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THElfCOMMONWEALTH OF MASSACHUSETTS BOAR® OF HE H smzu-T rij BARNSTABLE Alip iration for Uhip i ai or'bi Coat uurtinat Urrutit S Application is hereby made for a Permit to Construct ;�or Repair ( } an Individual Sewage Disposal System at lei ...... '"`z� 14 ':c' .... /0' `T��+1 � .. ..... atioS;,Address �Z or Lot Noe-01 . ,V 57— //'�p, Z Owner Address .......• ................. Installer Address Q Type of Building Size Lotl�._'`�` ' t Dwelling—No. of Bedrooms___.._) Dwelling Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons____________________________ Showers ( ) — Cafeteria ( ) Q' Other fixtures __________________________________ : ,boa, ••-•--•-•••-•--•--•.........---• W Design Flow......,/l .........................gallons per Caen per�d�y. Total daily flyw-------____�_—a__�_ __.__._.___gallons. If WSeptic Tank—Liquid capacityl�[?gallons Length/-. -.. Width.� -_Y_- Diameter................ Depth... ........ x Disposal Trench—No..................... Width____.... p__.___.. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No Y ----______ Diameter. ®®t✓ .. Depth below Total leaching area_.5Z'='_sq. ft. Z Other Distribution box (� Dosing-tank ( ) s�16�4.Yl //&Z �,A9� Percolation Test Results Performed b .-� .-. s ® .f /b a Y ate �� Test Pit No. 1 '. minutes per inch Depth of Test Pit15_rf`__'....... Depth to grounflwle-ater-------V_V.A1_5C__ G=, Test Pit No. 2_.5 .minutes per inch Depth of Test Pit../ ~_ Depth to ground water........................ CL' - a •i Description of Soil- ` ------__L "`--Z ----"------ �ql_•--•-cr�e3c� e c�.� e .v ------•"� `�"-�8�-"- --•CGaJ••iP/F®C�i�--f. _9( . U Nature of Repairs or Alterations— nswer when applicable................................................................................................ ____________________________________________________________ _ _______ ...... _ --_-_ __-.-_. �y�f Agreement: - 0,�./��+�q a .� �� ���-_/ 7-7/, The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of:T`: y g g p y of the State Sanitary Code— The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issued by the-board of health. Atigne //��, ����jj / Date Application Approved BY 1�.%..�,l,� �..... ...1 -7 Date Application Disapproved for the following reasons:......................................................... . -_-••---..--.--•--_......-----•.-- .....•-•-•-•-•--------•-•-•----•----••----•--•----••••-••-•--.....••-•-----------•----•---•-••-----•••--- ------------------ Date Permit No......................................................... Issued-.... --/2 - ;1'-?..................... Date t a 47 No.. ........-.-lt0F>s. ......�' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA1 T H OF_.- .................................. �<< .1 rltration for Uiipnial Worhfi Towitrurtion ramit Application is hereby made for.;a Permit to Construct "( or Repair ( ) an Individug S-tWage"DisposA•------ System at • ... ..:..... - ----•-•--- ----•................. .....•-- --------- Location Address or Lot No. . .--------•J �..- --h�y� * ;✓ ," v .e • fi a_.. Owner Address Installer Add�. Size ess Type of Building i Lot��F........................ GA-_f t `. _ aDwelling—No. of Bedrooms.........................................Expansion Attic ( ) Garbage Grinder ( ) p.l 1 Other=Type of Building •_______-___•_______________ No. of persons............................ Showers ( ) — Cafeteria ( ) I+/i- Y M Other fixtures --------- ----------------------- - ------------ ---- ---------••------•------------ t Design Flow....... ........................gallons per pffso r per day Total daily flow....... _ gallons. W -• ' ------------- lons. P4 Septic Tank—Liquid*capacltyZ.M;?gallons Length/ __ Widtih..