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ASSESSOR'S MAP N0. .J PARCEL 00
LO' 'ATI I'! SEWAGE PERMIT NO.
VILLAGE
64 ,
I N S T A LLER'Lr6-
S NAME A, ADDRESS
LltlaR rovvmcl,610 vice]_"
4x
0 1LDE R OIR OWNER
l C14 S
DATE PERMIT ISSUED
2z 3 o.':
DATE C0M.IPLIANCE ISSUED
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LOr�CAT10N �cJ' �-tSEWAGE PERMIT N0.
I
TSB. 41
Y ILAGE
INSTALLER'S NARIE A ADDRESS
G U I L D E R OR OWNER
p DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
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FEE.....� �
THE COMMONWEALTH OF MASSACHUSETTS '
BOARD OF HEALTH
--------------OF............ X,"00 .. ------
Appliratiuu for Dispuiial Workfi Tuuitrurtiou Frrutit
Application is hereby made for a Permit to Construct V`\) or Repair ( } an Individual Sewage Disposal
System at
................. :/.._....... /t/ ._. ............................................................................
37� Location-A dr ,�/ �j�Apo
7i ]�n�
-- s......_. �__ _---_� ------------------- ...._
Address
i
1 ner
a
Inst ler Address L�
d Type of Building Size Lot____T__r___A.�___.._._Sq. feet
U Dwelling—No. of Bedrooms........ ______________________Expansion Attic ( • ) Garbage Grinder ( )_
-� __.__ ersons_______________________ __ Showers — Cafeteria
p-, Other—Type of Building -------------•-------__ No. of p -- ( ) ( )
Other fixtures .• --
W
Design Flow_______________________________ � _ gallons per person per day. Total daily flow._..__. .:..gallons
WSeptic Tank—Liquid, capacity.l "--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.
ZOther Distribution box ( ) Dosing tan_ k ( )
Percolation Test Results Performed by............................
��,/�/ ...
-_ --.--: Date..........
-. .. ? ��
Test Pit No. 1. _.5 minutes per inch Depth of Test Pit____________________ Depth to ground water.........................
(s, Test Pit No. 2� ..... ....� minutes per inch Depth of Test Pit____________________ Depth to ground water........................
__ ���--
-
sue. - --
O Description of Soil___________________ ----------------
U --------------------•-•---•---------•--•-r----------------------------------------------------------------------•---------------------------------------------------------------
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 TITI.Z P of the State Sanitary Code— The undersigned further agrees not to place the system in
oper t n�erti'i e of Com Hance has been issued by the board of
/ Signed................ --- - - --- ----- .. ........... -=- -- .......... ........ ___�*
Date
hcation Approved B ---•�--�-'-�`=------•--------• - . ..---------•----••-•--- •---•------••--� --- .
P ,PP Y -
Date
Application Disapproved for the following reasons:................................................................` --------------•-----.......................
---------------------------------•-----------•-----------------..----•-••2--------...-----------...--..•---------...-----------•-.--•---------------------------------------•----------- _----
Date
PermitNo. •--•.................................. Issued_.......................................................
Date
FR$..-. .v`�a.._
THE COMMONWEALTH OF MASSACHUSETTS
JJBOARD OF HEALTH
��/
<,J.....................OF.......... C`' !/--` 1- _ ........-----
Appliratilan for Bhipaaal Workfi Cnomitrnrthila ramit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at: ��
r t Location-Address or Lot No.
Owner 60 Address
Installer Address Q Type of Building Size Lot...`,_�___________________Sq. feet
aDwelling—No. of Bedrooms__.___ ____________________________Expansion Attic ( ) Garbage Grinder ( )
p•, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
a Other fixtures ____________________________ _
W Design Flow............................................gallons per person per day. Total daily flow................. . ...........
WSeptic Tank—Liquid capacity,11 __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..................---------Z? _--........... Date........................................
a Test Pit No. 1 t..O...__-_minutes per inch Depth of Test Pit____________________ Depth to ground water........................
fT4 Test Pit No. 2 ...._minutes per inch Depth of Test Pit____________________ Depth to ground water........................
�, ..
•-- .......................
- -
O Description of Soil...................�s to' . ��?f_1�-----•- ---c�r'��vC' -- ._
W
_ V ------------
------------------------------------------------------------------
-------------------------------------------------------------------------------
_-------------
----------____--
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 iIT:.i; of the State Sanitary Code— The undersigned further agrees not to place the system in
ope n u til a Certifi e of Com liance has been issued by the board o7h.
