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TOWN OF BARNSTABLE
LOCATION b0eA�eg ram, SEWAGE # ?S 302
VILLAGE ASSESSOR'S MAP & LOT
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INSTALLER'S NAME & PHONE NO. kll?, gel
SEPTIC.TANK CAPACITY
LEACHING FACILITY:(type) Idw��r� �"'" (size) XW -
NO. OF BEDROOMS-PRIVATE WELL O PUBLIC WATER
" BUILDER OIi
DATE,?ERMIT ISSUED: hp/x,�
`DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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L0 CIA TION SEWAGE PERMIT p0•
VILLAGE
I N S T A LLER'S gAME b ADDRESS
0 UILDE Q OR OWNER
�i / �•�5•� GF Ty '77�0
DATE PERMIT ISSUED Fro
DATE COMPLIANCE ISSUED
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Divipnial Work.6 Tomitrnrtinn Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair (>4 an Individual Sewage Disposal
System at: `
--------------------------•--------..........---------------.........--....•--
Location-Address . or Lot o.
z
/ZZ
.............................................................
Owner Address
ao/L-1�1.t..`.�7 -- ._..._._ c� U� '7G� --
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. fixtures • ------------------------------------------------------------------------------- -------------------------------------------------------•-----
Design Flow- �
W
- U gallons per person per day. Total daily flow..-.------------- ..............gallons.
WSeptic Tank—Liquid capacitvl0k .gallons Length________________ Width-._-_-_-.--.-_._ Diameter................ Depth----------
x Disposal Trench— No. .................... Width_...__t.................... Total Length.---__---_•-.e_-__-_ Total leaching area....................sq. ft.
Seepage Pit No.._--.-__-.. Diameter-------LU........ Depth below inlet_.._..&-.......... Total leaching area..................sq. ft. J
Z Other Distribution box ( ) Dosing tank ( )
'~ Percolation Test'Results Performed b ?_...._.._. Date................:....................... ..
a y ---=--------------------------------------
a Test Pit No. 1.............:.minutes per inch Depth of Test Pit--------------------- Depth to ground water.......................
rX4 Test Pit No. 2.......... :..minutes per inch Depth of Test'Pit.................... Depth to ground water.............._......... '
�+ .................................................... --- -•----.--.. --•-----
O Description of Soil.............._ -
-••- -•--•---••••-•--------------- .....
U ...................................--- ---- ......•------------------•----------------....----------------------------•---•--------•--•--
--
U Nature of Repairs or Alterations—Answer when ap licable 1��..� -._.-.�}---...16#0.. ......�i �:..
T' _. . We-------- -s w ------ --- mi n...._..
Agreement:
The undersignedragrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions 6f'TITLE:5,of the. State Environmental Code—The undersigned further agrees not to place the
system in operati on*until a.Cerrificate of Compliance s b en'issue b he board of health.
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Signed ......... ...: ..... .... ..:... ... ..........:... . .......... � 9 .
y _ Dve
Application'Approved BY
- - -
� Date -
;Application Disapproved for.the folloluing rearonr .: -- :-- ---- .....................................
. z -
.. .. .... - ..........-. .....: "-. "-.-. --
Permif No -. 4J .. . �. ----- Issued ..............................................................
Dat
t .� 't .a x Date
THE COMMONWEALTH OF MASSACHUSEVS
BOARD OF HEALTH 1
TOWN OF BARNSTABLE
Appliration for Di-ripoti al Warlai Tlamitrnrtion Vamit
Application is hereby made for a Permit to Corstruct ( ) or Repair ( an Individual Sewage Disposal
System at:
............. .....•...------...----....._.....-----•---•••---••-----........-----.... ..... ------
Location-Address or Lot No
.......................-l�1.--....---- ` n1_ . ....../�1 - ---------- A-
Owner
Address, �
�'.............. .....'��J.-- 'P^,�' -•`y......
- f
---- ---------------------------
Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms-----•_-_-_.-_-_-�---------------------Expansion Attic ( ) Garbage Grinder ( )
Pk
Other—Type of Building ____________________________ No. of persons.___--_-_._._________-..--.- Showers ( ) — Cafeteria ( )
Otherfixtures --------------------------------------------------------------------------------------- -----
w Design Flow.............. ------------------gallons per person per day. Total daily flow................. .............gallons.
