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TOWN OF BARNSTABLE Zg` 4�
LOCATION, C�> '�/ Z�.� � / % SEWAGE #
7- .
VILLAGEti/?/�/!/� S ASSESSOR'S MAP & LOT
INSTALLER'S NAME Sk PHONE NO. 1
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER Sf! 1 I
DATE PERMIT ISSUED: �' Y-7 '
DATE .COUPLIANCE ISSUED: bS�'- '7~ rl 7
VARIANCE GRANTED: Yes No ��
/3'v J di
gal
L O C.QT_1.O N1 SEWN,GE P E.R.M.IT 1.1 O.
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1.1�1_S- -L--L E=- ►J-��� . E- -- A-D DR-E S.S
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IAA- A D DR-E SS
eZ
DL.T_E PER_N�1T
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�j ASSESSORS MAP NO:
r �� ' PARCEL NO:
No..---•••-••--•-•-••••- Fns......7!;;��.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
l:. wro................0F...... e .c � .....................
ApplirFation for Dispoii al Vurkfi Towitrnrtion thrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Systema •
qe
.... .......... ..................................... ......•• .................................................... ..........................................
LoFFation or Lot No.
L. ....1AJQ.J_Address5 ..................• ....................... ------......--•--------^............^_---...--•---
r Address
a ... - ------------.. ......
••••..............................
Installer Address .
U Type of Building Size Lot___________________________S q. feet
Dwelling—No. of Bedroo ..........................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Build .. No. of persons............................ Showers ( ) — Cafeteria (
a+ 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.
Seepage Pit No--------------------- Diameter.......:------------ Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
0-1Percolation Test Results Performed by.......................................................................... Date........................................
aTest 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........................
P4 •••--•-•-•--•----------•------•••-•-•-••-----•---•-----•------------•-•-•---•................................................................................
0 Description of Soil................................................................................................................................................--......................
x
W ---
UNature of Repairs or Alterations—Answer when applicable.------.1.0?00---4: .�- -<V---•------------•-:'----- .-.
--------•---••---------------••-----....----•---•----•-•----------•--•--•-••-•-..�� ------------•------•-••--------•------•-------•----------•-•-•-• ..............................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iIT : . 5 of the State Sanitary Cod e undersigned further agrees n o p a the s stem 'n
operation until a Certificate of Compliance has b su
$- n . . -•••--------• ................ -- ..• .........
`� Date
Application Approved BY .-•-•- .--•--- -••`--.. •-------------- -•-----•---................. •--------
Date
Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------------
...............................................................-----•---...--------••-•-------------•------•-------•-•---•---•----•---•--••----•-••-----------•---------------------------------------
Date
Permit No... 2� 2 --------•- Issued.....................
Date
Fizs. ��.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�._C).j/U L1.).................O F......
Allp iration for Uispwi ai Works Tayntrnrnnaa ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Sys at:
�Gf Ill 1 C� aL � r2 4 2
..........-•-•--_-•••.......................... ..... ..................................... -•--•-•----•--.._...........---...--•-----•-----.....--------------------------------••---•------•
Location-jAddress or Lot No.
......................-• r^ ....... .................................... ••-•••....--•--•-•-----. ----------•-•----------...-----------•------•-
Ow er ( ) � C�� Address
(� .l C .Z- .. ...
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedroo s...........................................Expansion Attic ( ) Garbage Grinder ( )
PL4 Other—Type of Building.' ' {?s>«%n_ _. No. of persons............................ Showers ( ) — Cafeteria ( )
P4 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.
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........................
Ra' •-••-•-•-•-•--•--------•-•-•----•-•--•-----•-••--•••---•-----•----•-----•---•-------•-----••.................................................................
0 Description of Soil........................................................................................................................................................................
x
c.,
Nature of Repairs or Alterations—Answer when applicable------ ................
------------------------------------------------------------------------------------4 2: ---•-•----------------------------------------•---------------------•-------•--.------.-.---••-
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT I.;.
p 5 of the State Sanitary Code, e undersigned further agrees n o p ace the system 'n
operation until a Certificate of Compliance has b " s17-
S' by o
in --. ..... ...... ....... ............... ......._....••--- -• --•---• ••............-------•
�- -^ ., f � . Date
Application Approved By •.'•- J= '"=-"-= .........
