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0255 WAQUOIT ROAD EAST - Health
t7 ,\P.j ck-.%. k-) 'A- TZ c> TOWN OF BARNSTABLE LOCATION `!` e SEWAGE # ! VILLAGE v ASSESSOR'S MAP & LOTO/ ry 0 INSTALLER'S NAME & PHONE NO. Y� SEPTIC TANK CAPACITY c, LEACHING FACILITY:(type) ��Z�00 ,; ��w (size)I — = -�t NO. OF BEDROOMS 3 OR PUBL "!WATER BUILDER OR OWNER DATE,PERMIT ISSUED: l DATE . COMPLIANCE ISSUED VARIANCE GRANTEDi No �. �. i �G� �� �. �' ��, � ) � � � �� � �� �. )SESSORS MAP NO: No.. . .�_.... - Fima.............................. *7_ THE COMMONWEALTH OF'•MASSACHUSETTS BOAR® OF HEALTH n\C -------------------- --------------------OF............. L ` ........................................ App trattvat for Elhgpvii al Works Tonatrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: e ..........� ...=--:-� 9------•--•---------- -----••----•---- .....--__................................ cation-Address __._ �i or Lot No. �t ............................................. ----vas..... .........................._.. •.. ------ es ddrs ..................................... 1_✓a!!_ .. :.................................. ..... Installer }� Address © ©b Type of Building Size Lot... ................Sq. feet Dwelling ANo. of Bedrooms_.....................................Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a � Other fixtures ....................................................................................................................................-................. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—.\To. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. _i ._...____.. Diameter____________________ Depth below inlet._....._____._______ Total leaching area.:.__...._.___._._sq. ft.Seepage Pit No.__ 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____________.___.._____. rZ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--__-_-__-__.__--_.____. fYi _ Descriptionof Soil `��� ----------------------------•---....---•----•-----------------------------•-•.......---------••------• ...-----•-----•. w VNature of Re irs or Alterations A saver the applicable. `0 Q..._ - ---------------- ... ................- Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance.with the provisions of' ":p of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by t1leboard of alth. Signed.. - --- . ..3.. Application Approved By....... - ....--AA �- ------�='� Date Application Disapproved for the f ollowi g reasons:-------•-------------------------------------------------------------------------•-----•. -----•••--....•••••- .............-........................................................................................................................................................................................... Date Permit No..............: Date TM ow FRs. ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Apptirafilan for Uhiposal Works Tutuitrurtion Prrutit Application is hereby male for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: _ !�✓ /1/] L011ocation-Address r _ or Lot No. --. der , Installer Address QType of Building Size Lot....... :_...:.... •...Sq. feet U Dwelling-.4—No. of Bedrooms._-1......................... .Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ------------- No. of persons............................ Showers — Cafeteria 0.1 Other fixtures -------------------------------- - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. t� Septic Tank—Liquid capacity------------gallons Length................ Width.:.............. Diameter................ Depth................ 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........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ODescription of Soil e % -•-•-•-•-•-----------•-----------•-•------------------------•------------------------..........---------------------------------•------ ....-------•.........................................................................................................•__... ....................... ...'_'_...._......_._..__.._..._.__._..._..... U Nature of Repairs or Alterations A saver whe applicable.._ .....�__-.f-----------�J ���`�w�.-- 1 ": * r __ ------------------------------------------•--•-------•-••------------ -...--•----------------------------------- Agreement: The _undersigned agrees to install the aforedescribed Individual Sewage Disposal.System in accordance with the provisions of TITS g g p y 5 of the State Sanitary Code The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issued by t-e board of 1}• lth. Signed. = '`..-----.r���,.��!;_ ............................... / � ate Application Approved By........ -1---------------•-------.---•- ... ---•--------..._._................ Date Application Disapproved for the follow i reasons:.............................................................................................................. ........................•............................................................................................................................---••---•----•------------••-----••--•------------- Wi Date PermitNo......................................................... Issued.......----j-----------------....------......--------- Date THE COMMONWEALTH OF MASSACHUSETTS r _ BOARD'(- OF HEALTH ......OF......,`-.`! 1 P`�i Trrtifiratp of Toutphattrr THIS S� TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( } ----_... '( .................. (7 Installer at .•��-•a ' -•---------•--- 1�•-`="= -------•...............•-....----------- ``,, has been installed in accordance Ath the provisions of TI IE j of The State Sanitary Coe as described in the application for Disposal Works Construction Permit No.___�� :.�.�r. / �dated---- ---- '- s THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE............... :. :. f.. ...................................... Inspector.-..... .- -,t-^-r--... .-- THE COMMONWEALTH OF MASSACHUSETTS 'BOARD OF HEALTH TG 1 .........................................OF..........: .`............................_..................................... (�1 vv o.....................: FEE........................ Disposal Works Tonstrudion ramit Permission is hereby granted............t ............U.L����- to Construct ( ) r epair ( )-.an InTtviqual Sewag IS sal System -• o f Street as shown on the application for Disposal Works Construction ermit No.................... Dateg................................1........ Board of Health DATE---------. ...:.?..._._.. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS n - �� THE C ONWEALTH OF MASSACHUSETTS r BOARD O�f HEALTH .........oF................ .... . . sf Appliration for Uiipuont Workri To itra�r�' fermi# Application is hereby made for a Permit to Construct ( ) or Repair (. an Individual Sewage Disposal System at: ...... t ..................j............................... ............................................... .......................................... Loc ion•Address or Lot No. ! ...•... .......................................... --------•-•-- --------- -- r Add ---- ................ . ............................................. .............................. --- :..................................................... Installer Address s9®�D q' d Type of Building . Size'Lot...