WSeptic Tank—Liquid capa6tv./0_ ga1lons Length________________ Width---------------- Diameter.__-.___.--_- Depth................
x
Disposal Trench—No. ................4... Width------.............. Total Length____-.__-_---__-____ Total leaching area....................sq. ft.
Seepage Pit No--------.-----l.... Diameter-------ALf----- 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........................
P4i ' ......-•................................................................•--•----•----------•-----------.....--•-----•--......----••----••......•.........---
0 Description of Soil........................................................................................................................................................................
w
U Nature of Repairs or Alterations.—Answer when applicable--------- - __✓-----------A......... ......
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 issue, by e board of health.
Signed ----------�G _7f...... . ,
Dace
Application,Approved By ..........-- �--� - - 5-=+� �'� `
-----f.,Fct.----- "----'--------------------------------------......-'-------.....-.. Dare
Application Disapproved for the following reasons- ---------------------- ----------------------------------------------------------------------------------------------------------
... ............................................. .. ......... .. .. ............... ------------------------ --------------------------------------------------------- ------------------------
Permit No. .......... � ----- .. .. . ..._.-..... Issued
- ..
............
Dare
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
t TOWN OF BARNSTABLE
C�erti irate of C�nmplianre
THIS IS TO CERTIFY 1-hat the Individual Sewage Disposal System constructed ( ) or Repaired ( �)
by......................... ... vim--------- ,rvs �t�c---y-�
h,�aue�
at -----------------------------------------....t F....-....-GV VLLP 1 .. y.._.......f �i//f /ill-.,S U✓U�------------.-..----------
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. ...._.----�.j:._-302-�. ..- dated ..............................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE. __' �.. .�-.. p �� "of' .'..-...
------------------------------ Ins ecto
_,_,___._--____--._.-._-_,____ - __,__q__-_T_._.._,_.___ .
Ld /S� THE COMMONWEALTH OF MASSACHUSETTS
�J BOARD OF HEALTH
_ TOWN OF BARNSTABLE
No..... FEE--�G-• ---..
33isplaii al Workii Tungtrur#inn rrrntit
plc-, cc,.�s����--�r��
Permission is hereby granted....................�.... -------•--........_....
to Construct ( ) or Repair (,,-
an Individual Sewage Disposal ystem
, V -f�4-------- . f z - li!`�
at NO.. - Street ^__ � - �..............
as shown on the application for Disposal Works Construction Permit No._.7..L/___ ..............
.............•-•-...................... ..................................................
a V Board of Health
DATE................... - ..�.------•--------------------
FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS
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CERTIFIED PLOT PLAN
LOCATION
EDP` ARD E. KE ALE ` SCALE . .e."/:40". . . DATE •7vz7.41./9Bo
GUhV,AA0U0, MASS. 04637 PLAN REFERENCE .L.�e7A!.G. . T. . .'".` . . .
/-•- ED +R
Lt£Y ?, . . . . . . . . . . . .
c� 2 1 Y f" I CERTIFY THAT THE . ..! /^/G /S✓"'��?77o...J
SHOWN ON THIS PLAN IS LOCATED ON THE GROUND
AS SHOWN HEREON AND THAT IT CONFORMS TO THE
�-_
u 5 SETBACK REQUIREMENTS OF THE TOWN OF
B!4Q'Ks7790449. .. . . . . . . WHEN CONSTRUCTED.
�!�4>'esAQC'E 4Lry 77i L�/ST DATE T�j .� e f g
PETITIONER:
/ REGISTERED LAND SURVE4R
- /Wt T' 2 OF Z 5#6z
TOP OF FOUNDATION
CONCRETE COVER
CONCRETE COVERS
P e 4"CAST IRON 12"MAX. � 12"MAX. •
PIPE (OR 4"ORANGEBURG(OR EQUIV.)
EQUIV.)— MIN. PIPE- MIN. LEACH
PITCH 1/4-PER. PITCH 1/4"PER.FT PIT PRECAST
° -� LEACH I N G
o' NVERT
INVERT INVERTI' .
PIT OR
SEPTIC TANK DIST. 33w EQUIV.