Signed....... ..... :.: ... . .
r . Date
plication Approved BY------- ....."'---......=.......'- - v.,._...... -•----------------- l 2 -----`�_-�-=�-----------------------Date
Application Disapproved for the following reasons---------------------------------------------------------------------------------•--------------•-•---••••-•-•••-
-----------------------------•-•-----.._....-------•---------------------•-------•----......-------...---•-•----•••---••--•••--•••-----------•-•••--•-----•-----•--•----•----••----•----------...._....
Date
PermitNo....... -=-•=........................................ Issued--•------•----------------....._..--------......_......
Date
THE COMMONWEALTH OF MASSACHUSETTS
_ BOARD OF HEALTH
Trrtifiratr of Tuntphaurr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed K) or Repaired ( )
., nstallerq
Z{ �at............. 2 .•• •• 411W; '�'�''.-�.. I-- -- ------• -`-.�-1r.........''.7......... -----.•-----------------------------------
has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the
,:-application for Disposal Works Construction Permit No---- - _.__.I-S-:1` dated---- -11.:?._1`y°r------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..................... �" :� ---------------------------------- Inspector.....__.. 14-----------------------------...................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
f
< - f'..........OF..... �� :!! ..-. "�
No...l`?. -.j. = 2.............. FEE... :
19ispaii l or �. _trvrn erntit
Permissio is hereby granted `. --'---V- ---........ ..............................................
to Construct N) or Repair ( ) an Individual,.Sewage Disposal System i
1-1
at No....... ..... L..,P.):_.:_r__..z.._:�......- -��`-
L. - ......... ----------------------•----------•---------------•••••••---_-•__•-
Street
as shown on the application for Disposal Works Construction Permit No.R a ! .Dated......._ ...........................
... ... ....... .-----------------•--•-•-••-•••••-••••••••---•••••••••.._
p lh Board of Health
DATE................--- 13-1-9-4.....................................
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
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{ w x only.., determined frog records and/or verbal �7�5;7" L�' ,-£
s. tfon.�The :contractor',is responsible, for; the
f �WW �� � ;
.et' ic�tion of the existing locations in. the field gCALE�` 4 D/ :QATE �' / /il' 4 r3
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'�.®RED`GE ENG/NEERN�lQ Ca IN Ct�IENT
_ •i•f- - I_:OERTIFY� ,THAT THE PROPOSED R, 1,4_._-— -
` E®ISTERE REG19_TEREO J08 �105. ®UILOINO SHOVdN 0!� TN�S tPLAN t�' i
_h ;art C1. k :LAND� .;- CONFORMS TO THE 20NIN ' ., I,-
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18 FLINT ROCK ROAD
FRM*40 SECTION Bametable,ma
Jdy L1,704 -
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7b'x5-0' 2b'x5-0' 7S 6-17 7b'x5'-0'
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Foyer
7b' _________ Emry Portia
--------- Ed.Din.Rm.
__ R
EdsL Sun Rm. Edst llv.Rm. _________
_________ Garage
73'
NOTE:[WERIOR:LAYOLFr AT EXIST>NOU E OXx NOT RED YET
7F Exist QM Approx.Not Measured Yet
This dimension is&R.Not D—b wale—►
Pima only fw eewaad'mon.
2-t0'
7b'x Y-61 Franca Dow 3'b'x Y-V
Plan wlll be ed)usled fatmnsW don '�
4 Dec 4 � � §; slepxmgmaeaereq.
slider 6 x 6-10
Slider SO x 6-10
3'$x 5'-0' 3'b'x 5'0 3W x 5'-P
CesemeNs W rrWda edst.Sunmam
vwKy Nlsdim. 07/B'
31'-0'
PROPOSED FLOOR PLAN
Stale 116'=10 ORCUTT RESIDENCE
18 FLINT ROCK ROAD
BARNSTASLE[MA>
Ady 3g2003
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08/05/2003 12:35 15087754300 OLSON DESIGN ASSOCIS PAGE 01
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ORCUTT RESImNu
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TOWN OF BARNSTABLE
UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS
NAMEn
ADDRESS ���. �-��d VILLAGE LOCATION OF OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE:
OR CHEMICAL
rw� o rhous-e- nkde- rddh uj rbo Oil-
(Give same information for any additional tanks on reverse side of card)
DATE OF PURCHASE OF EACH: 1. 2. 3. 4.
DATE OF FIRE DEPARTMENT PERMIT:
TESTING CERTIFICATION SUBMITTED:
PASSED DID NOT PASS