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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
AVVftra iun for Divi-Vu3a1 Worlai Tunulrnr#iun ramit
Application is hereby made for a Permit to Construct ( ) or Repair (1O an Individual Sewage Disposal
System at:
2—? 1 ..-� J 2J1 Lim
........
tt -� dress or Lot No.
----------------
Ow er dress
w c�"� �s c.�a�9 y ..... �t!i c- 't �P,t S........
- ---...
Installer Address �C
Type of Building Size Lot----
.......................Sq.
Dwelling—No. of Bedrooms---------------------------------------------Expansion Attic (Ab) Garbage Grinder Q4d
Other—Type of Building No. of ersons---------------------------- Showers
a YP g ---------------------------- P ( ) — Cafeteria ( )
Otherfixtures •-------------- ---------------------------------------------------------------------- ------------------------------•-•-•--•-•-•----•----•--------.
W Design Flow-----------5.5-------------------------gallons per person per day. Total daily flow............
WSeptic Tank—Liquid capacity--M— -.gallons Length--n--6-- -_ Width- 52V.--- Diameter..____ Depth..:8"-..
x Disposal Trench—No- -------------------- Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No.--__---..-k---------- Diameter------8--........ Depth below inlet----�9............ Total leaching area..' J.......sq. ft.
Z Other Distribution box Dosing tank (16)
~" Percolation Test Results Performed by.... A ? �. y � _C-....................... Date----�,�...:_13.'.9 5
,a Test Pit No. I---4.----__.minutes per inch Depth of Test Pit-----U............ Depth to ground water..
rzq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
R+ -----------------------------------•-----------------------•---•----------------•.................................................. ---------------••---
0
Description of Soil--------UM. ..S� L�.....1' ------------------------------------------ C
�
S1q.D.----••.-•••-J�lr�- lc� r lv_cc�s? 12 t7-•--•--------------------•---------------------------•--•--••--------------------
U .......
W
--------------------------------------------------------------------------------------------------------------------------------------------------------------•----------...----•-••--•--••-•---......--
M. 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 Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has ee issued the oard of health.
Signed ----------------- -- ------ - ...... .. -
R
/ D—
Application Approved ........................ �"'
Date
Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------------------------------------------------
.................. ... -- . -- ........... -- .................................... ....... . -- ..... ..................... --------------------------------------
Permit No. - .�z'�------------------- Issued ...... � �� Date...._..... -----------------
Date
f THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Ceztift>rate of Cnomplianre
THIS IS TO CERTIFY, That .h- Individual Sewage Disposal System constructed ( ) or Repaired ( )
1� f
Installer�
at ..... .. - Y.. - --�
- - -.......
has .
been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
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 AATISFACTO_RY.� -�
DATE----C - .._.. - - -- Inspecto
v
---------------'-----------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
,FEE��.�....:
Ropfial Wore T U
onotr fart "erutit
, G
Permission is hereby granted /�0/( U-------------------------------------------- !_N. ...-RCN 1 `✓
to Construct or Re air ( ) an Individual Sewage Disposal System
atNo d ---------.....................................
Street C�
as shown on the application for Disposal Works Construction Permit N90...\� +� Dated._-_......"`..�...
���.J------ - ------
�•- Board of Health
DATE............. ........L7 y.
' FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS
L(✓
N.
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y = THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
. ,1��lirtt#iu, "fur �t5�11�tt1 3�urltu. C�u�t��r�r#inn �rrutt# `. -
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at:
Z_? �Cc_ V� .L ...-t..�- �/I LC � ----•-----------------------------------------------------------------•
.....................................................I
2,0 14 Lo a4-ion- dress t5 or Lot No.
owner 7/JC— p`' /Adddpress eA
W •-•---._.........................................Insta�llelr�.s�!W CiJ N------ "--6�7••------L!1�'�-�L@...7-....L?- .....t.... •....... �•`-t-------------
Address -
UType of Building Size Lot.... °_-7 5_____________Sq. e tr
Dwelling—No. of Bedrooms-------3---------------------------------Expansion Attic (fro) Garbage Grinder Nc)
aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Otherfixtures --------------------------------- ---------------------------•---•--------...-------•--.........-••---••-•----••--•-•--•......-•-•-••--•••......•....
W Design Flow...........:5.5.........................gallons per person per day. Total daily flow_-____.___330_..._......._...._._.-gal
lons.
