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No. Z0 Z 36 b Fees
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye-1
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ftphCation for Mispo8al *pstem Construction Permit
Application for a Permit to Construct( ) Repair(-d,) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location
ca���;ress or Lot No.2C\ Gceec\bc�e�LG,r� 8wner's Name,Ad�iresoa �5N_,� &�'�-$3�,�C1y
yy S Oqti+�a pd ` h
A sbssor's Map/Parcel I&B
Installer's Name,Address,and Tel No. Designer's Name,Address,and Tel.No.
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Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs orAlterations(Answer when applicable) ( \Q \A-2 O
bc_)x
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of He t
Si Date
Application Approved by Date D 7wv
Application Disapproved by Date
for the following reasons
Permit No. 2 2 l Date Issued
ti
No. Z Z 1 _ -36 0 Feel y
THE COMMONWEALTH OF.-MASSACHUSETTS Entered in computer:,
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
4ptitatiotl for Disposal *pstem Construction Permit
Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components m.
X
Location Address or Lot No.'Lr-\ C�ceer� t� e' i�{? Owner's Name,Address,and Tel.No. '"` ->"' Ul
Assessor's Map/Parcel " fj 1(3-1'6 % 4,. o )L)Ct`1�ync . �Nc-.C%o A tJ;
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
9b V:1,6 rL. . P\C'\ lroo,4•,e ..�p d'14 OIL1°i '�' Cat sit
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( ) a
Other Fixtures
Design Flow(min.'required) ems.- gpd Design flow provided sr gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) �� {�{. ��p�- �� � ] C'j
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health
Signed (�f ry 4� Date CA L 0t ✓`
Application Approved by t/ w '� Date
Application Disapproved by ` t Date
for the following reasons
Permit No. 2—o Z I — -U o Date Issued [) y Zo7./
-�, - - - ,_- -- - --• •------------•-
°. THE COMMONWEALTH OF MASSACHUSETTS e
w GUt -�U�C BARNSTABLE,MASSACHUSETTS
`1 (Certificate
r tfitate of Compliance
THIS IS TO
CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(X Upgraded( )
Abandoned( )b CC-vS e C_ \£N c.
at 7"A C_Ncfl_r,�,P le' 1 I,_y,@ �Xj(�% Ti v has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.1021 ._Z0 dated /oly 7,7 t
Installer i... iti{1Y`."`a cc—,VA,( k—\ 4' Designer r ,
#bedrooms Approved design flV gpd
The issuance of this permit shall not be construed as a guarantee that the system will-function as desigi eed.
Date .t' I ib Inspector ,, )� iI A' `
No. ��G I 56D
_ Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACHUSETTS
Disposal O- pstem Construction Permit
Permission is hereby granted to Construct( ) Repair/) Upgrade( ) Abandon( )
System located at,7
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit. rr
Date �� / �� J Approved by
LOCATION SEWAGE PERMIT N0•
VILLAGE
09
INSTALL 'S NAME i ADDRESS
�Cl/lr 2 cJ �
2 UILDER OR OWNER
DATE PERMIT ISSUED �
DATE COMPLIANCE ISSUED
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEAL
/ rI...OF........
Appliratinn for Disposal Works Tow3trurtinn Prrutit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
Sys at:
---......�_ ------- __
�j Location-Add s �y14.1 S Lot No.
........... it' �^1.Z�d...., ._l d... ....... ..... . .........
U lQ ...�
Ow er Address
� .... ----•-
Installer Address
dType of Building q � Size Lot_ .-y�za.._.___Sq. feet
V Dwelling—No. of Bedrooms_____________ __ Gc___.__._______Expansion Attic Garbage Grinder
Other—Type of Building ______ No. of persons......._-------------------- Showers — Cafeteria
a' Other fixtures -------------------------------------------
--W Design Flow______________________________ __________-gallons per person per day. Total daily flow----________.�34•-...-_.__._____gallons.
WSeptic Tank—Liquid capacity.. gallons Length---------------- Width................ Diameter-------_........ Depth....._..........
x Disposal Trench—No_ ____________________ Width.......
/---------- Total Length.................... Total leaching area_________________ sq. ft.
Seepage Pit No_________ _______ Diameter_____ ld....... Depth below inlet..... Total leaching area.. .sq. ft.
Z Other Distribution box Dosing to /
aPercolation Test Results Performed by--••--••V � �/1
Test Pit No. 1-------s ....minutes per inch Depth of Test Yit____ _________ Depth tond water.___.,e7i,� _
( Test Pit No. 2................minutes per inch Depth of Test Pit____________________ Depth to ground water__-_____-___.__________-
-------------•- t
Description of Soil______________Q_�. __________ ofom...... --•• ------••----••------••------•--------------------------••-----•----------
------�' - --------------------------------------------------------------------••-------
-------------------------
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 i y g g p y
5 of the State Sanitar Code— e undersi ned furtl: rees not to lace the system in
operation until a Certificate of Compliance has been 's by the d of hIV 17
1
Signe A -- --••-----
Application Approved B ----- t �l ...-----••••--•. •-- = t PP PP Y 17�'
Date
Application Disapproved for the following reasons:................................................................................................................