�.....................S feet U Dwelling�No. of Bedrooms...3..................................:....Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons-•- .................. Showers'( ) — Cafeteria ( ) Q' Other fixtures ........................................................ •--•------------------•--•----------------•-•--• ........------.....---•--------------------. W Design Flow............................................gallons per person per day. Total daily flow.............................................gallons. 04 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ 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...........-------------------------- a Test Pit No. I................minutes per inch Depth of Test Pit................... Depth to ground water_____-_-----_---------_. Gz, Test Pif No. 2................minutes per inch Depth. of Test Pit.................... Depth to ground water-___-___-_-___----_-_ 0a ....................................................................•.---•---......................................................... 0 Description of Soil........_ _ _ x ------------------------------------------------------••••-......----•-••- x -------------------------------------------------------------------------------------------•-•-•••• g ........................................... -- ---- U Nature of Rep irs o Alt ations Answe when applicable_.1 %GC_----- --'-------------------�� -a!i .......... ..•.....• _..-------•................•-----------------------------•----------------------..._._..-----•---•------•--••---•-•--•--•-- Agreement: ' The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TTTt_. �of t he State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued V the oar health. . Signed. ......... ... ! .......................... �` ` A lication Approved B `ter to PP PP y-•--•-------•--- c= ... ._.._--•---- Date Application Disapproved for the following reasons:----•----------------------•-----•----------•-----------------•---------------------------------•-•-•--••....... ..................•----------•--••---•--......--••-•---------...............---------........--------•----•-••-•-•--•-•-••-••-----•---•••-------•-•-----•--••••-•--•••-•••------•-•--•-----•--------•--- �-j Date PermitNo._.. ...(.. Z-----...-•------.. Issued_............................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................h .....OF..........., dam. 9E..................................... %F. ertifiratr of TompfiFana THIS IS TO CjRTIFY, That Individual Sewage Disposal System constructed ( ) or Repaired ( — by-------------_-----. I ....... � -. Installer .. � n ..... ..____ L .__......____._.__._....._....._.........__.._.___._____._..__.._...._._ p 5 of The State Sanitary Cod as described in the has been installed in accordance with the provisions of T,-mtr application for Disposal Works Construction Permit No.._4_.0 ..._../ ............... da.ted_...__f__ _._. - 5 _._-------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GU RANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE... ..-. t� Inspector - � -._ ----------------------------- n r' THEpAkivIONWEALTH OF MASSACHUSETTS j BOARD O-F HEALTH OF.........-.:`"✓ 1. f: ........................................ Appliration for Disposal Works Tonstruryou thrmit Application is hereby made for a Permit to Construct ( ) or Repair ( '"`) an Individual Sewage Disposal System at _ -• ' ._,�� .................................................... ...-•-•------------------.........--•------•-•....•---......_..--••------•-------•----------•..... alr Lo tion Address or Lot No. t!�. ...:�------- - ----------------•-------•-•----•----•---_. .............................................. -----.--- ......._..--- Installer Address UType of Building Size Lot..'Lr_.��..0----0__--......Sq. feet Dwellin No. of Bedrooms. .......................................Expansion Attic ( ) Garbage Grinder ( ) p`-�, Other—Type of Building ____________________________ No. of persons__ `�............_..__.____ Showers ( ) — Cafeteria ( ) QI Other fixtures ...........•-----•------•------- . . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 04 Septic Tank—Liquid*capacity............gallons, Length.......:........ Width................ Diameter................ Depth................. 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 ( ) aPercolation 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..........._............ O 1------ --._.... ---------------------------------------------------------------------- Description of Soil--•••---_'" ------------------------------- x W -------------- --------------------- -----------------------------------------------•----••-•----•••••-• / --•---• --- .. ...... U Nature of Re irs , ltrarion —Answ r when applicable_ r"rC ��f ...1�__`:fG' � .__r4 ------------------- I ' ........................... �- = --------------------------------------------•--- ••---------•-•--•-------•--•---•-,--••-•--. Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of y g g p y� of the State Sanitary Code— The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issued by the,boa/i f health. Signed__l.�:r< ..... ! ' ' ' :. _ .. .. "'-•:'! Date __..., ,,.Application A roved B PP PP y----•-------. L 1 �=> � Date Application Disapproved for the following reasons:................................................................................................................ . ........................................................-................................................---------------------------------------------------------------------------------------•-•----- j _ Date Permit No.. ___.................................. Issued...............------ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................r..........�........O F.............fir.................... Tntifiratr of ToutpliFaatrr THIS IS A TO RTIFY, That e Individual Sewage Disposal System constructed ( ) or Repaired Cam''_ _ by...................... •-•................ ......--=......_�.....------.....------------.....................----------------------•-------•--••-----............----•-•---•-----------•------ Y, �✓G ----Install� �)'-- has been installed in accordance with the provisions of 5 of The State Sanitary Co e as described in the application for Disposal Works Construction Permit No....... -------------_------------------ dated_....I__----_� �iff ............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A G ARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE................•---•-------•---------•------------........--------••-----...... Inspector..................................................................................... THE COMMONWEALTH OF MASSACHUSETTS .:� BOARD OF HEALTH ti ..... ............. FEE.. ..._.........---- i k.� � atotrudion rrutit Permission is hereby granted.. 4 _.....=:.....'_.... to Construct -;or Repair ( )+ an Individual Swage Disposal System r am!' .., ....... mat•`_. 0�� ��S a s�at O Street .-- as shown on the application for Disposal Works Construction Permit No __.2 - Dated.-{ -= ......................... ••. Board of Health FORM 1255 HOBBS & WAR ft: ,. INC.. PUBLISHERS �•3 .r _ _..