WSeptic Tank—Liquid capacity_1 ..gallons Length Width_.`a ....I'--- Diameter__._-_-.-...... Depth-.S=�?.....
x Disposal Trench—No. .................... Width-------------------- Total Length-------------------- Total leaching area....................sq. ft.
Seepage Pit No---------- Diameter......8---------- Depth below inlet.... Total leaching area.._�.......sq. ft.
Z Other Distribution box ( ;) Dosing tank (t.Sa)
aPercolation Test Results Performed by.-__ *nr _ y. _)_ _4....................... Date...`` -:_�. _:_9 v__.._...__
Test Pit No. I... __Z...__.minutes per inch Depth of Test Pit----11............. Depth to ground water._�7-El\.�0U" 4 f- D
0-4
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 ..._....••-•------------•...............••-.._..-•••--•--••••......••---•---•••••------•••-.............-•-•-••-•-••-----••--•--••.......
O Description of Soil......... .... r� ._Su ,50!L \ �J >... ."'' `".)-'---, .Lam..._._...
V .....•-•............,4 rat •.---............ _V....... v cc�c�, - �ZLC?.................................................................................
UW ... .......................................................................................-------•----•------•----------------....•-------•.......•••---....•-----------...._...............-----••...
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 $''of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has Keeq issued by the board of health.
�� - .Signed ------------------- ------- :_��?<t/Z ,_....... ......... .------/.....`/....-� r
Dace
- �- Z
Application Approved BY � r.��--Ll.�s�....... - .... - . .. - �......................................... ...--...- �
. Dace �
Application Disapproved for the following reasons- ---------------------------------------
. . .... .............................. . -- . ...... ..................................... .................................................. ............... . .. -- .....
r*4
Date
PermitNo. - ---------�� ------------------- Issued ...................................................................
i� Date
TOWN., B-A-ANS'TABhE
LOCATION SEWAGE # 7113
VILLAGE ASSESSOR'S MAP & LOT //.S=00 e/
INSTALLER'S NAME & PHONE NO. PYI��U(-er 1 GUJ� J � o
SEPTIC TANK CAPACITY
LEACHING FACILITYAtype) P/7— </-) (size)
NO. OF BEDROOMS PRIVATE WELL OR UBLIC WATER
OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: �'
VARIANCE GRANTED: Yes �No
' G
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE
Appfiration for Uiipusa1 Marks Tonstrurtiutt 1hrmit
Application is hereby made for a Permit to Construct ( ) or Repair 00 an Individual Sewage Disposal
System at:
`
201� ......................... '_P- .iL`
..lLocation-Address or Lot No.
4 •c4 L' - --------------•--.....------------.........._...._._.... ... tfty!. ---... .......--•----------•----------•-------•---••----•--
Owner Address
"? -.............................. P. = ...... �Ni" � �c . .........................
Installer Address
dType of Building Size Lot----------------------------Sq. feet
U Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building ............................ No.: of persons............................ Showers — Cafeteria
P4Other fixtures --------------------------------•--•------------------.•---------------•----•-•------------------•--•..........------------....................---•--.
d
WDesign Flow.........•..................................g gallons.gallons per person per day. Total daily flow........................__................._ j
WSeptic Tank—Liquid capacitylO-M.gallons Length---I.!�..... Width.......7..... Diameter................ Depth.._9.1......
x 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........................................
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........................
a' -•-•------•--------•-••••••-------•-••••--••--••......--•--•------------ ---------------------------------------------------••--•-••••---•-•-•-----.....--•-
O Description of Soil------... Z.........
...._� 3----------------•.a -1� ��=�i� �'he sON
x
V
------------------------------------------------------------------------------------------------------------------------------------------------..----••-------•-----•---•--••••-•••-••-------•-•......
U Nature of Repairs or Alterations—Answer when applicable__\Y*: _____.. a� sit- •.VV5.0.VL ................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Cor441,iance has been issued b` the boar, of health.
Si ne ................. .. ...... .... ----.-�i--�.. ..........
--------- --------- ...".eI/r
ApplicationApprove ----------- ---------------------------------------------------------------- _ ----- .. . ... .
Da e
Application Disapproved for the following reasons- --------------------......................................................-------------------------------------------------------------
............ ---------.........................................................re......