••--•------••••••---•---------••----•-----••-••-----••------------•-•-•••--•---•------•-•---•----••-...•-••-----••---••----------••---•----•••--••-••---••••-•--••--••••-•-••--•------•----•---....__...
(` 1 Date
PermitNo......................................................... Issued ••-- -�_B ._(-J/-/..----•-------
Date
- : . 07:
No.............(1-� ;I'l-s FEE. .."r...............
THE COMMONWEALTH OF MASSACHUSETTS
—,BOARD O HE
----...... -c r'l...oF.....- r .......................
Applirativu for Uhipniia1 Workg Tomuurtion Prrutit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
Sys �' r�'!' � � j ? ,.. ..__... 09
.-- �
Location Ads + J t No.
____ -• ----•••••.............. c
Ow er dress
a ••••••.............•••••••. . . . • ....--
• -- ..........................................
�....................................................
Installer Address
d Type,of Building Size Lot: �..................Sq. fee
Dwelling—No. of Bedrooms--•---••-...k45 '•'-'..............Expansion Attic Garbage Grinder
p-, Other—Type of Building ____________________________ No. of persons_____.._____________________ Showers ( ) — Cafeteria ( )
Other fixtures_____________________________...__ _
---------------------------- �-.
W Design Flow............................. gallons per person per day. Total daily flow............. gallons.
WSeptic Tank—Liquid*capacity'___ +.gallons . Length________________ Width__.....__.___.__ Diameter__-_:_______._-..Depth______________--
x Disposal Trench—No____________ ______ Width ! ._._ Total Length........ ¢ Total leaching area--- sq. ft.
Seepage Pit No..____.__1'r ____. Diameter s_..._. Depth.below inlet.__..._.._._. Total leaching area__ sq: ft.
Z Other Distribution box ) Dosing taxk.(e
a Percolation Test Results Performed by........ �"_-. ._... ._ 'y" ____ _________ a e............ .
14 Test Pit No. 1...... ----minutes per inch Depth of Test Pit----/4?_........ Depth to ground.water____
Test Pit No. 2..._............minutes per inch Depth of Test.-Pit..................... Depth to ground water......................
-
O �dl �.
Description of Soil----•-- •-• e
� ------------------------------------------------ - -=-- -- �' ��'' ---------------------------------------------------.....................
V Nature of Repairs or Alterations—Answer when applicable................................................................................................
•---------------------------•------------------------------------------------------._..._---_-•--•--•-•••-•••-•------------------------------------------------------------------------------ -------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
T f'1:•-•
the provisions of�'1_T -._ 5 of the State Sanitary Code—Xe undersigned furtl: r-grees not to place the system in
operation until a Certificate of Compliance has been; by the'b • d of i 1t�
g
'
> ne } w ' :"=--ter '' ?'-- l--•-•--- -•-•-- • ........
Application Approved By........ - `-,� ---- .................- .................. -•--•--
Date
Application Disapproved for the following reasons---------------------------------------------------------------•-------------------------------------------•---
....................................................-..........................--.......................................................................................................................
Date
PermitNo.......................................................... Issued_•-.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD Of HEALTH
a
�rr�gfirtt�r ,af f�u�t�Ii��tre
THIS IS TO CEIFY, That thg Inuge Disposal System constructed ( ' or Repaired ( )
Install .n
at--- •-•-•-•— -------°`�'/,Y-- Y t t�------- ------- ..................................... `''
------A4
R
has been installed in accordance with the provisions of T a The State Sanita� Code as desc>;b m the
application for Disposal Works Construction Permit No. _________________.______.____ dated_.,.!_�:_-,��.........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
a
DATE .--•-•• -••----... ...._._... Inspector -
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF" HEAL H
//,
OF.........../�.l ....................................
101
FEE..... .........
RaposaIfthg .0aylitr Tian r fait
`^Permission is- ereby granted................... .. .........--------------- .......
to Construct (Aor R airs( ) I divldu wage Di 'osal Syst
atNo............................^4 -••--••--��-� r '�l t'/±�..................�'�,------��`'--- ------ _
Street d
as shown on the application for Disposal Works Construction Permi o ........ Dated......1p-'SI'
.....
-
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/� Board of H�
DATE......Ad ._ / % -----..._••--....•. -
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS -,,
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