... .. .. . . . BOXEL .. 7 >xINVERT ., GAL. INVERT ~a �INVERTV v 3 4'Aww o: ::�: / TO I I/2
Eo,BU. , : WASHED
' o
w STONE
o /do /8 ••'
DIA.--�-{ NouE=
PROR LE OF GROUND WATER TABLE
SEWAGE DISPOSAL SYSTEM
NO SCALE
PRE
LMAIN A
SOIL LOG WITNESSED BY :
DATE ?'!� �!l8..4• TIME. ��'30.! '1 PAL ! 'Z �`1c' !?� . , . BOARD OF HEALTH
TEST HOLE 1 TEST HOLE 2 ENGINEER
ELEV. . 33,30 . . ELEV. .. .. . . . . . .
s�8-so,c. DESIGN DATA '
30" 3
NUMBER OF BEDROOMS
HC�>� TOTAL ESTIMATED FLOW .330 . GALLONS/DAY
BOTTOM LEACHING AREA '78''S�. . SO.FT. /PIT
SAID
SIDE LEACHING AREA . . .�SB,.So SQ.FT./ PIT
GARBAGE DISPOSAL .NbN .(50% AREA INCREASE)
TOTAL LEACHING AREA SQ.FT
5A+va PERCOLATION RATE MIN/INCH
LEACHING AREA PER PERCOLATION RATE �4 a. . SQ.FT.
No .WATER ENCOUNTERED
NUMBER OF LEACHING PITS
APPROVED . . . . . . BOARD OF HEALTH
P/rT H(OMAS E.ICELEEY'CO.' '
. . . . . . . . . .
DATE . . . . . . . FNGINEERS—SURVEYORS
AGENT OR INSPECTOR 3415 LONG POND DRIVE
SOUTH YARMOU'TH,MASS. ZN OF M4SSA
QFq 02654
..� ? THOMAS
EDWARD
SOT"1. . . . . . . . . . �' KELt Y It e�� 4
tvo 2to-')
PETITIONER (`�f� cow
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THE COMMONWEALTH.OF MASSACHUSETTS
BOA R® �—i E LT �v,
-.
Allp irFa#ion for Disposal Works Tons rn.rtinn ramit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at:
...............1�n.�r........�1.\. cis....:.- J,J, 1.01A...
Location-Addr o LotNo. CjJ�
..................
........ �� ......I&A4.... . Gam.
weer Address`` 1
-Cls 11 � �-sG �.r -----------••---
.
Installer Address l
Type of Buildi Size Lot_ taus.?-...Sq. feet
2
Dwelling No. of Bedrooms___________________________?___.______._._Expansion Attic (�' Gge Grinder ( )
Other—Type of Building ..... -No of.persons............................ Showers ( ) — Cafeteria ( )
P4 Other fixtures ......................................................
W Design Flow.............S.,5. ...................gallons per person per day. Total daily flow..............IA v..-...__......-_...gallons.
WSeptic Tank—Liquid capacity.l.OW.gallons Length.......-s..... Widtli_.......r..... Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft.
Seepage Pit No 1-Q___-__-- Diameter...._1.n__..... Depth below inlet........4p....... Total leaching area..Q1r&4...sq. ft.
Z Other Distribution box ( vim Dosing tank ( )
a Percolation Test Result Performed by........Tt. ._.. _._. ...... Date..___ _ t4074._.....__....
a Test Pit No. 1_ ,..__._.minutes per inch Depth of Test Pit.................... De th to ground water.____......._._..._..__-
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
�•� ._.... •.-•-•-.--•....--
Descr>ption of Soil `==i _'.. .....A •-•• Gf-:..(.:�P _;;;P sw-
W
UNature of Repairs or Alterations—Answer when applicable................................................................................................
... •-•-• . -••••-•••-•-•----------•-•--•••-•-•----•-••••-••--••••••..............••----
Agreement:
The undersigned agrees to install the afor ribed Indio' 1 Sewage Disposal System in accordance with
the provisions of 1IT 5 of the State Sanita y Code T ndersi d further agrees not to place the system in
operation until a Certificate of Compliance has een issu by boa f health L
ned.. --- ------ --- :7.. '!
DaApplication Approved BY --- -•-----
Date
Application Disapproved for the following reasons:...................................................................................... .........................
---------------------•------•---------------•--•......---•••--•--••••....