Dace
Permit No. ���............... Issued ------------ r��
i t s O U C
,,.,,.-'^'"+No ....... FES............._.............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
. ppliration for Disposal Works Tonitrur#ion Prrntit
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at:
2'? lL �yL Rom .... ................... V 1L....�
Location-Address ! or Lot No.
........................................... S/Jz!J -----.----------•--•--••..._...----..............••.
Owner Address
.•---------------------------- ...4V 6 (146 1
Installer Address
Type of Building Size Lot............................Sq. feet
U
�.. Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—T e of Building No. of persons-_`*....................... Showers — Cafeteria
A4 Other fixtures ............................ .
<11
WDesign Flow............................................gallons per person per day., Total daily flow____........._.._...._..._.............•..._gallons.
WSeptic Tank—Liquid capacity i/ �gallons Length.../..7 �-..... Width--____-' ___- Diameter_--_____`-__•--- Depth..._.6._....
x 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 ( )a Percolation Test Results Performed by.............................................................. Date................
14 Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................
f� Test Pit No. 2.._.l......._._minutes per inch Depth of Test Pit.................... Depth to ground water........................
a' -----------------------------------•............... -••----••-........_........------...._....--••-......------ ....
O Description of Soil------ `?::I......... Q---------•-----.. ::..� .._.. '�� Mom_.. ��' - ..... - -
U ..................................=\•••._...-•-•---•...--•-••••••--•---••---••---•-•-----------=-----•...--•--•••-••------•--••--•--•�............•-•-•••••.......................................... ,
W ................. --------..............................................................................................................................................................................
V Nature of Repairs or Alterations—Answer when applicable__\NS'���..._....3.'�ba______5 ........................................
Agreement: `� �
The undersigned agrees to itistall the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of CQ4xugliance has been issued b the
* Q� boar of health.
S ..,.. ..----- -- �. . /
Application A oved y -=,-___ ----- ----.. ---- ------- --- --- — ... . - -1..7 � { ` .--
pP PPSr ....- - l�Date
Application Disapproved for the following reasons- ---------------------------------------------------- -- ------------ .........................................................
.............................................................--- ----- --... ---------.........................................----------- ----- ....-...................................
Perm ------ .......................... Date
it No- ---• - - � �---- --------- '� - Issued -------------�--�-/<�.��7---------------`
Dace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF,HEALTH
TOWN OF BARNSTABLE
" C�Prtif rate of Q.Wa ttnce
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
b --- ..._C.Ov�S`K C'-D. - -----------------------
Y '7...
` - Installer
`7 E _
oh VLL�----------------------------------------------..............................------------------------------
has been installed in accordance wthe provisions of '
TITLE 5 of The State Environmental Code as described in i
the application for Disposal Works Construction Permit No. ........... aC—?... dated .........�.Z.�/-5-�------------
THE :
ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.......... .......................................... Inspector ..............................................---...-----`...............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
- � TOWN OF BARNSTABLE
No._. ,.....::.... i. ,,.�._. FEE.......................
14sposal Workii Tonitr lion ramit
Permission is hereby granted_... �C CO..WJ.S!_fZJ� 7 L�_..___.. _..� �I ... ............................
y-•-•--•--.....
to Construct ( ) or Repair (�')7an Individual Sewage Disposal System
atNo.-•_5��� _1......------C )\ ............1- ..............has. 2V-LLI..�.........................................................
Street
as shown on the application for Disposal Works Construction Permit No _.._....� D/ated_______.a_._ .�. �_--------_----..
DATE.1 21Z�f �fS Board of Health �.�.
f......... ......
FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS
TOWN OF BARNSTABLE.
. LOCATION ` l ..15 V2r- :SEWAGE. # S�J .
VILLAGE ASSESSO.RI MAP aC:.LOT
INSTALLER'S NAME & PIIONE NO. 'G%(e �4nsf; ro -1- �.=
SEPTIC TANK CAPACITY DODl
LEACHING FACILITY (t7pe) l'+=p Ca51 Ga I�r,r S (slze) j 2
Ap
1-40. OF BEDROOMS PRIVATE. WELL OR PUBLIC WATER
BUILDER OR OWNER d i'-s
DATE PERMIT ISSUED:
DATE .COMPLIANCE ISSUED;
VARIANCE GRANTED:. Yes No
�.
Revisions: Date:
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