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LOCATION SEWAGE PERMIT NO.
VILLAGE
//�.�1
INSTA LLER'S NAME & ADDRESS
h c " G
8UItDER OR OWNER
Coe. e- waid-e
DA T E PERMIT. ISSUED
DATE COMPL ANCE ISSUED
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No....................... . ......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town....._.................OF.............Brns.t.apie
..... .. ..............................................................Apptiration for Uhiposal Works Tonstrurtion an it
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at:
Old Strawberry Hill Road Lot 9 Land Court Plan 32849A
........................................................................... ..........I.,............................... -- --- -----
'12,Location-Add 0�s_ r
I tM. _A._
%T�kmr 4 *,. P
.......... ......... ..........t
........................... ............... .....................f.
Owner Address
.... . . ............................................................... ..................................................................................................
Installer Address
Type of Building Size Lot.19,_L54---------Sq. feet
U Dwelling—No. of Bedrooms.................2
...........................Expansion Attic Garbage Grinder
4
CL, Other—Type of Building ............................. No. of persons---------------------------- Showers Cafeteria
Otherfixtures ...........................................................................................................
Design Flow....................55
........................gallons per person per day. Total daily flow.___.....33.0...........................gallons.
1
04 Septic Tank—Liquid capacity- ..gallons Length----.4.1--6"Width.-A'.--IQ!Diameter................ Depth_.5.'.-8"..
Disposal Trench—No. .................... Width.................... Total Length.___................ Total leaching area....................sq. ft.
I----------- Diameter____.---___.__.....8 f.......... inlet.-_...... f......
Seepage Pit No---------- ----- Depth below . Total leaching area—Z .......sq. f t.
Z Other Distribution box (X ) Dosing tank (
0-4 axter � Nye-A. Jones P, E
�--4 Percolation Test Results 2 Performed by...... . ............................................................. Date_�2419,t77..................
Test Pit No. 1...............minutesperinch Depth of Test Pit------�3 Depth to ground water........................
2.....minutesper inch bepth of Test Pit......1.2. Depth to ground water .........
... ............
PL4 Test Pit No. 2........... .. ...I
.......... ............ ............................
.0 ZY...�a-m---and
...Si6s.oi.-1................2.I.-.I.2.I....clean...medium sand
...............................
0 Description of Soil........7.............................................................................................................................................................
x
U ........................................................................................................................................................................................................
W ...............................................................................................................................................................................m.......................
tl�
U Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------
.......................................................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE Ti LE 5 of the State Sanitary Code—Th undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been iss b he board ofbealth Comp,
�Sign d........ ... .... .... .......................................
D
a e
...... ...../;k:::;Z ......7.7....
Application Approved By....... e.... ... ........... .. le.. --------------------------- Date
been R
Application Disapproved for the following reasons:...............................................................................................................
.........................................................................................................................................................................................................
Date
PermitNo......................................................... Issue(-... ..............................................
Date
v
s1 p.�,
No---• - ..... f FEB..f�..._..
THE?COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town '` Barnstable
-. . ,.OF.....--.....B -------------------------------------------------------------•-•---•
Atipliratio' n for Dhip`osaal Works Tomitrat.rtirnt Famit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:,-
Old Strawberry Hill Road Lot 9 Land Court Plan 3,2849A
........ ..__ _.....:.....:. .... -- ..............•- ---------------- __-------------•-----•---•--- ..
Location ddr re. or Lot No.
..... ..>_:P... . ..CARP : ..... . w. . .._-_..�A_.-------I ..............
Owner Address --
W ............................................................. -.....-•••••-•••--•-••--•-•...-•-•••-----._...-•--........•-••-•----•-....---•--•---•.....-•-•--•-
Installer Address
Type of Building Size Lot_19t_4 S 0....._.._Sq. feet
U Dwelling—No. of Bedrooms.............2............................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—T e of Building ............................ No. of persons____________________________ Showers — Cafeteria
a Other fixtures -------------------------•••-• •-
W Design FjdHw....................5.S...................gallons per person per day. Total daily flow_______��0_-____.•___.__._.__.._____._gallons. '
WSeptic Tank—Liquid'capacit ___gallons Length____" _ Width. �_......tDiameter________________ Depth g ''S�i
Disposal Trench—No_ ____________________ Width.................... Total Length..........._..._____ Total leaching area....................sq. ft.