�' _'_Y Diameter................. Depth....X_....... sDisposal Trench No...__....__ .. Width_._ R" _-•-- Total Length _ .Total leaching area....................sq. ft. Seepage Pit No .�'- ........... Diameter.�"'.�?`-�-rp..... Depth below inlet � .�!__ Total leaching area. ' _ .sq. ft. x '—' l Percolation 1Test Res lts { Performed byln� _._. < "='_ � zr_ ` /Date� ,;� 7�.�1�.. Z , ( g ( ) '� "' 'minutes per inch Depth of Test Pit 1 ?._'...... p g Test Pit �10. 1__._. f p p _ Depth to round water------^�ar�<r__. ( , Test Pit 'No. 2._:f5- ._'=_niinutesper inch Depth of Test Pit...� . Depth to ground water-______--_.-_`"-______ 3 O Description of Soil c''j �. j -:-- -.5 saw �c ,v 7o' ' ..tee e _ .'�•�•-_ _ -- � ~ r �- �.............................................. _•-• - -- -- / .�'✓/ itxr 2- U ^f .Nature of Repairs or Alterations—Answer when applicable_________________________________ _________ _______•. -___-____ -____-_-_-----_----___. --------------...........................----- . .................... -- ---- ..• = - --- ---------•--- Agree'ment: py��/ 010 ' �r -�,�• The undersigned ag in he'fOLbed Ihdivi ial ewage Disposal System in accordance with the provisions of l f'1: . ...f'"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. i. igned- ------------- ----•------==`i:.-----------------•=....-••=-'•-----------• ••--• -- -----•. I, Date Application Approved By----- ------ e 6 'f y--------- f Da sa�7 Application Disapproved for the following reasons:------•-----------------------------------------------------------------------------------------------``-•--•----- :.. --•---•-•--------•----------------------'--...--•-----------.......------------------------------------------------------....----------------------------------------------- •r Date PermitNo......................................................... Issued......................................................... Date THE COMMONWEALTH OF MASSACHUSETTS 6 BOARD OF HEALTH s awn x ...........O F........... ....:................................................................... { ,A Tpr#ifiratr of f1 outpli attrr y TH,4j� 0 `CERTIFY, That the Individual Sewage Disposal ystem constructed ( ) or Repaire ) - w'� by.... .... ... _............................................................ r..... �]............ __ Znsx ll� j 1. at... = �(y ---- 1 has�e titallea'i cco3'da ce With the provisions of T i a > of he State Sanitary C�Sc des�edin the; . 7 application for Disposal Works Construction Permit fro -'�.__�� .�� dated---C-----------------'---1 --------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRdEP AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................... .............. ..........---.....---•--...... Inspector..................-----------•-------------•-- =----------.......----•••-••.....-- THE COMMONWEALTH OF MASSACHUSETTS , BOARD HEAL H No. .. .. FEE........................ 15 womi$rig ion amit Perto Construct (ission is hereby pgT(ed�--an-Indivldu .. S.,..'age Di po al y terg? .............................. -�=-`--•--; -•--- ---�••,- •-•-•---•- atNo..... • •.•••-• .�. - ----- - ._... _7 �� Street •� as shown on the application for Disposal `Forks Construction Per No.. D�ate�d............... ...........III......._........ DATE. ............................ r, tk Board of Health FORM 1255 HOBBS & WARREN, INC., PUBLISHERS LO; C_ A$ 1��N 37 SEWAGE PERMIT NO. 'ric VILLAGE if INSTA LLER'S NAZE ADDRESS &JtE R U I L D E OR OWNER DATE PERMIT ISSUED. D A T E C O M P L I A N,C,E I S S Ul 0 <, � � h'-;. S � � +� �� �� � � ��� �� � �"" s�,� �' �,- � � p��F �� f Zy JV b' 7 H ; ! -„�� 7 t1 S �� !y i / 7�Q-�/ 37� t�rsi ?b��.1 N c�l��! �O !Y: a , -rlol. 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