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0162 BUCKSKIN PATH - Health
162 BUCKSKIN PATH, CENTERVILLE A = 170 071 UPC 12534 No. 2 153LOR HASTINGS. UN No. ?` — / (1,-;> _ Fee $ 50 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes f� PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS -" Zipplication for Mfqogal otem Comaruction Vermtt Application for a Permit to Construct( )Repair(x )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 162 Buckskin Path, Centerville Carole Shore Assessor's Map/Parcel /-7 a — V 1� 7 Installer's Name,Address, (and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service P 0 Box 1089, Centerville Type of Building: Dwelling No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil S and. Nature of Repairs or Alterations(Answer when applicable) Title-5 le tem, including I)-1inX._ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of a Environm ntal Code and not to place the system in operation until a Ce fi- cate of Compliance has been is ued s azd of He Signed ^^" DatV4 Application Approved by Wldo Date ��►2— Application Disapproved for the following reasons Permit No. Date Issued g .t �* No. ( r Fee $50 l/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS • 0(ppYtratton for Mtqooar *p6tetn Con!5trurtton Permit Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 162 Buckskin Path, Centerville Carole Shore Assessor's Map/Parcel /�a — 0 v 1� 7 ) Installer's Name,Address, (and Tel.No. / Designer's Name,Address and Tel.No. Wm. E . Robinson Septic Service P 0 Box 1089, Centerville Type of Building: Dwelling No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank wl I pg'o .A.S. _. f Description of Soil /S and. , .t Nature of Repairs or Alterations(Answer when applicable) Title-5 le s• stem, including Date last inspected:: f` Agreement:,.. i;,'IT The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system `in accordance with the provisions of Title 5 of)ye Environmental Code and not to'place the system in operation until a Certifi- cate of Compliance has been issued s aarrd of He 1� Signed Date✓ Application Approved by Date //-t 2- ' Application Disapproved for a following reasons } Permit No. Date Issued ------------------------------ THE COMMONWEALTH OF MASSACHUSETTS Shore BARNSTABLE, MASSACHUSETTS Certificate of priance r THIS IS TO CERTIFY that the On-site Sewage Disposal System Constructed( )Repaired( X)Upgraded( ) Abandoned( )by Wm. �. Robifibon Septic Service at 162 Buckskin Path , Centerville has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. W-76 dated f Z- Installer Wm. E . Robinson S r. Designer A The issuance o s ermit hall ji t be construed as a guarantee that the a 11 function de ' ed. Date f' a Inspector r / t A . / -7 --�--:-------- ---------------� ————— No. ! ` �(� J f�rj t'L' '` l! r :7 ee 0 THE COMMONWEALTH OF MASSACHUSETTS Shore PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migozar *paem Conttrurtion Permit Permission is hereby granted to Construct( )Repair( X)Upgrade( )Abandon( ) System located at 162 Buckskin Path, Centerville and as described in the above Application for'Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. (^ Q Date: /��Z//1 Approved by C- 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, William E . Robinson,SAereby certify that the application for disposal works g theni construction permit signed by me dated concern �' !� � property located at 162 Buckskin Bath, Centerville , MA meets all ofthe following criteria: • The failed system is connected to a residential dwelling only. There are no commercial or business uses sociated with the dwelling. • The oil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • Th a are no wetlands within 100 feet of the proposed septic system • ere are no private wells within 150 feet of the proposed septic system • ere is no increase in flow and/or change in use proposed • ere are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation '3 3 +the MAX.High G.W. Adjustment. DIFFERENCE BETWEEN A and B 7 SIGNED : /V G°G DATE: ZY29 — [Sketch proposed plan of system on back]. q:health folder:cent A 11C J9 7 y d 1 / TOWN OF BARNSTABLE L UC, KOCATION t5 il�-,-Ct SEWAGE # F9 —7 L 3 VILLAGE �'r%1 i ASSESSOR'S MAP & LOT/V 0, �+ r INSTALLER'S NAME&PHONE NO. /C 04 .4 6 �e 7S—S 27 4 SEPTIC TANK CAPACITY d i LEACHING FACILITY: (type) (size) NO.OF BEDROOMS_ BUILDER OR OWNER PERMIT DATE: //—'/'2 `Z � - COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility. Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by / Q✓�� �G I,' _. � � i 1 i� �� � ..� � �i ra , � � �, � ✓J TOWN OF BARNSTABLE /� LOCATION6 T04 , SEWAGE # —? 4 3 VILLAGE ef,.= i ASSESSOR'S MAP & LOT ' _ / r INSTALLER'S NAME&PHONE NO. 4 IS SEPTIC TANK CAPACITY r LEACHING FACILITY: (type) S � �' t' L- G (size) J� -3�— NO. OF BEDROOMS BUILDER OR OWNER /L PERMITDATE: %—�'2=`I COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet jPrivate Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If,any wetlands exist I within 300 feet of leaching facility) ;.'