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ASSESSOR'S MAP & LOT
INSTALLER'S NAME PHONE NO. 77( - lay p
SEPTIC TANK CAPACITY 14 y0 d
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r LEACHING FACILITY:(type) Le&k(-L 14 (size) (Dd 0�g gati5
NO. OF BEDROOMS PRIVATE WELL O PUBLIC WATER
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(\BUILDER OR OWNER ��)/c � �y•�c���, Ca,
DATE PERMIT ISSUED:
DATE .COMPLIANCE ISSUED-
VARIANCE GRANTED: Yes No �/
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.....................U(....' .'......OF........./3 l`�S_.%'./.. LF---------------------------
Appliratinn for Disposal Works (fnnstrurtiun Prrmit
Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal
System at: '
114 r3 ....... = .NI_,FiQ c_iLC .....-------------------------------••----•-••--•---•--
Location-Address or Lot No.
...................... ...De......81_AL......C ............................... ..........................................d. i3 a x .�.....
..
Owner Address
a -r .............................................................c L. ....... ..11 ,-9 5�U i f.:R.......... / L-s.............................
Instalier Address l
d Type of Building Size Lot.... ........ .....Sq. feet
Dwelling—No. of Bedrooms.._....-�...............................Expansion Attic ( ) Garbage Grinder e0)
Other—Type of Building u`�v.... No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures .-----•.............•-••-----••. • --
W Design Flow.....................�J_...............gallons per person per day. Total daily flow------------3.30.....................gallons.
WSeptic Tank—Liquid capacity.&PfJ..gallons Length......../... Width....6......... Diameter________________ Depth___-._____--_---
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No--------- ---------- Diameter-----------(0------- Depth below inlet.................... Total leaching area._ .y....sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
14 Percolation Test Results Performed by....................................
---•-.............................-•- Date.......................................
,al Test Pit No. 1.._L_.�...minutes per inch Depth of Test Pit......�. '.... Depth to ground water_A10."e jl?tJ D
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
a ••-••..... .. ..............................••---..-- ...........................................•--•--------------------=---------------------•---•-.----
O Description of Soil...Q� �tzz2 _...�,Q i'Z:&I.." t�r�?c, c Zl�j........ `......
x /
Vlu_ � Y'.1.:3._.._..l�nu _trl. if �1t:� !l�c._�Lc-�s c1 � � r':L�1
W ----•-----••---------------•--------------------••---------•-..............-•--•••-•------•-----••••---•-•----•------...••--•-••...-----------•••-•••-•---••---•---•----•-•-•-----•-----------••.......
UNature of Repairs or Alterations—Answer when applicable...............................................................................................
--------•--------------------------------•-----------------------•-----------------------------•---------------•-•••••--•-----•----------------•...-•-•• ..............................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in actor ante with
the provisions of T IT 15 of the State Sanitary Code—The undersigned further agree of tQ plat system in
operation until a Certificate of Compliance has been issued b the boar o liealth. 'i
Signed---....... c 4'��.. - . ........... to
i / to
Application Approved By..........' l ' =` ' •k..�.f��'_ :..�.............• .................. .............. .. 7
Date
Application Disapproved for the following reasons:...........................................
•••••---•--•--•-•-•••-•---------------•----•••-•--•--•-••••--....------....._-----------•---••-........-.........................................................................................
Date
'
PermitNo......................................................... Issued-.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............. .........OF........ ) .','fv-......................................................)
Trrtifirat a of Tnntpliattrle
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( )
by..... JZ. '5l:l 1. 6::
_,�y
G f .... 1� ,-1" !' ' f 1�1 _ _z_:_' .. _f _ _l am
has been instailed in accordance with the provisions of Ti TIE j of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No ri.... ............. dated...... ................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.............. .................................... Inspector•--0............ ...
-----------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARp OF HEALTH
......OF......... `�. i)_1`�'',11 571_11 r ..._._.. N..
r- .J
NG FEE.
Disposal Works Tonstrnr#inn fautit
Permission is hereby granted......."'r__J......
to Construct or Re'pair ( ) an Individual Sewage. Disposal System
r• j =) - f
\rG �t/. /1L:."�? .r _l.1. Z: ! r f J°1 TP` _✓A L.f }
Street —y / .. V -7
as shown on the application for Disposal Works Construc ' Permit Noj Dated...
-------------------------------
_-------
•-••- „ "--`-'�---------------•---------•------------------------
r Z Board of Health
DATE.................... ----•----•..............................•-
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS -
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LEGEND
EXISTING SPOT ELEVATION O.,�Q_ ���/v`a3 DAVID P.
I PROPOSED SPOT ELEVATION �Q�
MAR OF
,c IN �[n
EXISTING CONTOUR ---0- -- CIVIL
PROPOSED CONTOUR 0 A No.31115 ® G' RO
NOTE THE LOCATION OF ANY UNDERGROUND GISTE .
