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LOCATION SEWAGE PERMIT NO.
VILLAGE
�INSTA LLER'S NAME+ A AD�DjfRESS
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DATE PERMIT I SUED
DAT E COMPLIANCE ISSUED
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THE COMMONWEALTH OF MASSACHUSETTS
_ BOAR F HEALTH SUBJECT TO APRni G ,
tW of ��A�R9�TA�LE p r
Appliration for Uiipuuaal arks Ton' rnr�iun p�u't��'�;
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
S stem at
IS...V.0...Cipmu ...................c
Location-Address or Lot No.
.................................................................................................. •-----•--------••-------------....._...----------•---•------------•--•--------------_._.......•---
1 20Own Address
a _____.... Y......._�?-`-`-'. ......................................... ----______---------...........--•- ._..------.........................-•------
Installer Address
d Type of Building Size Lot 53k__.___Sq. feet
Dwelling—No. of Bedrooms_____;]___________________________________Expansion Attic ( Garbage Grinder 45
PL4Other—T e of Building No. of persons____________________________ Showers — Cafeteria
Otherfixtures - ------------------------------------------------------•--•-•--- ---•-•-----
Desi n Flow..........�S.. ....................... allons er erson er da Total dail flow_____,
w g -- g P P � a Y• � Y w ��---••------•--------------gallon`r
W Septic Tank—Liquid*capacity_10�?gallons Length_*-6_ ._. WidtA._-1n ._ Diameters._ Depth__
�
x Disposal Trench—No.___............... Width...A-G._......... Total Length.__Z.L2 r......... Total Total leaching area_1 ......sq. ft.
Seepage Pit No------_----- ___ Diameter.................... DepV1 below inlet.................... Total leaching area..................sq. ft.
+a Z Other Distribution box q� Dosing �tank ( ,
'-' Percolation Test Results Performed b . �� �s191 A( Date ._ .. _ __._...
Test Pit No. 1_4Z.......minutes per inch Depth of Lst Pit.....Z5........... Depth to ground water...�________________
Pr Test Pit No. 2_4"Z ___._minutes per inch Depth of Test Pit...... . Depth to ground water._(;,4_5_.........
P4 ...........................................-- ---•-•-•---------._......__... ....
O Description of Soil.......O._"__j. ....... __ ______ ��e
---•---
�► _�.�*r`eft.�.-------�--'----��--•------------ �---�1��4.1�._......
w
G--tA--�c_ 't........................................................................................
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 5 of the State SanitaryT e u fied her agrees not to lace the system in
o e ation until a Certificate of Compliance has i'sS`>4c l 4 g P Y
S gned_ ---•-------••.............. ..%/ !
D e
ApplicationApproved BY-----------•--•-._...-•- - -- -...•••.••-----•••-•-•-- --------------------------- _.._._.__l _ .!t ��
Da
Application Disapproved for the f ollowi reasons:-----•------•------------------•----•-----•------------•--------------------------------•-•-•-•••--•-•••----=---
................•--•--------•---._._...----•--------•------•----•--•--•--•------•---------------•----------•-•-------------------•---•--•---•.... ..................................................
Date
PermitNo......................................................... Issued_.......................................................
Date
BAXTER, & NYE, INC.
Registered Land Surveyors and Civil Engineers
7 Parker Road/Osterville, Massachusetts 02655/Tel. (617)428-9131
WILLIAM C.NYE,A.L.S.-President
RICHARD A.BAXTER,R.L.S.-Vice President PETER SULLIVAN,P.E.-Vice President-Engineering
September 12 , 1986
Town of Barnstable Board of Health
P .O. Box 534
Hyannis , MA 02601
RE: Lot 13 Cap' n Samadrus Road Cotuit
Applicant : M. Lainer
Installer : Reed Ellis
Dear Board:
In accordance with the terms of the permit , I have
inspected the septic system at Lot 13 . The system has
been installed as per the approved plan.
I trust that this meets your present needs .
Very truly yours,
Peter Sullivan, P . E.
Baxter & Nye, Inc.
PS/bc
CC: M. Lainer
jN OF MgsVti
PETER
SULLIVFM -4
No. 29733
MEMBERS OF
CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS/AMERICAN CONGRESS ON SURVEYING AND MAPPING
MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS
c+ S
No................_....... Fxs............._...............
THE COMMONWEALTH OF MASSACHUSETTS
EOAF�®F HEALTH
_
...._..... ............................._OF................. 'ac.,..,.: -•v �lr �..__......._........._.
