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THE CAONALT� HEALTH
F�� TS
BOARD
d -t,....oF....... ...................................................
Appliratinn -for Miivoii al Worko Tonotraarttnn Vrrmft
Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal
System at:
N--_---------------------- --------------------------------------�.7....._.......---------------•-------------....
Loca on- ddres or Lot No.
_t �� ----------- - ---------------- -----� ---------•( j ------ c -------------.........._...--
Own ........................... --•----Address
-------- --------------------------
Installer Address ®
I, U Type of Building o Size Lot_ te-1-.9!'!q__....Sq. feet
- Dwelling—No. of Bedroo ---------------�---------------------------Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ZVMJ __ No. of persons-------If----------------- Showers (. ) — Cafeteria ( )
Pa Other fix res --•------------ -------------
W Design Flow................. C.-_______•-_ .gallons per person per day. Total daily flow---------_, V..0..............__.----gallons.
WSeptic Tank l Liquid capacityJ_A-00gallons Length................ Width.--_-_-.___.. Diameter-----...._...... Depth................
x Disposal Trench—No- ____________________ Width...._...._ Titatow
ength-------------------- Total leaching area--------------------sq. ft.
Seepage Pit No...I................ Diameter...4__P�C?___ Dept inlet.....
_ _......_.. Total leach' ...ig area.-_ ___._.___--sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) _,,)e " — 2/mot// 7'f,
a Percolation Test Results Performed by-------- ---------------------------•------------------------------------- Date----------------------------------------
Test Pit No. 1................mittutes 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------------------------
-------------------------------- _
--- - _---- -- ------------------------ -= -
Description of Soil----------------------------------- -b'-�---
-- ---_7-------
W ------------------------------------ ------------------------------------------------------------------
UNature 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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be issued byQheoard�jf health�� ��-- - ------ -
,1�7 Sign
jate
Application Approved By---- ... -
to
Application Disapproved for the following reasons----------------•-----------------------------------------------.......------------------------------------------ ..
--••--•-•...................•--••-•-•------------------------•-••---•--...---•-••---------------------------------------------------------------------•-•----------------------------•.-------•--.-----
Date
Permit No......................................................... Issued....../� 7
.......................
Date
No.-` FBs.... .... r
TH B OOM^O�N®ACTH OFLM�ALTH TS
T11 II'�� I-7
, "Ritd .....OF. �,r�f'✓'`'•�•'yrR`--....._-------------------------------------------
Appliratinn -for Ui,ipuiittl Workii Towitrurtion Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( } an- Individual Sewage Disposal
System at: j
_ C ............e�o -
Z........... ..-------------- �-_q--------.- .r__ ...0 t No.o :.....�._.....---.......................
W Own � / Address
a ....................
......................r.¢ L_4,....................... ..__...._....-.__.-.._-...__._.._______._..___._._.______.._......___-.__..___._.__..._.____._._..
Installer Address
Type of Building Size Lot../Kt_�od---___Sq. feet
U Dwelling—No. of Bedroo .................... ----Expansio Attic ( ) Garbage Grinder ( )
p`q Other—Type of Building _4s (.�r_ ._ No. of persons_..•------ ----------------- Showers ( ) — Cafeteria ( )
Q' Other fix res
d .....................--•----------------------------------------------------------------------------------
W Desi n Flow.. ........... e___ ._..._..._.__-- Mons per person per day. Total dal flow.._._.._. -_---- -..-.--__ allons.
g -- g P P P Y Y g�
WSeptic Tank f Liquid capacity le_.bPpgallons Length................ Width........-------- Diameter...... ;..... Depth.___-_._......
xDisposal Trench—No..................... Width_._._.....: . , o,,til,Length-------------------- Total leaching area----------...-------sq. f t.
Seepage Pit No....I---------------- Diameter...4..A!�®... Depth below inlet.................... Total leach' ig area------------------sq. it.
Z Other Distribution box ( ) Dosing tank ( ) — _e)e- ) l c , "/--/17',
Percolation Test Results Performed bY-------------------------------------------------------------------------- Date----------------------------------------
a
Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water-..------------.-...._.-
fs Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water...-.-.--_---_------. -
�+ -------------------------------- ---------• --
. � ---- -/ ---- ---- -'=--•------------------
oDescription of Soil ? . ..........
�
f
UW ---
---------------------------------------------------------------------------- ----` ---- {"�, �i
----------------------------------------------- ---••---------------•--------------------- .<
UNature 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 Article XI 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.the oard f healthy
Signe ' .._. � x
t Date
Application Approved B . g�
PP PP Y------j.-- _. = :*1..�c : 7" tDa e "
Application Disapproved for the following reasons------------------•--- ------------------•----------------•---------------------•----•------------
.-----.--•-------------------------------------------------------------•-------------•---•-
Date
Permit No......................................................... Issued........ 7
Da e
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALTH ( .
J�✓L
..........
.OF......... . :....:... ... ... ..... '......
Trrtifirate of 1.1umplianrr �.-
THI I 0 C 1�.TI at the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by......0. .".----� j --------------.--•----•-•--•-----•-----------------------------------....------------•
at...ti� / �' '`.........
Installer
has been installed in accordance with the proviston� of Article XI of T-, e� State Sanitaryy Coydedes ribed in the
application for Disposal Works Construction Permit No..................:....! ""..-....... dated..-. �,J.. 1------.-----
THE ISSUANlCE OF THIS CERTIFICATE SHALL NOT BE CONIST ED AS A UNITEE THAT THE
SYSTEM WILL N TION TIS ACTORY.
DATE.............. �� Inspector----- -- ----------------------------------•-----------------------------•-----
THE COMMONWEALTH OF MASSACHUSETTSi-
BOARD/OF HEALTH '"( ' �2
...... �1!' 1..............OF.....: .✓.. :111.2- ..._..--------------------......................... r� `
No....... ............ FEE 1-J-----•--......
Di-spniittl IM rkii �U'.Ja t urtion "rrmit
Permission is ereby granted---.... i-.�' .
to Constr.ct or Repair an 'dividu, 1 � e Disposal System
( ) P ( ) g PP Y
at No...........f .......... = f f .. iJ`
Street
as shown on the a lication for Disposal Works Construction Perm',t No.... �.. �'
.PP P ;� .ted , r� ----....
------------- - -- -- ------- --r-;.-w' -- - ----��---- -- ---------------------
oard of ealth
DATE................................................................................
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
AS SHOWN IN REGISTRY PLAN BOOK 58 PAGE 99 AS LOTS 81
AND 82 BARNSTABLE REGISTRY OF DEEDS DEED REFERENCE
BOOK 2009 PAGE 022 ALSO PCL . 770N ASSESSORS PLAN
271 .
N 120 44' 05E CB FD
120 '
LOT 83 LOT 80
3 11000 GAL., S7`�h-P
2
LEACH TANK
• 11000 GAL. In
SEPTIC TANK O N
32, r
Z ;t et
N N Z
TOP OF
34 32 ' 64,
FOUNDATION
WILL BE MORE
THAN 2 ' ABOVE O
THE ROAD.
120' GB FID
N 12°44' 05" E
L I NCOLN ROAD
I C�:F�(pT�`1' /PLAN
THAT` THIS PLANN SHOWS
THE
T=-, ,-; Z- T VvI i-1-4 THE,
FLAN Oir LAND
/ I
H Y A N N I S MASS.
a�
OWNED BY
` �.v,4,x gasSS4, A L FRE D E. OLKKOLA
k� k t. i r p:�4-k sue. RRANt� FrO,NERY HYANNIS, MASS.
'p
JhdFt�y �ia a
"9 i t -;�C�w„'4`1 ) CG'I51 E fD ENGINEER 8i LAND SURVEYOR
IrALE t IN -30FT. MAR 1974
�6 .