? Feet Furnished by —=----- y ` .. i x ' � y . 'TO1,1'N OF BA.RNSTABLE Li-CATION ` l!/�- /JGC 'S l/ G�`i SEWAGE # VILLAGE 'I _ _-- ASSI,SSOR'S MAP '� LOT 70 7 INSTALLER'S NAME & PHONE NO. • n6 ),Z[F'!� 7-sore LhC , SEPTIC "TANK CAPACITY__ _-- LEACHING FACILITY:(typc)_� NO. OF BEDROOMS L P ' dJELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED:__—_- �i��._ DATE COMPLIANCE ISSUED:— VARIANCE GRANTED: Yes _ Nei__ ;�; n A' �� . �, , � \ y, I ` � \ \ �� > 1 � 9 � � �� �y . qj ® ��� � 6. No.... ... Fps............2.-0•.-•-00........._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for UWposal Works Tnntitrnrtion ramit .Application is hereby made for a- Permit to Construct ( ) or Repair (X� an Individual Sewage Disposal System at: 162 Buckskinpath Centerville ..................__-- •---............_..-................................................ -•--•-•-••-------•••-•---•-•----•-••-•-•--•••-•--••••---...-----•----............---........•--... Shore Location-Address or Lot No. Owner Address W J.P.Macomber Jr. a ........... -------- Installer Address UType of Building 3 Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria 04 d Other fixtures -------------------------------•----------------------'-------------------------------------------------------------•----------------...........------ W Design Flow............................................gallons per person per day. Total daily flow......_.....................................gallons. 04 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ W 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........................ W -----------------------------------------------------------=----------------------------------------......................................................... 0 Description of Soil.................................... W Saffff.& brave Z'•-------------------------------- v •--•-----------------------------------------------------------•---....._...--•---------------------------------------................................................................................ W UNature of Repairs or Atporations—Answer when applicable......1-1000---gallon...leaching...pi-t............... -•------•---------�........ ............................................................ ---..... -•------ -------------------- ---•-•-= --•---•---- 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 Gs su d by th board of health. Signed - --------------------------- ------ -------)..f.�,7./9��.......... Dace Application Approved By ............... .. ---------------.......................... ----I---..L7,...96..... Dare Application Disapproved for the following reasons: ... ........................................................................................... ................................ �' -------------------------.............................................................----------------------------------------------------------------------------------------------------------- ---------- ........................................ Dace PermitNo. ---------70----------, ------........................ Issued .................................................----------------- Dace r 20.00 -No.:. d.- J3-- Fss. ........_............._ THE COMMONWEALTH OF MASSACHUSETTS -BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Dispnittl Workii Tonstrnrtiun thrnti# Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System62 Buckskinpath Centerville ................__--...._...................................................................... -•----•----......---••--•---•-•-•-••--•-••-•-•••-•-•----••-........--••-•-•............---•----•-- Shore Location-Address or Lot No. ......................-.......................................................................... ..........--...................................................................................... � Owner Address W J.P.Macomber Jr. - Installer .'` Address dType of Build* ''g 3 Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( ) U Other—T e of Building No. of persons............................ Showers — Cafeteria f4 YP g P ( ) ( ) Q' Other fixtures -----•......--••••-•---•----•-•. ------•.=-- WDesign 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........................................ aTest Pit No. ]................minutes per inch Depth of Test Pit.................... Depth to ground water-___--_-_____-_-__.__-:- G%, Test Pit No. 2................minutes per inch Depth of Test Pit..............._.... Depth to ground water........................ -<`------•------------- 0 Description'of Soil.__-:------ ------------------------ �,-----._.