Appliration for Disposal Works Tonstrnrtinn Prrutit
Application is hereby made for a Permit to Construct (, or Repair ( ) an Individual Sewage Disposal
System at:
. .... C:—n a u `. � ,fi--
„_� - .... ---- ---....._. .....................•----.........------.
Location-Address or Lot No.
......................_.......................................................................... .............................................
-------•••----------- --•-•••------..........._
Owner Address
W
W
� - Installer Address ,�,.•, ,...�.-y,.�
VType of Building , Size Lot.... f_=___ _�...._Sq. feet
Dwelling—No. of Bedrooms_____
............................_..........Expansion Attic ( �• o Garbage Grinder (� )Q
aOther—Type of Building .............................No. of persons............................ Showers ( ) — Cafeteria'( )
Other fixtures ............. -•----
-. ---------------------------•----------------•--•--------••---•-----•-----------------•-- -- ......................................
.. .t
Design Flow__________ _5______________________Y._gallons per person per day. Total daily 4ow........ 2............_____.._.___gallons' P
Septic Tank—Liquid capacity.,!t' allons h,ength_ .___ Wldthy.t�? __. Diameter________________ Depth___�__."�'__-
W Disposal Trench—No._...1............. Width....t4........... Total Length---- _........ Total leaching area___3E>P-----sq. ft.
x
Seepage Pit No____________ ____ __ Diameter............._...... Deptki below inlet.................... Total leaching'area_____._____.__.._.sq. ft.
Z Other Distribution box Dosing tank
Percolation Test Results Performed by...: '-L`:v^� �__. fi f`= j�$i ��`�C Date_r" _
Test Pit No. L 5 7_......minutes per inch Depth of Test Pit.____ .......... Depth to ground water._.t:ta__....................
44 Test Pit No. 2..�:�:.....minutes per inch Depth of Test Pit._.__.9........... Depth to ground water...! ..5>..........
O Description of Soil_-_____(`7-_2-`-Ir________-_�•_'_'�'�``..'�._ `r_ ` c!_t-c___.__,__ C-,,/" _.._____ __,=,C;) -' -----•
V ----•.....................................................................................--................................................
W
U Nature of Repairs or Alterations—Answer when applicable................................................................................................
-------------------------------•--------------------------•---._...--------------------••-------•-•----•----------------------------------------------•------------------------•••-•----------••-----•.
Agreement: r
The undersigned agrees to install. the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code—The undersi ned further agrees not to place the system in
operation until a Certificate of Compliance has n issued by� e b of health4C
. >
S ned• -••---• JG-'----------- ...
Da
Application Approved BY -------------
------ --------
---------- Dat
Application Disapproved for the f ollowi reasons:-----•--•-•---•--••--•-•---••-•-----•------•-•---••--------••----------------------------•-•---•-._....._......
---------------------•------------•-•-------•------•------------•--------••-•--•------•---...•-•-_._._....---•--•-•----•---•-----•---•-------------•-••---------•-----•---••---••-----••---•---•---=-_---
Date
PermitNo.........................•............................... IssuecL.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
� ....................OF.....��lUS 1A-v-�.�
. ........ ..................................................
Trr#if iratr of Toutpliattrr
I IS TO CERTIFY, That the Individual Sewage Disposal Sy t m constructed ) or Repaired )
St er
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as-descri ed in the
application for Disposal Works Construction Permit No.......;_........11q-J............ dated-------- .---.----
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAR NTEE THAT THE
SYSTEM WILL FUNCTI ,N/ SATISFACTORY.
DATE --{ .................... Inspector....................................................................................
M•fiT THE COMMONWEALTH OF MASSACHUSETTS
S�IPEr ��SrE �usT�4Ur17r�FV BOARD OF HEALTH
_ J 14 .......... w..''�..-....... ......E...... A . -�5.. -�................... s p
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No........ .._ FEE........................
�i��a���t nrk� �nn��� •nr#Uan anti#
Permission is hereby granted.......... ......... ..............................
to Construct ( ) or Repair ( ) an Individu,41 Sewa a Disposal ys
at No............. d7 - •Jk (,,^1)N �A 6H 0t S 't: CC7Tv1`r ff-v-�16,
Street Q '�' 14/
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as shown on the application for Disposal Works Construction Permit No......._____________ Datgd_
��Z,� /
DATE_ 6 I
......................
Board of Health
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS /,
�064. .
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SULLIVAN �'�
No. 29713
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