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TOWN OF BARNSTABLE
LGCATION 15 G,'& ®.&e4-4 A� SEWAGE #
VILLAGE ASSESSOR'S MAP & LOTo77/• 4/,
INSTALLER'S NAME & PHONE NO. ,�02i aL� 7 C'Q�l1Sf >/
SEPTIC TANK CAPACITY e,
wry
LEACHING FACILITY:(type)
NO. OF BEDROOMS <� PRIVATE WELL O-PUBLIC WATER �
BUILDER OR OWNER A'J
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
I VARIANCE GRANTED: Yes , �� ___�
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No�.9...&.91 Fizs�--
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® F , HEALTH
OF... ....... ...............•- ........................................
.,.
Appliration fur Disposal Murks Tjanstruetinn
Application is hereby made for a Permit to Construct ( ) or Repair;,X) an Individual Sewage Dispo"sale f,
System at:
... _. - ---------- --------------------•-------•----..__.._..---------------------------.....---•----•------......-
"''�' Location-Address o ro.
Owner �f�dcess
---- ------ - . -- .... ................ � '�.�._..-__...
installer Address
PQ
U Type of Building Size Lot AW---_Sq. feet
a Dwelling=No. of Bedrooms............... 9
................_........._Expansion Attic ( ) Garbage Grinder ( )
p, Other—Type of Building ............................ No. of persons.........._................. Showers ( ) — Cafeteria ( )
Q' Other fixtures .
W Design Flow................. ..................gallons per person per day. Total daily flow.............ss-Rdr..................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. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
4A Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P ...............
----------------------------------------
_____...........
_------
-_-...............
•---
-------------------------
-----------
•--------
0 Description of Soil.................................................................................-........................................'..........................-....................
x
x -•••--------•------•-----•-----------•---•---•-•-••••---••••-----•••-••-•-•-•--------•------•--•....
U Nature of Repairs or Alte e ena d -
se
--
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of it 'p.. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until'a'U tificate of Compliance has been sued by the ar f health.
Signed_._ ..
to
Application Approved By._.:: -•-------•-- = ...................................................... ..
...............
Date
Application Disapproved for the following reasons:------••--- ------------------------------------------••------•--•----...------------------••-•••-•--••-••-----
-----•..............•----:-.........----•-•--•--•--------.....------------•----------•-----••------•-•---•-------•-----••-•----••••••---•••••----•----•----- -•••--------••--••......--•-•----....••---
_. •i ��y� � � � Date
Permit No.... .!. .`!�._. _L. .... Issued......
Date
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No!H .&3! Fus...........
2�
THE COMMONWEALTH OF MASSACHUSETTS
CJ
_ BOAR® F• HEALTH
.............OF......................................
Appliratiun for Biopootal Warkii Tonstruriion ramit
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at: � f� /
Location-Address o o.
......................--..............�•-- -•• .......................
Owner �6�... Y_dress f
a = ......�................. ... ........ - ........
Installer G^CJ���%��o/ Address 71
Type of Building Size Lot. DOD�" S feet
U YP g � j----...-----•---- q•
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
d Other fixtures _...........
I W Design Flow.................. .............._..gallons per person per day. Total daily flow._....._................. ........................_.gallons.
jW Septic 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 ( )
a Percolation Test Results Performed by.......................................................................... Date........................................
Test 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........................
y.{ ............................................................................................................................................................. 1-
ODescription of Soil......................................................................................................................................................................... F
U
W ----••-----•-----------------•-•----....--•-------------•--•--••---••------------•-•---------•-••---•••••-••••11.1------------------•----- ••..
U Nature�5of Repaaiir�s/QJr Altfjer s—Ans r`jwhen a plicable_ !! le.--�t'1 Z? C`
i _..._._./Q�� .S�T. d........ -------- -------- / `"��-. /`:1�,!tt.e!_f..,e� _� "' .'� cr J ...+�� f .-t�?�2! =:` ..2'..j" .......q............ ....,�z_ t............... . .._._.._.............. .........._.._
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT1Zj 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been ssu d by ardAf health.