Date
Permit No..••-••-:. -_ -----•--------•-------------- Issu --------------------------
_ �a- - - I
No......................... Fizz......................
THE COMMONWEALTH OF MASSACHUSETTS k
BOAR®.- O : .HE�rLL
_..
ar
OF.......
A .................................
ApplirFatiun for Uispao al Works Tonxi#rn.rtiun Vamit
Application is hereby made for a Permit to Construct ,( or Repair'( ) an Individual Sewage Disposal
System at:
................LO AF_-----....9....------4ar!VP�!"�� .... - F��........ �>♦r•t& a
Location•Addre ( t
..---•---------•- - !P�.Y.SC r . =Fs -43. 1�!w_1: ..-•- _tr yC.....� .1.____.. !^. .(Sc
W wrne�r ddress t
a ..................................... - _ ..............e....... .................. (.:.... �kis4__-kA, - ____
Installer Address f
Type of Build Size.Lot__ _ G-____Sq. feet
V Dwelling No. of Bedrooms_________________________________.___Expansion Attic (�-^ Garbage Grinder ( )
aW Other—T e .
Other—Type of Buildin g _____yr_yu1/9�..___. No. of persons____________________________ Showers ( ) — Cafeteria ( )
dOther fixtures -----------------•. --••--••=•••••--•---------••••--•••----•••••••-••••••--••-•---•---•---•-- •-•----------
W
Design Flow............... _'S•"`...................gallons per person per day. Total daily flow............ _.:___��__:................gallons.
WSeptic Tank—Liquid'capacity_A.P(JOgallons Length....... +___. Width.......!en..... Diameter________________ Depth....._..........
x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft.
C-
Seepage Pit No-------t. _______ Diameter......1__G-3_...... Depth below inlet________4a....... Total leaching area.. e_&_.sq. ft.
z Other Distribution box Dosing tank ( )
~
Percolation Test Result Performed by-___.__ �_.-_ _•_ Date- ---.. r --------- -
W � �C>•�.�.: _ Z� = __
Test Pit No. 1._ ._.____.minutes per inch Depth of Test Pit____________________ Delth to ground water........................
(14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
O ` - ..._l �- f
Description of Soil_._"_:_ J ..._---- -- --_--f__ .__( 1_ __. t .1 '°*f/.:.................
c, -------------------1_• ....- l ._ ....... = =`
w
UNature of Repairs or Alterations—Answer when applicable_________________________________ ____________________________________________________________
-•---------------•-------------=-----•-------------------...................--------------------------=-------------------••• ------------------------------------...--••-_••. --
Agreement
The undersigned agrees to install the afo ibed Indiv 1 Sewage Disposal System in accordance with
the provisions of TITTLE of the State Sanita y Code T ndersi d furthUagrot to place the system in
operation until a Certificate of Compliance has een issu by' boa f healthpS.' ned- A-•• ---------- � �D Gt.0----
a
Application.Approved BY ✓ � "� 7.. - ------
Date
Application Disapproved for the following reasons---------------•------------------•- ..................................................
.......................................••----•--.....----•••...--•---•-•-••••--••--•---••••-•-
Date
PermitNo......................................................... Issued_.......................................................
Date
q
� t
THE COMMONWEALTH OF MASSACHUSETTS i
BOARD ODFHEALT
:........OF............ ..-:. .... •__.....: ........
., V;a; .. . ............
Trr#ifiraU of Ton'tplianre
T,jS TO 'C#IFY, t the Individual Sewage Disposal System constructed ( 'or Repairedby T-DA-__ -- ••---------------------- ----- -----------_____------
�nat.__..'__._._4I � -•' ' . -Installer -•-•••.._..----••••--------•---
has been installed in ah the provisions of TII > of The State Sanitary Code as des��cjjlb d in the
_ fu
application for Disposal Works Construction Permit No._ _____��'_ ___.._.___. dated__ . 7k? _-.1!`_ _______________''
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAXITHE_
SYSTEM WILL FUNCTION SATISFACTORY.
a DATE...................................