�._.._. x Cana nc'ciy ve v ----••-••••-•••-----••-----•••---•--••----------------------•-...............---••-------....---•-..........._.._...----.........-••••-----•••-- W --•----•...............•`-•••---•--•••--••---•-----•---•--••••--•-•--•••-•-----••-------------------•-•---•-------•••--•---•-•-••------••------•-....--•----••-----------------------•-------------•- UNature of Repairs or Alterations—Answer when applicable....- -1000--aallon-••leaching--U-it---_----••---- ----••......•...:�-. -- •••••••---•---•-•----------------•-----------------------•----•-••----------------------•---••-•---•--•••••.------------------------------- 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 ha eenf ssued by the,board of health. f Signed ............j ,.:........./�� .... - -------------------------------------- ------7.,/_..ILTZQC......... Application Approved By ..--- = 1 .......l...7...�...`1G....... .. ................................................................... Date Application Disapproved for the following reasons- ............................................-----------------------------------------------•------------------------------------------ ...... ............................................................. ... ....... . -------------------------------------- �p ate Permit No. 7 .---.... f 1 -------------2- ...----.... Issued .........-----------------------------------------------D-. e...... r Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (9elrt#ifirutr of Q-11u>rrtylinure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired.,�XX ) by .J.P.Macomber Jr. .... ...................................................................................................................... 162 Buckskin path Centerville. Installer at ............... . ..........................................................................................................................................................-....-------------------------------------------_---_-.--_---- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ......c�b...-../.. .................. dated ...........--..................--............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR;UU�DDAS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. .-...-. .. . ...., ...DATE r � A ..... ....... l / -------------------------------- - ,....... --•-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Q TOWN OF BARNSTABLE 20.00 No..../._d.....:�...... FEE#�................. Disposal Works Tonstrudion f rn it Permission is hereby granted.. ...P.Macomber Jr. to Construct (BL�cics�inpa{th) tenndividu 1ewage Disposal System atNo............................................................................................................................................................................................... Street cc�� as shown on the application for Disposal Works Construction Permit No./. .:n/_3..... Dated.......................................... a -----------------------------------------------------------� ' 9 D DATE............../-..--...•-• / ---........./-----•-................................... Board of Health FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS r No...... ...... Fps ................ THE COMMONWEALTH OF MASSACHUSETTS, - BOAR® O HEAL H ..................OF.-. -.._........ . ............................................... ApPration for Disposal Works Tonstrnrtinn ramit Application is hereby made for a Permit to Construct (A) or Repair ( ) an Individual Sewage Disposal System at 4 --------- ;O�� ---Locati : ddres 'or�No. ^'ra'c•'''---- .,['[' �....---•--..:....:---------•-•-------•---------- ..... - ......... ........ -=--.. :. ....-•------------ ......... ....................... Address Installer Address Type of Building Size Lot---- .f. .......Sq. feet U Dwelling—No. of Bedrooms. _ ..............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Buildin_a4s�_�,�_._,_...... No. of persons-------mod-...------•__-__-- Showers (Y, — Cafeteria ( ) 0.' Other fixtures -------------------------------- - W Design Flow.... -3..�............................gallons per person pe- day. Total daily flow------- ......................gallons. WSeptic Tank—Liquid capacity-/_gallons Length....r....... Width._K._._.....Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area-___---�"4 ---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.......eYpt .................. Date....`, a Test Pit No. 1................mmutes per inch Depth of Test Pit-------/.2" Depth to ground water_.R/P --------- Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -- .......................... .................................................................................................. 0 Description of Soi __ x •----------•-•-•-•--- •--•----------------------------------------------------------------------------------------------------•---------------------------.