` 01
Signed---- /�_ ....-- �A J,.r;
Dat
Application Approved BY--------------• ...... l f
Date
Application Disapproved for the following reasons----------------•--.....-----•--•------------------------------...---------------------------------............
--------------------•-----------
-Date `
Permit No..... ........ ........•(----------•-••---_.. Issued.......... 1 1I...............
l
t ,... ----- --•-------•--•----
Date
e
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 9F HEALTH
..........................................OF.... ....................................
(Intif irat a of ToutpliFanrr
' THIS IS TO CER.T� t_ ndi�5lual Se ge '`sposal System constructed ( ) or Repaired
at. ` .�..........................................................I� !/..6L:�.....................----------------
3 has been installed in accordance with the provisions of TITLE 5 of The tate Sanitary Code slesq,-rk ed in the
application for Disposal Works Construction Permit No......�C">.......... ...�.I..... dated ..................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
.1 ` . - ..... Ins
DATE -••••................... ect 'or ..:�.......%� .. ........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF
F HEALTH
r . ..OF....... ;`!i1't C .r `'t......................................... '
No..............._........ FEE........................
Disposal o otrwtiott rrr it
Permission is hereby granted ............ _ `�•- -
to Construct ( ) or Repair ( ) n I�' eX&��sal Sat No. ------------. �1---••-•-•---�
_. .6"q,-,e4)...............
Streetci
as shown on the application for Disposal Works Co ion e%'t No: ..�.... Dated.._. / ..............................
_ -----------
77 zt Board of Health
DATE-----------•. 3 �- -----------------•-•-------•--..
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
LO,C AT ION s � SE E A E PERMIT N0.
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VILLAGE
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INST LL R'S ;NA i DDR•ESS
B U .'L D E R OR OWNER
DATE PERMIT. ISSUED t
BAT E COMPLIANCE ISSUED '' —�
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
O Jie .
Appliration -for M-4poottl Workfi Tonstrortion Vamit
Application is herebyinade for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at: .y �.
-•------•--•-- �•-_--_.----Y ,.. .•-----------------------------------•-----------•-•------------
�f'o�cation- d ress or Lot No.
-- - •-•-- ---- ......•a�"'� 'r . -- ......• . ....................... .........•------•-...................... ............-•----....
er Address
-•------•--•---------------••----•--
nstaller Address
Type of Building Size Lot____________________________Sq. feet
U Dwelling—No. of Bedrooms--------.... _.____..-_Expansion Attic ( ) Garbage Grinder ( )
F+
Other—Type of Building __________________________•_ No. of persons..________-__---_--_.-_-____ Showers ( ) — Cafeteria ( )
Q' Other fixtures ---------------------------------
W Design Flow--------------------------------------------gallons per person per day. Total daily flow----------------------------------------.---gallons.
P4 Septic Tank—Liquid capacity------------gallons Length---------------- Width----------- -Diameter____..._..-_._- Depth..--------------
xDisposal 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--------_-------------------------------
aa Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water-----------.__-.__.._---
GTq Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water__._.-________._____.__.
9 . --••---- -------------------------•------•-••--•-•---....-•-•--•-----......•--------•--•---...•-----.........................................................
0 Description of Soil-------------- -----•-------•--------•-•-•--•---•---------•----------.-_-_-_-__--... --------------------------••---•------------•-------------- ------------------- --
x ,
v
W ---------------------------------------------- --------------------------••••-•••-•--------•------- ----- ---- --- -- -------- - -- ------------- - ---- --
UNature of Repairs or Alterations—Answer when applicable.. __ 1 P 1�f1 d� l.._ ___.___...
-------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has issue by the board of health.
Signe .
Date
ApplicationApproved By--------------------------------------------------------------------------------------------------- ----------------------- ----------------
Date
Application Disapproved for the following reasons:--•--------•-•--.....--••-------------------•--•-----....-------•-•--•--•-•--......_.........----•-............
