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V d a. -.. .,e F. z, ,.:a,x',., ... r c, a, m,zg. ,_,, r,, t r , , - ,,, f, e, ,`R_ a , ;: ,,, .+..w:. '>,.a ,,o,;,°;., ^ :.r„ ''d .F *.:. k fir;,-),, .., •� ,, ,Y r„ . � IF( 7116,11- , ' r y " l r / r a, �i 1 ,. > q t r. " E J r { ,z �` b - r ? '1 ,, , - II £, J 'i' 2 "m,y F x ! 4 , 1 x. TOWN OF BARNSTABLE i LOCATION SEWAGE # 9� - S3 0 VILLAGE ���/ ,,, ,i5 ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. C®-6 . ` taX -(vX37 SEPTIC TANK CAPACITY /@©o LEACHING FACILITY:(type) _ (size) /a®Q )c NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER Pa6"c— BUILDER O DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: oI VARIANCE GRANTED: Yes No p� i i 1 Y ice` 1 F � -4�z , MY Y a ® i e� V 1 I J , 9 f 93 Al THE COMMONWEALTH OF MASSACHUSETTS - BOAR® OF HEALTH . TOWN OF BARNSTABLE µ-r Appliratiun for Uiipuual Works Chun -,3 0 -gam Application is hereby made for a Permit to Construct ( ) or Repair ( �an Individual Sewage Disposal System at: -- - �- .-- ............... ........... ..... -. lLocati d dress or Lot N -_.... wne.�`S............. ............ ....... � a �.mty-h-<•g �LFr'�. -- ;-L-j2 . r ss PQ Installer Address Type of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms--------- ...........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers ( ) = Cafeteria,( ) a Other fixtures •____•------•__-. _ fl Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons. W 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water•-_________---•-•-_--_.- G%, Test Pit No. 2--•--••--_-_:-minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ---•-••••----------------------•--•---•---•--••--•••--•-----•-----------......•-----._...--•------••........................................................ 0 Description of Soil...............................................................................-------------------------------------••-•-----------------------•-•---------._....•--••- U ---------------------------------- ----------------------------------- ---------------------------- •------------------ •-------------------------------------------- -------------------------------- W --------------------------------••--••••-•----•-•------••-------•-•----------------•--••--••-•-•-----••------•----------------....... -- ------- -- -- U Nature of Repairs or Alterations—Answer hen applicable� v___�J_ - '- =- ' � / -- Agreement. . The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental We—The undersigned further agrees not to place the system in operation until a Certificate of Complia ce h een issued br y t oard f health. Signed .. = - . . . -- - ✓ .. y- Da[e q Application Approved By ------------------ ' = .p Date Application Disapproved for the following reasons: ----..................-------------------- -- --------------------------------------------------------............................ ................Da[e................ PermitNo. ----- -- Issued ................-------Date-----......................... Dace 9-3 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE , ppliratiun for Disposal Works Tuuutrnr�t� ,��'r��ti� Application is hereby made for a Permit to Construct ( ) or Repair ( �an Individual Sewage Disposal System at a, ................ ,+ %i(//t/!.�._.... ? -" - ----------- ��'�----- -i��1� ==.1--=-. --------- ��a� Locati dd ess or Lot Noa� / p� L- ►S _.. _....-• r- =` ram' fir=c¢ Owner /� OF Address Installer Address � Type of Building Size Lot............................'Sq._ feet U Dwelling—No. of Bedrooms.........._--ram................. _Expansion Attic ( ) Garbage Grinder ( )�+ Other—T e of Building No. of persons............................ Showers — Cafeteria Otherfixtures --------------------------------------•----------------------------••----•--••--•-•-•---•••--------...--------••--------------------....._......._.. Design Flow.............................................gallons per person per day. Total daily flow............................................gallons. 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 aPercolation 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........................ P4 -------------•-•--------•-•-----------------••-•------•--....._....--------....-•-•••---•••---------......................................................... 0 Description of Soil---- ------------------------------------------------------------------------=........................................................................................ x U w UNature of Repairs or Alterations—Answer when applicabhZ �.��r—._S_?L_.__ -------------- 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 hasbeen issued by t e-board of health. Signed Application Approved B � Application Disapproved for the. 1 owing reasons: --------------------------------------------------------------------------------------------------------------------- --------------------------------------...... - ---------------------..................................................................................................................... Date ------ Permit No. - ----- .�� .............. Issued ............................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Ter#tfiratr of Tontylianre THIS IS TO,CERTIFY, That the Individual Sewage Disposal System constructed y ( ) or Repaired (�) b L�....:�'.-f.-...... ..........Al a.. . Y ....... -�a�S... Installer... �....... - ----- ------------------------- at -.. �� -.. �t.1 � -�..,.. 1 � - 1'C..................................... ................................................ 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 14o. ............ ...�1.-..57':Zo...... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ----------------------------0 1.1 �1/-P/`h..... �V �-.......� ��I.-��/.�-��-..:...i-, ..;- ...�-!.......................... Inspector .... ....­; f ' . ` !a/ ...� .. _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No7.:.:. 3��.. FEE.30.... Disposal orku Tonstrur#iun Verna# Permission is hereby granted- �- �/-(....l �:CI�„� = k/C 7 .. -�> ................................................... to Construct ( ) or Repair an Individual Sewage Disposal Sptyem at No.......� ---•-----.-��d !��.J ��:.... 14 a__.,,f'..------. ! ! d . .: ................................................. Street as shown on the application for Disposal Works Construction Permit No.h:-;5 __ Dated.......................................... ........................... ::D............................................................ q Board of Health DATE.................f: - �.�-�_!._ - FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS