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L0 CAT 10Nl,:2T �9` d� G EWAGE PEIt MIT� NO.
VILLAGE
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IN"TA LLER'S NAME i ADDRESS
B UI� DER OR OWNER
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED _�7_��
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THE COMMONWEALTH OF MASSACHUSETTS
11 BOARD OF HEALTH
Q..W.N..................OF.........8./.,P-MAIAJ .LL..._...--•--.........._....................
Appliratiun for Disposal Works Tonstrnr#iun Prrmit
Application is hereby made for a Permit to Construct (`I) or Repair ( ) an Individual Sewage Disposal
System at: _ CW
C i Co )-*t .
Location-Addre or Lot No.
�=l.. .Vie,/, ,"� - ��1.��!!�-sue �r��.��Gc��"................
• .................... ........
caner Address„
/ 1✓L'........�. c r�l�s[�
Installer Address
Type of Building //�� Size Lot... ......Sq. feet
U Dwelling No. of Bedrooms......`.`................................Expansion Attic ( ) Garbage Grinder (Yr)S
`4 Other—T e of Building No. of persons............................ Showers — Cafeteria
Q' Other fixtures ...................•--••------• . .
Design Flow..J---..`•'�..................................gallons per person per day. Total daily flow.......4r 4.0........._ gallons.
l lons.
WSeptic Tank—Liquid'capacity`S� -gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.....2............ Diameter.....8.......... Depth below inlet.............. Total leaching area.........._
Z Other Distribution box ( ) Dosing tank �sq. ft.
aPercolation Test Results Performed by....................... e.............•----------...------------•----•------ Date........................................
,.a Test Pit No. 1�.Z......minutes per inch Depth of Test Pit.....1_y4_........ Depth to ground water...ek��G_'.__.
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...............
-----__-.
O Description of Soil-- I�&mAy. v ............................... -------------------
x
U --••••-•-------------•--••••••---•-•--•------••--•-•------••---•--•-----------•-•-•.............__............---------•---•---•--••-----•--•--
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-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--•-----------•----
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 iITLL 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 oard of health.
Signed ,/ ` ----_----•------------------ Z /zho....--
Application Approved B ___.. Date
te
: Date
Application Disapproved for the following reasons:.................................................................................
......•.. -----------._
.....................................•--......_....------------------------------....-----.....-----•---------•••---------•------........_..•---•••••-•--------•-•--•---•-•----------••--------•••--•---
ate
Permit No......................................................... Issued--.......a
ate .............
NO,62.".�.. ......................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-To.w.4..................OF........BAPL 5. k-131t...........................................
Appliration for Disposal Works Tontrnrtion Prrmit
Application is hereby made for a Permit to Construct O or Repair ( ) an Individual Sewage Disposal
System at:
................_.................... ...... . ................_... M+j..!L�.j.._......... .......... - ----.._..........
......--... ... ...-
Location-Address or Lot No.
.................•....__........................................................................ .....................................................
Owner Address
W
Installer Address
d Type of Building Size Lot.. 4 A.:>:V......Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder W)s
Other—T e of Building No. of persons............................ Showers — Cafeteria
04 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.
3 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P+ •---••••-•••-••••-----...---•-••-•••-••••-•••••••...•••••...--•--••...................••••-•-•--..••.........................................................
0 Description of Soil..'.....................................................................................................................................................................
x
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 T I TLE 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 board of health.
- Signed.................................e-_----._----•-----------•-••-------- --- ---•--------------------.- ....
Date
Application Approved By.... 0 ...............
Date
Application Disapproved for the.following reasons:.............
.....................•--------------------------•........................•.-. ------------
---....-•-•-•----•--•.........................•-•.....-•--•-..•....•••......---••----........------•-•-•--•-----•----•-••-•.---•-•--•-••••••••-•••---------•••-••••--•---------•••......--••-•----•-••-
Date
PermitNo.......................................................-- Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
, . ...........o F...... '�At.1u. ".............................