--••----•---•----------•------•-•---•-----------------•---------•----------------._._...----•-------•-•--••-------------•-----------•---•--•-------------••-•-•---------...._.._............------..--•-
�� Date
Permit No. Issued ------�----- . ------`----F
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOAR9 OF HEALTH
,F ------o y..�t..{.�s.�y+
Applir-atiun -fur IR-nVouttl Works Totuitrnrtion Vrrmit
Application is hereby'made.for a Permit to Construct (I` ) or Repair ( an Individual Sewage Disposal
y System at.
#41.
s,
ocatiioon- d ress or Lot No.
---- r JA.. _ _ ....... .......
--------- ---------------------------•---•--•------••------------•----_____-•-----••---------------••------• ,
er Address 1
a ...... ._. .d"rr!w ., ---•- ................................. ---•-----•------------- -----• .......__..._..------......._.......................
nstaller r, Address 1+
Q Type of Building t q.
U Size Lot............................S feet
?,
Dwelling—No: of Bedrooms--.__.-' ______________________________Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons. . Showers,( ) — Cafeteria ( )
Other fixtures �-- , ---- � ------------------------------------------
Design Flow.... ..................... ____gallons per person per day. Total daily flow-------------- gallons.
04 Septic Tank—Liquid capacity >gallons Length ............... Width................ Diameter `7,... ------ Depth................
x Disposal Trench—No.............. Width__ ,,._--____'l;otal Length--------------------- Total leaching area--------------------sq. ft.
Seepage Pit No..................... Diameter-----------------------•+Depth below inlet------------------- Total leaching area---------_---_-__sq. It.
Z Other Distribution box ( ) '":rs D`osing tank ( )' _>
aPercolation Test Results Performed by ' ................. . ............. Date____:_____----_.--.-_-Y-.-.--___-°_--
Test Pit No. 1................minutes per trreh Depth`of til ester Pit f.._.___...__.... Depth to ground water.. ---_ --.__-.---._ ---
LLI Test Pit No. 2......_---------minutes per inch, Depth of'tlr6sI l it i `}-__-_ _-__ Depth toy ground water-_.------_---.----------
„
>,
O Description of Soil __ -- --•--------•-- - F
-•--•-----•-•-----•-+-----------------
x --•- ri
U
-----------
U Nature of Repairs or Alterations—Answer when applicable
Agreement:
The undersigned agrees to install the aforedescrib.edAT dividual Sewage Disposal System in accordance with
the provisions of Article NI of the State Sanitary Cod m The undersigned further agrees not to place the system in
operation until a Certificate of Compliance hasr issue by the boa d of h th. °
S>gned__•__ .. Date
Application Approved By.................
Date
Application Disapproved for the following reasons: =r_ ---------------------_----------------------------------------_
AiY
+Y t a________________
Date
PermitNo......................................... ........... Issued..................................................
a _ Date
rI
f� THE COMMONWEALTH OF MASSACHUSETTS r _
BOARD OF HEALTH
oFt. :7Z'
.3
> Trrtfirutr of 0.111nmpliunrr
TH LER 'i.IFY, Thd the I vidual Sewage Disposal System constructed ( ) or. Repaired
b ....................................................... ------------------------------- ---------
' aller
at... ................. . t i a -`--- ----------
has been installed in accordance with the provisions o Ar XI The tate Sanitary C de d cr bed in the
application for Disposal Works Construction Permit No.___:_:_..._..__ ........... dated_.--- .'� ~______...................... _
s
THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE
'SYSTEM WILL FUNCTION SATISFACTORY. ,A
DATE " Inspector ---------------- -------------=-----------------•-••--••••----•••.
..<
THE COMMONWEALTH OPMASSACHUSETTS
',BOAR-D OF HEAL-TH
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_[ 1
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1 ,Y .. ,.. _.f
No. ------- FEE
ivivo 1 r trnr.'jon rrriti#
Perriission is hereby granted r ------------------••---
to Construct ,(_ ) or Re i ( a 1 n tvid a Sewa D�posa System{
at No---- --- -
street ,.
as shown on the application for Disposal Works Construction P it N f D1ted_.__ `" .............
•
QY
an► Board'of He
DATE•- f, -------------------- E
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS