ._...�<.......f-..
Board of Health /
DATE--------------- ------------------......?------------------------
FORM 36508 HOBBS h WARREN.INC..PUBLISHERS - -
I
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiun for BiuVitial Work,i Cnunitriirtitun Prrmi#
Application is hereby made for a Permit to Construct ( ) or Repair (�an Individual Sewage Disposal
System at:
Location_Address /r or Lot No.
Ow,er Addre s
a -��PtGLV� S Cz
Installer Address
Type of Building Size Lot............................Sq. feet
,., Dwelling— No. of Bedrooms._.�___------------------------------.--Expansion Attic ( ) Garbage Grinder ( )
Other—Type T e of Building No. of ersons---------------------------- Showers
0.� YP g ---•------------------------ P ( ) — Cafeteria ( )
a Other fi tures --------------------- ---. . .
W Design Flow.......f ... ......................gallons per person per day. Total daily flow.---._ _�� ......................gallons.
WSeptic Tank-� Liquid capacity/��__gallons Length__=d_----------- Width-.-_-------- Diameter................ Depth................
x Disposal Trench—No- --------------------� Seepage Width-__---_�-_-.-._-_-- Total Length............ Total leaching area....................sq. ft.
See a e Pit No-.____j------------- Diameter------ �� ._.._. Depth below inlet____________________ Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by------- ------- -----------------------------------------•---------------- Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit__.__-_-_____._..-. Depth to ground water-.-______--__-__--_--.-.
(X Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 ............................................:................................................................................................................
0 Description of Soil.........................................................'...............................................................................................................
x
V ....-----•-•---••---------•----------•---••••---•••-•-•••------•---•------••-•---•----••••-••-•-----•----•--•------••-•--•••-•---•-------•------••-----•••---•-•----••......-•-••-••...................
------------------------------------------------------------------------------------------------------------------------------------ ------- ---------------------•---•-----------
U Nature of Repairs or Alterations—Answer whe applicable._ c 14_� ___�pG ..S57
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 has been issued—by—the board of hea4t-h.
Signer _-- ---- ----------- / -------- ...../......../C�..---� .....
Date,
Application Approved By............ 1� ; ,��' �//`�""
- / Dare
Application Disapproved for the following reasons- -----------------------------------------/-------......---------------------------. ------------------------------
----------------------------------------- ------------------- -------------------------------------- ---------------------------------------------------------------------------------------------- ------------------------------------
,.-�^- 7 —note_
Permit No. ........ ..,�'.-- ....... Issued ....... ^"../� "` �............
Dare
LIZ
No. L*.__..._ Fxs. `...........
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE -
Applirotion for Divi-Voottl Workii Tomitrurtion Vautit
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at:
P
Loc 6011-:\ddre&s or Lot No.
QTrC........................V�. .&w._!_..__ .........................................................
owner
moo Addres
Q
-----------------------s?- - ---------- --••__7.�___....................
Installer Address U Type of Building Size Lot____________________ Sq. feet
.. Dwelling—No. of Bedrooms_____ __________________________________Expansion Attic ( ) Garbage Grinder ( )
aOther—Type
of Building ____________________________ No. of persons------------------------.... Showers ( ) — Cafeteria ( )
d Other fixtures --------------------------------
W Design Flow.._.____..5_�....................gallons per person per day. Total daily flow____'3�........................gallons.
WSeptic Tank—Liquid capacity............gallons Length________________ Width_-____-.-.______ Diameter................ Depth................
x Disposal Trench—N _ ____________________ 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. 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........................
1::
-------•------••••--•---•-•-• ..,.............. ........
Descriptionof Soil.......................................................................................... ---•---------------•••--------- ..............................................
----------- ------- -------------------------------------------------------------------------------------
i -
U Nature of Repairs or Alterations—Answer when applicable._.^-S_1. l._1__-__ F __yr` 1�i�_ -
.......... 4---IT �- 5�-----•- ................................................
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 Com liance has been i ed oard of �ea
Signed ....... ------ ---------------------- ---- ---��`7,.
'�Application Approved By -.�:.n..... �Z�> --.�--- ------------------------------------- ............ . --
Daze
'Application Disapproved for the following reasons: ...................................................... ` '
----- ---------------------------------------------------- ----------------------- ---------------------------------------
Permit No. '.. Issued :' _
..�'. -.
- Dare
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
(9jertifir to of Complianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( yc)
/�In l<. tnu n i �.. I
by -- ...- ...... - - - - .... ............
- R.
-- Insca��e�
at ....................... ......... .. - ►. �...�.Gt�..:..�.. 1/t-```/-----------........------------------------------------.... ......:---------------------------------
1 as been installed in accordance with the provisions of TIT1, of_T e>St4w. Environmental Code as described in
the application for Disposal Works Construction Permit No. -`,7 dated
--------- -V. ....---
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION
SATISFACTORY.� � Inspect( r.�
DATE_..... ............................... —--------------------------------- - __� -t //^/ �,-ZI74-4
- ----
�1
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
MaVotial Work,5 Tonotru#ian Upawi#
Permission is hereby granted.............�-_. :-L ►9 ..�1,-I•I6=..--•-----. ............................ •----•-••-•-----•----
to Construct ( ) or Repair an Individual Sewage Disposal System
atNo----------------------------------------------
Street
as shown on the application for Disposal Works Construction Permit No ated---- `---------------~� .:
__--- ---------------------------t` .l ..... '---------------------
Board of Health
DATE......... ` -----
FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS
No........_..... F>�s. .: ...
s t THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiott for Diti-pootti Workg Tontrnrtion runtit
Application is hereby made for a Permit to Construct ( ) or Repair ( x) an Individual Sewage Disposal
System at• ( (� {
r Location-Address or Lot No.
Owner�j fin[ ^ AddressL�t/J /
Installer
Address
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms....�_----•__________________________Expansion Attic ( ) Garbage Grinder ( )
aa Other—T e of Building __
yp g _____ _____________________ No. of persons._______.__........_____.___ Showers ( ) — Cafeteria ( )
Other fixtures ------------------------------------
Design Flow..........: ..-S.......__.._.........__..gallons per person per day. Total daily flow....:73 l ..._....................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.--__---1 Diameter--_/.3 -..--______ /.�........ Depth below inlet___._.......... Total leaching area.................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
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........................
1:4 .--••••----•-------------------•-•--------•"---•------•--••---•••----•--•--•-•-••........_.._................._...---••--•-•-•--••-...._......0........-----
0 Description of Soil.....................................................................................................-..................................................................
x
U .....................................-.......................................................................................................................................................-..........
w
UNature of Repairs or Alterations—Answer when applicable.. w �.!..✓s_�._�_-...�Sc�_��..._.!1r1�.....��'C.�!.!.
�T.----------------------------------------------•--'-----•-•--•-------------....---------------------------•----------------------•--------------•--......-•------
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 has been issued by—the—board of health..
Signed .....-.--��'." / -------�7.
........ ....._.. -.... ...... Dare
...................... -.....
Application Approved By ...... �`% ��-�t��-�---- `a --- ----------------------------. ..�-
Dace
Application Disapproved for the following reasons: - ............... . ............ ......................
............................................ ............... .. .. . .. ........................................................... . ---------------------------------------
Permit No. � �f— 7 ` ` M _
_67 ------------------------ Issued ......................--..................- � .......
Dace