Tnr#ifirtt#.t of TomptiFanrr
THIS IS TO CERTIFY, That the Individual Sewage 'Disposal System constructed ( ) or Repaired ( )
by..........7R4.4e.f...........4.4f, ' '_1 ------------------------•--------------------------------------••---------•-----------..........--•-------.........------•-----------.
Installer
at......k l .......t�..............Qj?S2.0A------ / c .. J-70. ----- --�-._....W--a-cf-_-------------_------------
has been installed in accordance with the provisions of TITLZ 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit Nosh --a_ A........... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE. `3`� •'•` J AZ'64
---------•-----....... Inspector--. it!1
l
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
i/'�...k.u.a!1,f..................OF......... t.t. � � ...-•-.................
FEE.... .A........
Disposal Marks Tons#rudion rrntit
PermissioPIS)
' hereby granted--•-. .e! P 4----------• 4"� ---•--•----....•..•-----.`------------------
to Construct or Repair ( ) an Individual Sewage Disposal System
Street
as shown on the application for Disposal Works Constructi rmit No..................... Dated---4.....................................
----------------------------------
}/ Board of r lth
DATE..........��---••/........................
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
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To -PeTF-CM'ttE %..OT uwag. � -ERE[ _ CONSTRUGTIC�Pa
9/9/21,9:04 AM ShowAsbuilt(1700X2800)
LO CAT ION/er-"9"� EWAGE�] PERMIT NO.
VILLAGE
IN_,TALLER'S/ NAME i ADDRESS
RUDDER OR OWNER �y ^
✓�/H�s/l� ��c G �i ram" (b._� -�uit_G�'=
✓c�//N-GUiGG i/��5- O wiYE=2
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
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T WN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
ADDRESS: 146 China Wav MAP NO. 121 PARCEL NO. 145
OWNER NAME: Rodnav F. Salzberczar _ VI L GE: Marstang M111A
INSTALLATION .DATE: 6/11/81 BY: Cannons, in 350 Main S ., West Yarmouth
ADDRESS: 350 Main S�reet, West Yarmouth C 'RT. NO.
f e 7 ) TANK INFORMATION
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LOCATION OF TANK: hear of House - Beside patio & 4 back of Garage
CAPACITY 550 gal TY.EE -9mAGE � years FUEL/CHEMICAL Fuel ail
TESTING CERTIFICATION C ] PASS C ] FAIL DATE
LEAK DETECTION ] CHECK IF N/A TYPE/BRAND
z I^, ( ter
IN
YE C ] NO ATE .TO BE REMOVED
ZONE OF CONTRIBUTION C ] ,
FIRE "DEFT. "PERMIT ISSUED. CJ YES C J NO DATE51111$1
CONSERVATION E ] CHECK. IF N/A DATE
BOARD OF HEALTH TAG NO3- 3ic
]C ]C ]C: J DATE..
,
PLEASE PROVIDE" A SKETCH" SHOWING THE TANK LOCATION ON THE µBACK OF .THIS CARD
I
CENTERVILLE - OSTERVILLE FIRE DEPARTMENT
r
PERMIT FOR STORAGE OF FUEL OIL
In accordance with provisions of Chapter 148, G.L., and Regulations
made under authority thereof.
Name .... �hal. �onstri.icti.,on... Name ..Cannons) Inc..., .........
..................
(owner or occupant) (Installer)
Address 1.4.6...Chi..ne...W.ay,.,M........ Address O, llain...St.......Vdest...Yar.
'", Burner Storage
Make Carrier Steel
.......................
................................................ Type of Tank .................
Manufacturer ........................... Capacity .5�� ..... gals. (or) Size............
ON..
undeground
ModelNo. or Size .................................. Location ..................................................
Type....GUN . Mass. Approval No. 147
..................
Permit issued Chief John M. Farrington
.......................................... . ..............................................................
(Head of Fire Department
............................................................... By i.. ...............................................
(THIS PERMIT MUST BE CONSPICUOUSLY POSTED UPON THE PREMISES)
Osterville P lad h i n e Q
4
V
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ftPlication for -Misposal 6pstem Construrtion i3er iit
Application for a Permit to Construct( ) Repair/Upgrade( ) Abandon( ) ❑Complete System ndividual Components '
Location Address or Lot No. ��/� �p C�_ A Owner's Name,Address,and Tel.No. OD
Assessor's Map/Parcel
Installer's Name,Address,and Tel.,No. 5Z)% Designer's Name,Ad ess,and Tel.No.
�'!v` cv moors =ric po• x / MIA0cX On
a
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. 15 07 S
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
i
accordance with the provisions of Title 5 of the Environmenta a and no place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed - Dated
Application Approved by Date s
Application Disapproved by V61 Date
for the following reasons
a
Permit No. 90 Date Issued tu
-------—_------ �------- -- ---- ---_-____—_====-1a - -- ----- -- - - - - -
No. fO h Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered m computer: tt'�
Yes
1 PUBLIC HEALTH_ "-.DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS
. 2pplitatlon for`bi8posal *pstem Construction P-tr tit !
Application for a Permit to Construct( ) Repair.(1) Upgrade( ) Abandon( ) ❑Complete System 21,ediidual Components
/7)' Owner's Name,Address,and Tel.No.Location Address or Lot No. IV6 6 V.
Assessor's Map/ParcelAl /�'/�� iojt t:> .,,, si`Q tin . 4,1 A '
Installer's Name,Address,and Tel.No. '��`tf v� Designer's Name,Address,and Tel.No.
Type of Building: i
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) IVIT gpd Design flow provided gpd
N
Plan Date Number of sheets Revision Date
r:
j Title f
Size of Septic Tank �'- `! f y Type of S.A.S. C—Ni
J 14 e
Description of Soil
t Ili
Nature of Repairs or Alterations
lterationsE(Answer when applicable)
t t/1-,.5rzj�.S A,?-,1.� /4zo ('�d.���� /,r��- ,A t1k'''?: !}X
(i7x t' i-t tZ c� !x 9 2�! f nr 4r� s 9► r .�sJ - may/ / r�
J j / ✓lam t M.1'"n !.-" .,.F....s"I ,✓•
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 Environm6 ntal.Codd'not.to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health. �.
_. Si ned -fir Date + /�`L�
/ApplicationApprovedby - .••. r t //
/.y F ' " Date
Application Disapproved by �/ __,�� '" �� ' t , t Date
for the following reasons -
Permit No. �` r ~ Date Issued U
----.-_:-- _--.---- -_ -------• --- - -- -- - - - • .
i% THE COMMONWEALTH OF MASSACHUSETTS
} BARNSTABLE,MASSACHUSETTS
1,
Certificate of Compliance
THIS.IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired O Upgraded( )
Abandoned( )by a f"'f4641f 1. cjb rk 404011 .ti-7_ an C.
at �f R �,; /Yl k. fd," r�/ilt�r has been cons ructedd in accoo�ndce
-
P ikj /1
with the provisions of//Title 5 and the for Disposal System Construction Permit No. �` dated l0
Installer �: �a�t . O ram!Y-.tt rhy n( Designer N l r r !` 1?--)n X. br) L-t- /!
Y
#bedrooms tV Approved design flow /1/ gpd
The issuance of this permit shall not be construed as a guarantee that the system w11-func o as designed. r
Date /l) � ` Inspect6r Z-i 1
-_ -- --(�- - - - ----- - -- - - --- -- - -
No. IJIT f " j Fee [
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS
` Bisposal 6pstrut Construction 3pPrmit
I ` Permission is reby granted to Construct( ) Repair �y /Upgrade(/r) Abandon( )
f System locateVat IW,� l ri1,( /rt Q L/
1
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 comp eted within three years of the date of,this permit..
Date Approved by r` .,
L0CAT10NAT'�`/` �� � S EWAGE PERMIT NO.
VILLAGE
I"TA LLER'S NAME ADDRESS
e I DER -OR OWNER
DATE PERMIT ISSUED 3i3�8/
DATE COMPLIANCE ISSUED
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