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TOWN OF BARNSTABLE C\
LOCATION z 9 19sQ SEWAGE # _00—
W.LAGE Namo0iS ASSESSOR'S MAP & LOT 2 G 9- 2 y6
INSTALLER'S NAME&PHONE NO. 4 71-03y 4 Jo s e�°li at [J.di°roS
SEPTIC TANK CAPACITY /b00
LEACHING FACILITY: (type) -SDO 6v1 Ziy Ge ��size)
NO.OF BEDROOMS 4�
BUILDER OR OWNER /SeMAVIC /rW*, 2
PERMIT DATE: /O-17 —00 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leac 'ng facility) Feet
Furnished by
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I /TOWN OF BARNSTABLE
LOCATION Z 9 (',a V,rc l lr5l'k- SEWAGE # ,20-
VILLAGE Tl LIL9H H1c ASSESSOR'S MAP & LOT 2 G 4- 2 S'G
INSTALLER'S NAME&PHONE NO. 034'
SEPTIC TANK CAPACITY /bOd
LEACHING FACILITY: (type) -5�70 601, rise 4L, /size) 33 A /-,T
NO.OF BEDROOMS el
BUILDER OR OWNER_)tedwlc r�/Ofa
PERMITDATE: /O-!7 —b0 COMPLIANCE DATE: /O— 3I—00
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Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Welland Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility (If any wetlands exist
within 300 feet of le ac 'ng facility) feet
Furnished by
v NO,A
No.ZAP" �7 Fee
THE COMMONWEAI_TWOF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Zipprication for Miopozar *pMem Construction Vertu
Application for a Permit to Construct(C�epair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components
Location Address or Lot No. 01WL_ Vjl=4' .101:r< Owner's Name,Address and Tel.No.
hl �81d11/� �lY�d✓ //'//�/ w
Assessor's Map/Parcel o
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Installer's Name,Address,and Tel.No. 4?"—aJ 5%T Desi ner'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( )
i Other Fixtures
Design Flow- gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil :�1�c°/
Nature of Repairs or Alterations(Answer whe applicable) ;�;g S 70 —,.5-00 60"A )9.'4/
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 Certifi-
cate of Compliance has been issued by this oard of Heal
Signed / Date
Application Approved by Date /0 '/7—ZdTO
Application Disapproved for the following reasons
Permit No. � `'Lff Date Issued a ? �
No.
Fee J
THE COMMONWEALTH-6;;MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSAC,HUSETTS
ZIppYication for MigpogaY 6pgtem Cougtructiou hermit
S
Application for a Permit to Construct(G)Repair( )Upgrade( )Abandon( ) El Complete System O Individual Components
Location Address or Lot No. 2 9 Owk V�� Owner's Name,Address and Tel.No.
�syr�is �rs9sr� �/gyp
ssessor's Map/Parcel H
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No:
T ✓osspG7 U,% V_e /3"ol-w-U5 ,
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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 gallons per day. Calculated daily flow gallons.
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 whe applicable) '
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 Certifi-
cate of Compliance has been issued by this oard of Health.
f' Signed Date /®-/!'—o o
Application Approved by .t / Date /0 -/7-ZQ?-O
Application Disapproved for the following reasons
Permit No. - `2 y Date Issued U Zgo—
———————————-•.——————————————-————————————
"THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY, that the On-site aSewage Disposal System Constructed( 4.)A4paired ( )Upgraded( )
Abandoned( )by o s4,e�
at -119lO has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No."2. y-fG Z G/ dated /0 -/ ) 4-ry
Installer `112t�P,411 /21 &V4._0 Designer AseAl- de /?a,y01d S
The issuance of this permit/shal of be construed as a guarantee that the system will function as;ldesigned)
Date i /,'){ Inspector ,i-; %(. iIV
� �
No. �/�/� '"lo -----------�6 9 14 4�V Fee.THE COMMONWEALTH COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
lwigpogaf *pgtem Congtruction Permit
Permission is hereby granted to Construct( eair( )Upgrade( )Abandon( )
System located at 2
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes 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 p t.
Date: w - % ' Approved by �'���L. .. �-
ti6i99
NOTICE: This Form Is To BeTss t For the Repair Of Failed
Septic Systems Only. -
CER=CATION OF SKETCH .kYD APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERtiQT fWITHOUT DESIGYED PLANS)
hereby certify that the application for disuosal works
cons=cnon permit signed by me dated /0 —/%— ea concer una the
propery located atS meets all of the
following criteria: Ir
The failed system is canoe-c-;ed to a residential dwelling only. There are no commercial or business
uses associated with the dwellinz.
i
r/,—The soil is classified as CLASS I and the ee:colation rate is less than or equal to 5 minutes cer inca.