SEWERAGE,WELLS, OR OTHER UTILITIES SHOWN ON
THIS PLAN IS APPROXIMATE ONLY AS DETERMINED I�►
FROM RECORDS AND/OR VERBAL INFORMATION.
THE CONTRACTOR IS RESPONSIBLE FOR THE � L Lae�o�
VERIFICATION-OF THE EXISTING LOCATIONS IN
THE FIELD.
REGISMERED ENGINEER— R
LE VY ELDREDGE ASSOCIATES,INC. C $8���. PROPOSED PLOT Pt AN,
CLIENT
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ENGINEERS - LANDSCAPE ARCWITECTS JOB NO. /2..�...�. .L.oT�� W4jl
PLANNERS - LAND SURVEYORS 'r
DR. BY: IN
889 WEST NWN STREET CHO.BY;„964-41
CENTERVILLE, MA►. 02632 T,,,..L�,C1? XA1.E'.�....,�..,�� DATE_ -2/4 IV
'ASSESSORS M�RP NO: a2 yF
No.. .. -; Fmm..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
_7_............. 11� ./z--------------------------
Appliration for Mipaaal Works C9nnotrurtiun Prrutit
Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal
System at:
407 Y11 .44 a E.R_T.L A.y.................... � Nr iP t�i L ... .....................................
Location-Address or Lot No.
�`� S(D • .. A ... C��................................ -----------— X `?'--�------ �NTE,e ✓i L t
Owner Address
L L ✓j'?9.25.......... /L L. ._.
Installer Address �� n
Type of Building Size Lot_•__....__�................Sq. feet
UDwelling—No. of Bedrooms----------- ...............................Expansion Attic ( ) Garbage Grinder (�D)
Other—T e of Building eeANE No. of persons............................ Showers — Cafeteria
Q' Other fixtures .........................................--
W Design Flow..................... ............--gallons per person per day. Total daily flow............. 0.....................gallons.
G: Septic Tank—Liquid*capacity_AU d!1-_gallons Length....... Width....(.(.__-_ Diameter________________ Depth................
W Disposal Trench—No..................... Width....._--_...._._.... Total Length............._....._ Total leaching area.................... ft.
x , /
Seepage Pit No.......... Diameter...........(....... Depth below inlet.................... Total leaching area..c-24Y-.._.sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
a� Test Pit No. 1-..G_a---minutes per inch Depth of Test Pit------- Depth to ground water-/✓QwEfO//ND
fT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P ---•--------------------- ---•- ....................................................................................
0 Description of Soil..-0-� - ---P�� -- -.=:V .l _r � -f---- `��---- �n•- .�G�
•----------
-•-----------------------------------------------------•---------•--•---•-•-•-•--•---•---------••-----••-----•-•--...-----------••------•------•-------•-------•---------•-•---•-------•-•-•-......----
UNature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------....................
-----------------------------------------------------------•------------------------------•-.-----••-•-•--••-----••••----------•-------••--------••----••-•-••-•-•-•--••---------......------------....
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in actor ante with
f-1T niT^
the provisions of 1y I I-E 1 of the State Sanitary Code—The undersigned further ag&eo Wpla system in
operation until a Certificate of Compliance has been issued b the boar o health.
, II Signed---......�.. ......... .. . ----•-- --- --- ... ...�7.....
N �`Dto/ "
Application Approved By-------- aNLf�C�-•---- Ef%!"`?------------ -- •---------•----•-- -•----...-----�..... • . ....
Date
Application Disapproved for the following reasons:-----•--------------------------------------------------------------------------------•-•-• •-•---••----------.
-----------------------------•--------------------•-----------------------------------......-----•------.I-----------•---•--•--•-••••--•-----•-----•-•---•---•----•--•--------••-------••----------•-----
Date
PermitNo......................................................... Issued_.......................................................
Date
FA r 1
V
No... .-.. � FEE...........................
THE COMMONWEALTH OF MASSACHUSETTS
- BOARD OF HEALTH
.............. t -------OF....... : ' ` .J0.6 4-�........--------------------•------
Appliratilan for Disposal Works Tonstrurtinn Verniit
Application is hereby made for a Permit to Construct �/) or Repair ( ) an Individual Sewage Disposal
System at:
. ......jX.K. .1....... ' °r /T ' .; .........................................................r� Location-Address or Lot No.
---•--... ..... .-- -
owner Address
Installer Address
Type of Building Size Lot..�c' ._ .��••--.-•Sq. feet
U Dwelling—No. of Bedrooms....... ..................... .Expansion Attic ( ) Garbage Grinder/04)
44 —Type g No. of persons---------------------------- Showers ( ) — Cafeteria ( )Other—T e of Building � �f�____ �!j% ..