Seepage Pit No...................... Diameter__._8.1
.._._.._._. Depth below inlet.............. Total leaching area.. P____._.sq. ft.
Z Other Distribution box.F ) Dosing tank
� J
`-' Percolation Test Result Performed b 13 t5e Nye-A' .Yokes P• B•_ Date.1`2.�Z9�77_________________.
Y -- t-•-•--•-------- ----
1.4
,� Test Pit No. 1_______ ______minutes per inch Depth of Test Pit......_____ Depth to ground water........................
(s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
r .
p 0,2 Loam--and ................ -------•-----•--.._.....--•----2 clean mec��um sand
Descriptionof Soil ............... ........ ---- •- -----• ------------------•---...-------------------------.............---
V ----------------•--------- -----•-••--•----------------_----- ---
-----------=---------------------------==--------------------------------------------------------='"' `------------------------------------------................................................
V Nature of Repairs or:Alterations—Answer when applicable...............................................................................................
---------=-•-----•••••---------•-•-•-•--•-•••--•--•--•----•--•-•--••.•.................•--•--•-••-•-••••-•--•--•--•-•--••-••-----• --•-•-••--•-•••----••••----••••••••••••--•••---••--•--------•--•---•
Agreement:
..The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLi; 5 of the State Sanitary Code The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been ed eDbgar loofflie�al�tN'Pe � co-Rq
Signed----------------•_ U y�a ...............
I Da e
Application Approved-;4y......i;--- f. G� ----•-•--...--•--•------
/ Date
Application Disapproved for the following reasons:=#----------- -=
_...:..-•-------------•----...._...-•-------------•---------------------------------------•-----.......---•-•••-•--•------•-----•---------•---••-••----------=•-------••--•--••-•--•-•---•----...•-•---
�,/ Date
PermitNo.........==------------................................ Issued._-.'f--- .........................................
Date.:-.... .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
� ^-'.....................:.:oF...�:� NS-7 I� C
Tntifiratr of Toutpli attrr
THI S jERT,IFY, That the Individual Sewage Disposal System constructed (�r Repaired ( )
by.. ---- .....::. t---------------------------•---•-•-•---••------•--------- -------........----••-•----...._..-------•-•------------•------•------ ---......-------••-
at.. �
� /'. •-V at 57OCfQGI-) �JC'!� R �� fIpstallgraDA�� J�l� /�I1.11111�j ��j �
€ ------•----- -._. -------------------•-----------•............... ............................................... •-•••••-•---1 --••••-•-•--••--------••-•---•--••-••--•••-
? has been installed .in accordance with the provisions of T _ F j of The State Sanitary Code as described in the
application for"Disposal Works Construction Permit No _ _ _________________ dated_- -_ _ :-7.7_.._._._______.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A C9 ARANTEE THAT THE
SYSTEM V%L EUNC"TIIO SATISFACTORY.
DATE.. ___-----•--------
................... Inspector•• ..........•-- -- �---1..- " -----------...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH,
J1LJ ..................OF..-- A2S A /e.
.....6 ...
N ........ f:,7..... FEE.. ir--------------
Dispo 1rkg Tonstr i�tta rrmi#
Permission is hereby.granted• -- ............._..-••-----------•---•-•••-•-•-
to Construct ( or Repair ( ) an Individual ewage D- al System
at No._.(,' Dl ...5 ?._r`�W__!eo_ ' ..... !a�� ANf7 / V q/jA.) 's ' !�'J/9,.•--•- --• ---__ ..............................
Street
as shown on the application for Disposal Works Construction Per •t No ___ _____ _____ Dated_-__.(": _- _F'�' .__.__._....
...••----;�- E:: °!� � ---- -------•----___---••----------
1►wt�l
.,
DATE- --------�-
-_-_... oard of Hea
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS ^f'^
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