�/ I p t _..._.. --
o r � LP
THE COMMONWEALTH OF MASSACHUSETTS
BOARD Z HEALT
-
.........747..C4,;
yL........OF... •.. "�'
No......................... FEE
Disposal IV rk rrani#
,�/
Permission - ereby granted.---- 1 A r
to Constr t or epair ) an/ IVIdu Sewage Dis sal System
at No. S �r`~ . ` !tree.-----
�l f:
as shown on the application for Disposal Works Construction P t N ..(/_�,ry7�___.
� �' V Dated ew
s ..e - ---
�1 Board of Health //
DATE......... �--`--�---------..(.•----...................................- VV/
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
-
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3� 171V ® 3�
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'�.StitsErD D�v y
CERTIFIED PLOT PLAN
LOCATION ! !.4s�//y!s�o� M,9S
EDWARD E. KELLEY SCALE . .�.��:4iO�. . . DATE
C11MMAOU' , I-A �-;S. G�637 PLAN REFERENCE .
O!u . Lq•0.o
f�� rLL£Y
�
CERTIFY THAT THE
F' SHOWN ON THIS PLAN IS LOCATED ON THE GROUND
AS SHOWN HEREON AND THAT IT CONFORMS TO THE
SETBACK REQUIREMENTS OF THE TOWN OF
DD� 7�9D�C.E. . . . . . . . WHEN CONSTRUCTED.
�EfeSA�C'E ��lL7j/ j'�ST DATE •7�/, .2,8
PETITIONER: /�/AN/V/SPo /UJASS REGISTERED LAND SURVEAR
SNIT Z OF Z 5#62rrZ
TOP OF FOUNDATION
. CONCRETE COVER
CONCRETE COVERS
• • 4"CAST IRON 12"MAX. 12"MAX. •
PIPE '(OR .
4"ORANGEBURG(OR EQUIV.)
EQUIV.)— MIN. PIPE- MIN. -T LEACH
� PITCH 1/4-PER. PITCH I/4�PER.FT. PIT
PRECAST
o'o NVERT , Q ••��:: LEACHING
` e EL..3.7...C.�r.. T OR
INVERT INVERT p PIEQUIV.
SEPTIC TANK , DI S.T. 33 1 w
n INVERT EL... .. . . . . . BOX EL...�. Z. >_ :•:
/000 .• GAL. INVERT ~a
e; EL..3L./7... . . . .. EL,3 t3 INVERT V w w o• :�: 3/4"TO I V2
o � EL3o.Bo �� �: ;:•. WASHED
•" w STONE
DIA
PROR LE OF GROUND WATER TABLE
SEWAGE DISPOSAL SYSTEM
NO SCALE
PRELIMMARY
SOIL LOG WITNESSED BY :
DATE SL47 //94P TIME. ��.30.!4 !� L e: !��' �! • BOARD OF HEALTH
TEST HOLE i TEST HOLE 2 Tir �RS . E, P...E,_. ENGINEER
ELEV. . 33t3o . . ELEV. .. .. . . . . . .
01
DW!9T1a9 .E,,IE.' r RC,S.
s�8 c DESIGN . DATA .'
30�/
NUMBER OF BEDROOMS '3
Htl►� TOTAL ESTIMATED FLOW .33o GALLONS/DAY
BOTTOM LEACHING AREA 78.'S. SO.FT. /PIT
SA,u D
SIDE LEACHING AREA . . �BB,.So . SQ.FT./ PIT
GARBAGE DISPOSAL (50% AREA INCREASE)
TOTAL LEACHING AREA .2'47 9 0 SQ.FT
GJ Ale-
5 A-Fo PERCOLATION RATE 46 .?VAlt- 7U!0. MIN/INCH
/ST
LEACHING AREA PER PERCOLATION RATE SQ.FT.
No WATER ENCOUNTERED
NUMBER OF LEACHING PITS
dF STONE OAV 441— S/D ,= /.S;G 7Otit5 of-1;iV E"
APPROVED . . . . . . . . . . . BOARD OF HEALTH
DATE . . . . . . . THOMAS E.KELLEY CO.
AGENT OR INSPECTOR ENGINEERS—SURVEYORS
346 LONG POND DRIVE
w� rma-- - RI YARMOUTH,MASS. �p� OF
G�
- .� 02664 Z
THOMAS�
47'l. . . . . . . . . . ' ED EARD
!CELL Y/, .24260
/eon
No 2 ��'G �aIST�P�
sSIONAL
PETITIONER AhMAs s "sue