Date
Application Disapproved for the following reasons:-------•--------=----------------------------------------------•--------------------------------------••-•------
....•----•-------•••--•••--•---•----••--••---•-•----•--•---••-•--•-•--•-•----••-••-••••----•--•---•---...--•----------•-•••-------------•--••-•--••••-••--•----••-••••-------•-•...--••--•----••-•-•-•-
Date
PermitNo...-'" ......<............................. Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........�. ..��...�............OF........... � �{2R1
Trrfifiratr of Tnmph anrr
THISr,�
.,TO CERTIFYI That klie Individual Sewage Disposal System constructed ( ) or Repaired ( )
by-------------. ............... ------•---------------------------------•---•---------.----.--.-------.-----------------.-.-
Installer _ q�
has been install m accord'nce with the provisions of TITIE j of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No--- �,....... dated-.------- _`7----------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE......................: - ............................. Inspector Inspector....... ^ --i- ---- "-
THE COMMONWEALTH OF MASSACHUSETTS
r ..�IOARD OF HEALTH
(7� `� N........OF.......: 5.. .�...................._ ...... O�G'
......
No...... ��. - FEE .....................
RoposFai ork Tnn#rudinn rr�nft
Permission is hereby granted-------•`,Z..�.� .1. -----•---- .nz... . .... ....................•-----•--•-•--•---•-----•--....
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System _
at No..........k_ ---`-A--Apj--•415-7�C=t-.:erc.. �.....-•.. -- r�- - ' � J r�
Street
as shown on the application for Disposal Works Construction Permit N __::_.7` /ated.._ ��; ................
_-
--•--
Board of Health
FORM 1255 Hoe WARREN, INC., PUBLISHERS
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March 11;•1987 •x r .. .,
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Ms Gail F Spiliotis `,A t _� R .. �•
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Dear"Ms.'Spiliotis
v�f`,y'.'r�i'r l �'r9 �� � av ` .,r.., . M1• } _�4, .. _ Lea.. ,yet as ,�ti � r �•,.. .,r 3� �,t � ,l2 j`,s.
r S`iS�;H'�y �if � r , '1 � ., . r: ,ti ,, ^s , r . t.s { .i3•� s•, ; _ a,r rt. '
New En land'Pizza #.2;Food Service Bstablishment'owne'd by ou 'wae insn�ctedV` k
�4i.ydaa""r d dvY'`t g .w✓ yr• ,.- y l .l.y ►5 ..}.Y... i..P•o
s,t ,k ,, '.'on March,..9,��1987, by ,Thomas, 'McKean Health Inspector -
+ .. pe or or,, the Town,t of`- r:
"Barnstable. r + A ^^. Y�
N, Yk ar y* ,•.: nw
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7 You Aare,.in violation of Regulation 15.05 Grease;Traps:of A"310�"t MR 15.00 .of:
-the ;.State EnSironmental, Code, Minimum, Require men s for.;the, Subsuirface�4:
'Disposal 4 Sanitary.Sewage,. 'Ttle'Town of.,-Barnstable"Health Regulations:and-' ••
1
Re lation,'590 016 of''105.CIviR•595 x
g. ;•Minimum• Sanitation .SYandacds for Food,
u
'Service Bs ta6itih`ments.ty
J j r:_- •z> y <<". r.,#.+s s.• t1 rr .� 4 `{ S± 5a. =a: �� e , S .,'r. ....y�.
•You`are•directed to-install-an,outside'greRse interceptor within .thiicq .(30) daysr'k _ : < '�
of receipt of'this notice. t" ,
:4 �P• .Lw« i �' Ls .. r.w-�_ ,r. {' r �Y � .�i ri ^• - ..,- 4 ir.?'. rb"
"You re nested a'fivatiance on Dece to continu � } }` i
�r q tuber 12; 1983, a,the use of.your.