�j—The:e are no wetlands within 100 fee;of the orocosed septic system
There are no private wets within l:0 fer,of the orocosed sc:)6c s-rse n
�j- There is no iner=se in flow'artd/or change in use proposed
The:e are ao variances requested or needed,
t ne bottom of the proposed leaching facility-will not be located less than five feet above the
ma.,dmum adjusted goundWaMr table elevation. (Adjus the groundwater table ;Sin; the Frimntor
method wheat applicable)
• If the S.A.S. will be located with '_50 fe--;of any vegetated wetlands, the bonom of the procosed
leac!iing facility will not be located less than oureea 0,) feet above the -naLcimLm adjusted
Q*cundwater table e!z•iation,
Please complete the following:
A) Too of Ground Sunace =i(riation(cuing, CIS intortttauon) y6
B) G.W. Etcvaaon _the :NL4 C. High G.W. Adjusment
D FFE3-ENCE B E T WEN' a,and B
SIGNED : 7�1.-[ r D ATE:
(Sketch procosed plan of sYsea on bacll-*
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LO CAT 10N SE AGE PERMIT NO.
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VILLAGE
INSTAL CER'S NAME i ADDRESS
BUILDER OR /W. EA .
C)
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED ,� �_ ,�
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALT
I 4A4
Appliratinn for Bi-spinal nrko C�nntitrnrtion ram
hereby made for a Permit to Construct or Repair an Individual Sewage Disposal Application is
Sat• r-•-" �
Location-Address / or Lot No.
/ '`��=------------------------------------------••--
-
Owne Address
W
nsta Address 7
UType of Building Size Lot---- feet
Dwelling—No. of Bedrooms....................../..................Expansion Attic ( ) Garbage Grinder ( )
'� Other—Type of Building No. of persons............................ Showers — Cafeteria
G� YP g P _ ( ) ( )
P-4 Other fixtures .....••••...... •--•--•-------• .
W
Design Flc.W...............<.�...................gallons per person per day. Total daily flow............._........._.........._......__gallons.
WSeptic Tank—Liquid capacityt_` 00-gallons Length................ Width................ Diameter._:-___-__--__- Depth................
x Disposal Trench—No. .....1............ Width...J6.._........ 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..... -C ___. ._Y..._....�__........ Date.... Z
Test Pit No. 1_.4_-._minutes per inch Depth of Test Pit---- .......... Depth to ground water------------------------
Test Pit No. 2..!�!Z—minutes per inch Depth of Test Pit---------Z__/.__. Depth to ground water....:_---
-- .........................................
^- _
Description of e •,z....1
x
V ---•--•---------------- -------------------- --------------------------••------------ --•
.......-----------•---------------------------------------------•--------------------------- --
---------------
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 TL 11=1, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a'Certificate of Compliance has b en issued by the oav% of iealth.
xSi �edICJ,!
ate
Application Approved BY-•-•-• ,r7.2 --41.2A. - ----•••-• ..... ••`•-. 1------
Date
Application Disapproved for the following reasons:--------------------------------------------------------------•----------------•---------------••-•---••-•-•--•-
-------------------------------------------------------------•--------- -----------------•-•-•---•----------•-•---•----••-•............•...-:� �-------- ---------•---•--------------------------- `
Date
PermitNo......................................................... Issued --•I....---- ---•-•--•-•----------•----
Date
1`
NO. ....`.......^ ---•• .. .. Es.......... .�.......�...,
� + THE COMMONWEALTH OF.MASSACHUSETTS
,--BOARD OF HEALT x
Appliration for whipwia1 Works Tomtrnrtton Vamit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at:
AL
Locate Address or Loft] No. ................
r k-ewner Address
___- .._ .......................... ......_._.
aller Address
Type of Building Size Lot.......... .. (: S,q, feet
,., Dwelling—No. of Bedrooms....................... ,...............:.....Expansion -Attic ( ) Garbage Grinder ( )
p`4 Other—Type of Building .......:.................... No. of persons...........' ----------- Showers ( ) — Cafeteria ( )
a' Other fixtures ..................................
W Design Flow................ik _..................gallons per person per day. Total daily flow......................._....................gallons.
WSeptic Tank—Liquid capacrity_f)!!(_�.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.
Other Distribution box ( ) Dosing nk ) 1 f
Percolation Test Results Performed by
a ---- 4_s� .�__�S� .ti�� j..................... Date....