Q' Other fixtures -----------------------------••• .
W Design Flow....................53 _............_.gallons per person per day. Total daily flow____-__----3.30..____._.............._gallons.
1:4 Septic Tank—Liquid capacityle)O t...gallons Length..........._.. Width---G.`....... Diameter________________ Depth................
Disposal Trench—No. .................... Wid1th.................... Total Length.................... Total leaching area-----------t--.......sq. ft.
Seepage Pit No...------ _._______._ Diameter--___-__.(._ Depth below inlet.................... Total leaching area.rr4.5/.....sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed bY.......................................................................... Date......................................Alo ..
Test Pit No. 1..�:_ °....minutes per inch Depth of Test Pit-----f l/..... Depth to ground water......!���''�.
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a -•••--••••-•---•-•--•-••-•...---•..........•-•................ ..•-.................--•----- ----------......•----•...--•-•-•----••-----..............---•-
0 Description of SoiL0' t-).......
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 1I-7 1 j of the State Sanitary Code—The undersigned 'further.�gree-s,Vwt tp plac�` system in
operation until a Certificate of Compliance has been issued by the boar health r
�.
P P �
Signed...... :. ':
A 11 l' f Z e.t
I V `rY �+ fq Ly
Application Approved By...... `Fj�• / -.-
Date
Application Disapproved for the follow ureasons:-----•--------••----•-------•--•----•---------------------------------------------------------------------------
--•••-••----•--••••••--••----•-•.....------•••--•---•---•-•--••--••-•-•••--------•--------•---.......--•-I-••--•------••-----•-••-•-••--•---•••-•------------------•----•••----••-----•---•-••......---•-
Date
PermitNo......................................................... Issued_......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
....... .........OF.... 1 . i' ...............
Trdifira e of Tomplianre /
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (w' ) or Repaired ( }
by..... ------------------------------------------------------------------------------------••--....._.....•-•....... .
Installer
at...................... ..A...------ •--•----- i'' ....-.=-..... --.......C/
has been installed in accordance with the provisions of T I T IE j of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No-----�?-_�_'_5��............. dated------ ................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE......•..---- r `{ '= . Inspector...�<-- .
—2— THE COMMONWEALT,;H OF MASSACHUSETTS
1S
BOARrp OF HEALTH
. /j i iRA
NT R f.: .f(�f FEE r
o. ....--•-••.... .. --•-•--......
Disposal Works TDonstrudion erniit
Permission is hereby granted......9 ..___ ..............•-------
._ ........'�.L. �-•
........................................................
to Construct ( (/)` or Re air ( ) an Individual Sewage Disposal System
at No....94•----....44.'-37. t&� 11.......- �' ✓t�Tr _�' d� �
............................................................
Street _7 / _
as shown on the application for Disposal Works Construc Permit No. _......: _. Dated.......................Y ........._.
=�,� ' ' ---------------------------------------------•----
G Board of Health
DATE............ -•--•- --- - ---------•------•---------------•---
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
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LEGEND ��`
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EXISTING SPOT ELEVATION 0 �,� DAVID P.
PROPOSED SPOT ELEVATION MARIANO f� �� �N OF
EXISTING CONTOUR 0- CIVIL �►
PROPOSED CONTOUR - 0 w N'o.31115
t
NOTE: THE LOCATION OF ANY UNDERGROUND No '��•GISTE
SEWERAGE,WELLS, OR OTHER UTILITIES SHOWN ON '`F
THIS PLAN IS APPROXIMATE ONLY AS DETERMINED "ry
FROM RECORDS AND/OR VERBAL INFORMATION,
"sac cacao {�.
THE CONTRACTOR IS RESPONSIBLE FOR THE
VERIFICATION-OF THE EXISTING LOCATIONS IN
THE FIELD.
REGISTERED N IN R
EVr a EE�EDGE ASSOCATES,INC. � NT Pf PLOT'
C�.
ENGINEERS- LANDSCAPE ARChiITECTS. JOB. NO. 42-03
,,.,.
P�,ANNERS - LAND SURVEYQR;S DR. BY
689 WEST hWN STREET C,HKD QY= �•.,,�. ��>21VS�R$�:�a
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TOWN OF B.ARNSTABLE
`4.0CATION Lo0 8 1 SEWAGE # `37
VILLAGE ASSESSOR'S MAP & LOT ��
INSTALLER'S NAME & PHONE NO. 1.3, -771- cay a
Y
I
04 SEPTIC TANK CAPACITYdC
4.
rd LEACHING FACILITY:(type) U0A% .Q (size) (Dd Q J 6a 5
f
NO. OF BEDROOMS 3 PRIVATE WELL O PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE .COMPLIANCE ISSUED;
VARIANCE GRANTED: Yes No
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