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No.....13-.:::1�3 Fica..�,7�62...........
THE COMMONWEALTH OF MASSACHUSETTS
APPROVED BOAR® OF HEALTH
C=r*=!3 rvetion Department TOWN OF B A R N ST A B L E
Application is hereby made for a Permit to Construct ( ) or Repair (VI"'an Individual Sewage Disposal
System at:
........................(0.......Csr.WN.--- ........�Q%`' ....---•..... -..--•.......� -�`�-�}�/�•1� ------•---......------•------- ....--------
----- -------
Location Address or Lot No.
l,�^,L- �
Opener Addre
pq Installer Address
UType of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms... .................................__Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
04 Other xtu
d
W Design Flow.........`_-- ---------------_-__.-gallons per person per day. Total daily flow.....�_3.6..........._....-:--__gallons.
WSeptic Tank Z—Liquid capacity-(.gallons Length----- .... Width...-__-_--_ Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No �.............. Diameter-----I ........ Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test 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........................
P4 -----------------------------------•----------•-----------------------------......--•........................................................................
0 Description of Soil........................................................................................................................................................................
x
U -------------•-----------•------•--.....................--------------.............------------.....------•------------••-------------...----......-----•----------...----...----.............•----.--••
W ............................
UNature of Repairs or Alterations—Answer when applicable.... -�� . ._.... _ ...J� .,.,................
1� .. Pk-1.-...................................................................................................................................
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 Complian�hhas n/issuejbthe bo d of hea h.
Signed ---- ----- -' ... ....... .... ...................... ...... ..,-..` ...:
Dace
Application Approved By ...............< ^Date ..-...` ..��
Application Disapproved for the following reasons: ............ ................................. ....................................................................................
......... .............. ..... ..................... ................... ...................................._... --........._.................................................. ........................................
Dare
PermitNo. 3.......1 Issued ..................................................................
Dace
��y',�..ny„t..-a....:....,•„r+.�c1�. _._- r-... -�—.^�:-�---�.,�_..-�.-w+.--.-+rr�•-•. �ss.r.�.•..�ro-•.:r-..--_:.i�:-.�+�.�..�y�r�,�,.a<..�r�.-::?ib ..-.s:J3raL1%�Urt+G4arNr;:�+>..1�,!�?''�.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
�,� Iirttttuu`fur Diriputiu1 Works Towitrnrfion ramit
Application is hereby made for a Permit to Construct ( ) or Repair (vKan Individual Sewage Disposal
System at:
• .......................................................... .........................................................
•.� Location-:Address
or Lot No.
ty J�� A.fn__ - = C tll !/lam-- /
_.._..._.. .................... ........_..............-----•---•-'-•----...........................__----
own" Address ,/��^
W ................ . ............ n !`.�._ r c.r�l(�_ I.l l i''f
a - f ............. f = ; ..-----
� v
Installer Address
UType of Building Size Lot............................Sq. feet
►-� Dwelling— No. of Bedrooms... ....................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures ------------------------------------------------------------------------- -------------------------------•••-•••••-•-••---••-----•-•--........._-•-•-
W Design Flow......_. �"a.....................gallons per person per day. Total daily flow------ ......................gallons.
WSeptic Tank 9 Liquid capacity_(Z lM_gallons Length.-_-.�...... Width...'75�------- Diameter................ Depth_:..............
x Disposal Trench-- No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No......I.............. Diameter...... ........ Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) '
Percolation Test Results Performed by.......................................................................... Date........................................
Test 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........................
04 •----------------------------------------------------------------
--------------
••-•--------
__....._......
••----
•......
•---------------
----------
_.......
__•-
0 Description of Soil-•----------•--•--......--•••--••---•--......-•---•-•-•--......---•--------------------------------•------------.....-----------------------------------......._.......
x
W
x ••••- ..............................................................................................--..................................................................................................
U Nature of Repairs or Alterations—Answer when applicable..._"T� _;n.-. a- .•(_......t , -_:' `,r> t_5-C—................
...................J.n v....(_ P-Fs - r........................................................................................................................................
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 been issued by the board of health.
Signed `` �'>" �..� :V. � ..................... - L�-�7_
.
�✓ _ .-��. Dace
Application Approved By ---------------QQ oo_ --� .......... ' .,.-.:-, .:,_. ._.....I............................. ..... ...... .......��'^ iY..c...`7. '>
Application Disapproved for the following reasons: ............. ............................................................................................. .......................
................................................................................................................. ........ ......................................................................... ...................................
-�� Dare
PermitNo. ...........q j------- �.. .................... Issued .........................................................-.........:
Dace
—cam--- ----
THE COMMONWEALTH OF MASSACHUSE17S
BOARD OF HEALTH
TOWN OF BARNSTABLE
C�Pr#ifirate of Compliance
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by ......................... .fi-............. .. .. .._/�.�-- --
..�- `- Insrdlcr
has been installed in accordance with the provisions of TITLE 5 oe State Environmental Code as described in
�' ...
f h
the application for Disposal Works Construction Permit NO. ......... .... ..--..��Jr..._.._ dated _._..._..
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
q — TOWN OF BARNSTABLE
No...,/.._3 �. �, FEE---
Disposal Work,5 Tono#rurtion "rrmif
Permission is hereby granted-----------r(A ny � �=`-n- C-= ---•-------------•---------------•-----..............---........_..._
to Construct ( ) or Repair ( L)an-Individual Sewage Disposal System
at No (. r__..���_{�= ^= ..............(-�... l.::...,.... �--.....................................
----•----•--------------------------•--..( ...
Street g,
as shown on the application for Disposal Works Construction Permit No.., Dated.......................
� C Board of Health
DATE.............. ......................................
FORM 36508 HOBBS!}WARREN.INC.,PUBLISHERS