Date___-
Test Pit No. -- --�' --•-- ---
,a 1__At_�.minutes per inch Depth of Test Pit / __. Depth to ground water-- -_____ .
�+ ll ----- .....,.,.....,� ...
(z, Test Pit �o. 2__ °`_�_-_.•�.minutes per inch Depth of Test Pit____________________ Depth to ground water........................
O of Soil_ hx tc: '� = - �� -44: -- ---------------------
Description
x
V
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 TIT.:, 5 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 boa o iealth. a
Sig d ---- ll -------'-'-'. ``••• `
ate
Application Approved BY . --• ---� - '--'-"-"'----''.. Date f
Date-------------------
Application Disapproved for the following reasons_________________________________________________________________________________________________________________
---'-''_._.......'-•••""--"---•-•---------------"-•--'-'------"-------'---'-'-------"--'---""'---I--------•------------------------------•-------------------------------------------------------
Date
PermitNo......................................................... Issued...................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEALTH
........:..... ......OF......... ..: !.,'...........::... .....:..I..............::.............
C�rrtifiratr of Tounptianrr
�IIS IS TO CjE- TI r That the idual Sewage osal System tructed ( ' or Repaired ( )
�-'�.�..............'_'- --- -------------------------------
by Installer
at.- ----- --
has been installed in accordance with the provisions of.TIT-, 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.__. _. _
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.........�.a:.... � =-I port-?'a",-------------------•---...---•---••----•------- Inspector.-------------------- -- -.........................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. '' OF.... s ' 1.
No............`.............. FEE................
Btsp d irk o lion rrntt
Permission is hereby granted..... __:--- :....
.....................................'---""-'•"•---- ....-
to Construct a ndividual Sewage DIs os System t
at No.—S., .__ '•'-..... _ -
-------------------- -------• --........
S et
as shown on the application for Disposal `'Forks Construction Pe No___ ____ ______r Dated---"'---f-�..�--..�__�'-_______
�,, 2 Board of Health
DATE.-------- '----=- r----....--------'--•----------------------------
FORM 1255 14OBBS & WARREN, INC., PUBLISHERS
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BUN „' G.:ERT.�FIED PL T :PLAN
E:XIS"TIN'G SPOT ELEVATION0A0 �_�:No._2 �� ry Q
EXISTING CONTOUR. - 0^.- ._ _ \��c,srE�'%ti`� ' . LUT ,.3'-3
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' A.`PPRQVED` tBOARD `.OF HEALTH "
flA E AGENT - -1 _ �yQ Q
SCA-t: E DATE,:
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( E L DREDGE ENGINEERING CO. INd c i3
CLIENT 1 CERTIFY THAT THE PROPOSED
I ; E'GIST:ERE< REGISTERED : h"JQ �-.6", BUILDING SHOWN ON THIS PLAN
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JOB NO. ;
I4_ CIVIL LAND CONFORMS TO THE Z0NING L#WS
ENGLNEE,►?, I SURVEYOR OR B;Y
_. S jO.f`„ BARNSTABL E , M S
MAIN T r 2 MAIN T. CH .BY •�3 y
S(' YARVIO�-r11, MASS. HYANNIS MACS.
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7 2 _r _ FT D/i�1 M. C(,5 TABULATION
INLET SEPT/C TANK �_F?'' ' �4-- ---
OUTLET SEPT/C TANK _97.0"FT. f`
�'• SECT/O/V O F GROV NO WA7,6R TABLE `
//VLET U/STR/43UT/ON BOX 9 FT h} _
0UTLE7DI57-R48UT/UN BOX �..3 FT +3
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3, D.ES/G/Y CR/TER/A D/MRnNi,
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BEDROOMS 3. ,Q/MENS/ON C FT, �'
Gi+RBAGEO/SPOSAL UNIT SOIL /-OG tiia
TaT.4L EST/M ED Ft0i_V 3 3 y G.4[.�0�4Y SOIL TEST SO/L TE'S7-#,a `SOIL TEST
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NUMBER OF ::0ACHING PITS D E QP SOIL TE57T y
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S/DE LLfACH/NG PEit P/T —SQ, FT. U' a RESi/LTS-/NlTNESSED BYE�• L3CiN�/c/S
BOTTOM LErgCH/NG PAR P/T ?��SQ. ,t'T.
PCl+lCOLA,T/ON,RATE I / _S s MlN /hlc
TOTAL LEACHING AREA 2 .SQ• FT. c,/� '=0/L I�EItCOLAT/oN.R.4TE 012
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