.N g ase tra
=r' E inside re rap. r
The Board tof Health+ ranted. ou'an xr P`
n"of time to ex ire Januai •' 1 ` 1985
.t g y., e tensio t p y ., • ,�� . .:
r ^ •`w r', ., to <in�fall.:an�outside• grease interceptor., .You .ignored;the order .an,d.failed ;to` j',
. r. comply. z + • } 5 r
"Failure to.comply with•this;,order may result in a fine not- toy exceed��500.04; y'+
''�. ; f You are.,remirided±that°you have"been in violation slnce"January198''S, a�=periods ' '` 4.} }
-0f over two{2),years. H ' r. }''
r ,
1 : ar s ✓ }, � g i
Each days failure to comply.with an order, shall constitute=a separate"offense{i
%ln addition, the'Board,of Health may�.order the revocation oVyoir Food Service:
:Permit
f * { r �i. , .�P r •. � L.• .;i.,i"ri ta• ,"va a ,t is y t {
PER,ORDEWOF THE HOARD OF HEALTH,,..' •i`p� ; s
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'� �'� ,, +<<John'M. Kelly,, ,, ,r~r� ' r „ .` ;. � _ . r -" � ,. : •
"Director of Public Health
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•1987,,,j- `;ail' tr J,'; ` L ,,,•; s " '�
April 10
, "
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M ,Theodore,S'pitidtis�
10 Hummock:Lane
Yarmouthport, .Ma 02675
,, a� A r.,S p i ., a , ' t y�� L *M1a.r f r r�°•. a x•r, y r 3 � t 't' .}r y. :C.r. ,'� _'t4'fit�c , * u r�'1+,. '`� 4 x ,!
_:,Dear Nei ^Jp,IllotiS ''4'`. ;ry.r -.rr wr + ,,yi•" F- ., . i •. r .c ° j-. - '' r
! L S
� '✓�; �� Y ! } ,. r d ,�• • ee t. , f i t yP i y#� C.. •J +tk #'"�' � ,fy`'S's ;� 1•_l'•� .t' S Fr'1•__.
� " �b � t ''at C t.. l - �' �.!` a C � - �•; < t r � {S 4 e
The,'Board Hof, •Flealth order dated December `21;. 1983 ,and,-2v4arch`X'1, -1987,� 4 �
T r requiring, you :,to install ,a` minimum 1000 .gallon,zoutslde' greaser interceptor,.: ,
�` yy�s sustained You .wiil,`'however; be granted' additiorialx time to expire. May
t�} '',Yr, '� .*0,...'19$7�t'o make`the•installation 4.
a,' F • ;# tF. tP +r 'a a r
`�;f +•3's.4 ,� r '� �'a ° �••S e t ..ir• a � r •�•: ,P,.> 5 r� , o.ar i :a'j^-. t ., J'r R�..
You appea ed fat };Show;Cause*h gr o f 6, 8y r,',v�iith gout attorney,,,.',,i ' ::
r eanri n,'Apri 19 ,
44 i- _Michael'*McGrath, to,.present information as to'why`'you did' nat_,feel1�a' r t `
[ -
- '`grease,.inteicepto ed et�yout es'tablislmenta The, Board, ;lioever
quire,this installationas sCated above ' r
!
:s
You"`are directed to. have •an outside`.'1000 gallon; greaee` interceptor pstalled'° 'Pt
't t a 4 by Ma 8 .1987 y. �w i J�: -.
y �. t• a�' "YxS+• _.
x + ♦. /t f +.• a { ' i �+ it •
rt Yery trul ours;
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NO.' —,
DATE
FEE
TOWN OF BARNSTABLE
OFFICE OF
! BaaasTsat S BOARD OF HEALTH
i639' `0m 367 MAIN STREET
'E0 MAY I"
HYANNIS, MASS. 02e01
VARIANCE REQUEST FORM
All variance requests must be submitted five (5) days prior to the scheduled Board of
Health meeting.
NAME OF APPLICANT ��/� ���1 le, T % S TELEPHONE NO. �—��3�
ADDRESS OF APPLICANT (J/yJ/j?( k ( ter/
NAME. OF OWNER OF PROPERTYI
LOCATION OF REQUEST 27YA 1,1CqX
VARIANCEIF'ROM REGULATION (List regulation)
VARIANCE REQUESTED (Specific request) _
REASON FOR VARIANCE (May attach letter if more space needed)
ln,-)
5a(V%ce�l�o also ��-�� U N 7Lf G SYS7e- 197 ,
PLANS - Two copies of plan must be submitted clearly outlining variance requested. . j
VARIANCE APPROVED
NOT APPROVED
REASON FOR DISAPPROVAL
Robert L. Childs, Chairman
Ann Jane Eshbaugh
H. F. Inge, M. D.
BOARD OF HEALTH
TOWN OF BARNSTABLE
f