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APPROVED THE COMMONWEALTH OF MASSACHUSETTS
rn le Conserva n Deft+ BOAR® OFF HEALTH
TOWN OF BARNSTABLE
igned Applira h for Diripuml Workii Towitrur#ion 11amit
Application is hereby made for a Permit to Construct ( ) or Repair (11 an Individual Sewage. Disposal
System at: r /
.... �-�d_._... . '4 jam.........._........t--------------------------- -- yj_ _2 L.t../ ...........................................
or Lot No.
.............. ............................................. ....-.----------------------- ----•--•------------••-----__-_____---.-_----------
O.rner Address
Installer r Address
Q Type of Building f Size Lot............................Sq. feet
V Dwelling— No. of Bedrooms---------------------------------------_________________ _______t� _Expansion Attic ( ) Garbage Grinder ( )
p-, Other—Type of Building ---------------------------- No. of=persons---------------------------- Showers ( ) — Cafeteria ( )
QOther fixtures ------------------------------
W Design Flow--------------------------------------------gallons per person peray. 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 i�et-------------- Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank( )
1--4 Percolation Test Results Performed by......... ......... ..•-••• -----..,-..---------------------••••......•••. Date........................................
.a
Test Pit No. I................mmutes per inch Depth of Test Pit.................... Depth to grourid"water........................
0.4
Gx, ,Test Pit No. 2......::........minutes per inch Depth of Test Pit.................... Depth to ground water........................
a •-••••---•••-----•••••-•--••••••----•--•-••------•••-•---•--•--•-•-•--•------•-----••----••••--•---•-----------
•---------••-•--------•-•.......
-----------
-
0 Description of Soil----•-.....------'---------------------------------------•-------------------------•......---------------------------------------------------------------................
x
., W ---------
.-------------------------
, -----------------------------------------------------------------------------------------.-.-------•--------------- ------------•••--------
••••--.....••------------------------------•---••••-----------------------------•--•-••••••------------------• ---------.......-----.....
Z - ----------
U Nature of Repairs or Alterations—A sir when applicable.____ .l�. _ ._.__.____ ..... _... ...........
M
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 unde ned further agrees not to place the
i system in operation until a Certificate of Complien e ssue b
..o
31
----Si n e ............... ........ ............ y........ ..Dace
"..r Application Approved By ..............
........._ - �.,-,,. ;- ............. -
Application Disapproved for the ollowing reasons- -------------------------------- :-....-...,:`...::.......................-........:....
.................................... ........ ...._......... . ....................................__...........-:-............:...............--................-... ----------------- -.... .................................
Dace
Permit No. .............3.
--------------------- Issued .......................................................---..........
Dace
r�ti-.�..�..-w'•--� •ti ..a ='�..- ..�.._.. ..... ......r 7,S_
•ti--.»_-.+-^,,.•-ti... n..w^. �....�....-__....,... ...^•s,r�c--+•-+"�-'�--... .�... ....s-=^ .:.+ . ...r .,. i....�..... .- .. .,...-..+. ..._v.....
1 _ S '
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
r`
J
Appliration for Diripatoul Worl:o Tottotrurt"ton tIrrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at:
..../4/4..... ... --•-•----/=----------------•---•--•-•. .... //c--------------------•-----------.....----•-.
Location-Address or Lot No.
� .............: ----------------------------------------- -------------------------------------..------
Owner Address
Installer Address
Type of Building F Size Lot............................Sq. feet
t..t Dwelling— No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures ------------------------------------------------------------ -------------------------- -----------•-•-----•---•-•-••......-••--•----•-•-•--•--•••-••
W Design Flow............................................gallons per person per d'ay. Total daily flow............................................gallons. "
1:4 Septic Tank—Liquid capacity............gallons Length.......".. Width._............. Diameter................ Depth................
Disposal Trench-- No. .................... Width.................... Total Lengtthr................... Total leaching area....................sq. ft.
3 Seepage Pit No..................... Diameter------...----------- Depth below inl'et.................... Total leaching area..................sq. ft. if
Z Other Distribution box ( ) Dosing tank ( ) P
aPercolation Test Results Performed by-----------------.......................................................... Date...-----........................0......
,.a Test Pit No. l................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........................
a ......-•--••--------•--•...........................•-•--••-•---••-••-•--•-•••-•-••--••-••-•--...........••-•--••---•••.........0.0....--- ..............
....
ODescription of Soil.........•.....................................................................................................................................................0.......
x
--- ............................................................................................................................................................. .......•-��°
U Nature of Repairs or Alterations—AnsN�r when applicable...._�. 13.A ...........-;T ----/l...................
-•-- 00 D ------------------•-••-•.....----••--•........................-•-•••......--..---•-
. . ....... .....................
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 und/s-igned further agrees not to place the
system in operation until a Certificate of Compliant,,has'-een_issued by di boa d .f--h kh
Signed .. .... --------- ....�
O I?are
Application Approved By ................. .............. .......
........
,. .. ....f�.....^../.?�..-..�(..j
LTace
Application Disapproved for the ollowing reasons: ........ ............ . -- ............................... ......................_------------------
................ ............................................................. ....................... . ........... .............................r............................ ........D........ ............
ate
Permit No. ....... .. ..-... .... /----------------- Issued ........................ua.e
---------- —————
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
(111'ertifira e of (1,11oraptiance -
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by ..... ............-- .. 2 -- ---- ---_.--
-- _..........................
at ........... A!..
... ...... t��........................... ..uet
t . .. •�.. .....................
has been installed in actor ante with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ....._9.�i ._ _..g..�.. dated .._._....._................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.__.................. .-. .�.-...(1 ....- - -- ------- .... - Inspector _......__....._.�... ......._... -
--------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
u TOWN OF BARNSTABLE Z
Bioloottl Vorb Taanotr ion "rrntit
Permission is hereby granted .2.G-�---------•----...•----
to Construct ( ) or Repair (L an Individual Sewage Disposal System
atNo. -------- --- ...-- ...---------------------------------------------•----...----••---
Street C)
as shown on the application for Disposal Works Construction Permit Noo.. J_-� Dated...........................................
yam: r Soard of Healtlz......... —
U
DATE...........�1 3 �� -------------------------------•-•---
FORM 36508 HOBBS&WARREN.INC..PUBLISHERS -
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