•---------------------•-------•-•---.........._-----------.._..... V Nature 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 iIT3TL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee�iisued by the bo 'd f health. d _ ----- .—� ....__ --- -----_---------- Sign ate ApplicationApproved By....../ - L...:.......................................----••--••---•---••------•-------• ............ ,/�,v Date Application Disapproved for the following reasons---------------------------------------------------------------------------------•----------•---••-----•-----•... ----------------------------•-------------�f-�----1��-----Date-------------` Permit No........�a A3 ......---•--•------------------------- Issued---•---- j Date 4 t A .. THE COMMONWEALTH OF MASSACHUSETTS _._.� BOARD O HE /! ..................0F.... ..... ...... �?!--!� ............................................. a Appliraation for Bispoaaal Workfi Tonstrnrtlon Prrmit Application is hereby made for a Permit to Construct (>) or Repair ( ) an Individual Sewage Disposal System at: � �`G ............. ,. FC LLocatio ddres ' or No- • -- ---...- --•• --- �-tr r Own ( y Address ............. ..................................................... _-/' Installer Address ype of Building Size Lot....._....;�.. .Sq. feet Dwelling—No. of Bedrooms___. ...........................:.Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Buildin No. of persons ................ a Other—Type g� :______`__-_•___._ p Showers (�) — Cafeteria ( ) P4Other fixtures ------------------------------------•--......-------------....------------•-•---------...--------------•- W Design Flow____.._ _ ____________________________gallons per person per.day. Total daily flow.... — __��_0 .............gallons. WSeptic Tank—Liquid capacity.A gallons Length.--_............ Width...k�......... Diameter................Depth_._._........... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area__.....W-7..sq. ft. Seepage Pit No----_-------------- Diameter.--................. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) f Percolation Test Results Performed by......l4/ne, x-_�.. Crn-�.-t .........._...... Date.. Z.:_! Test Pit No. 1................minutes per inch Depth of Test Pit........ Depth to ground water..��✓�["'��.. Gx, Test Pit No. 2................minutes per inch Depth of Test Pit...._............... Depth to ground water........................ ...•-- •--......._ Description of Soil_ __ -, - <. 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is ed by the bo �fd healt Signed ...... ..... . 1 ,�� ............ ... •....ate. 4r n Application Approved By----- �:.J = �'� l i b Date Application Disapproved for the following reasons:................................................................................................................ ......._..-•........................•--•----------...---•-----•--------------.._....------....-------------------------•--------•--•---------•--•-••-----------...---------------------........ Date PermitNo......... • ----------------------------------- Issued_---------.................... .. Date THE COMMONWEALTH OF MASSACHUSETTS �_--.- BOARDQ JQF HEALTH ..................0F.. ....400.............. { . ` Tertif iratr of TompliFanrr " THj IS TO C'E IFY�hat Ke Individual Sewage Disposal System constructed ( )- or Repaired ( ) ,� Ins 11 eej \ ------------•---•------------------------------------------------•------ has been installed in accordance with the provisions of TI L� ` of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.............� �................_ dated--...._.. ". "_ . 1�_............. ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST D AS A UARANTEE THAT THE SYSTEM WILL FUNCTION SATI FA TORY. / ' r DATE..........' R 11,,�--� � Inspector --- ------------ ------•------___-----•---.._... THE COMMONWEALTH F MASSACHU�SEtTS,�, ,y BOARD OF HEALTH bF No.... FEE........................ Disposal ork ntrrtion rraattt Permission is hereby granted. _ '-- . ...... ......,, .,., to Construct ( >5-or Repair ( ) arh ndividualYSewage Disp�ystem �. at No.�,1t� ° r' -7.. ...- - --------- •' uti. ., --- 1 street as shohn on:the application for Disposal Works Construction Permit No.....33 f..... Dated...... 6.:._.�l� .7.-.._.... ...................... Y '"� ...............................�/ f..._a_ . 2 �•:..-.____....__.....---------------------- /� �. ! �`+f Board of Health T DATE.............. -----.................--•-•...._._...........--------------.--- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS 8 C.' 10 C'A T ION l- L-�= S E W A G E PERMIT NO. VILLAGE C-p-A-)L )--,�n LC oql INSTA LLER'S NAME i ADDRESS _ ,p BUILDER OR OWNER . DATE PERMIT ISSUED 0 DATE COMPLIANCE ISSUED i i` �TV , .. � •�,� d t �' � _ "4 ,-fit- a . a 4 7 .d����"',� �i++r+,4HE"r+P.�D�•�� r �i�csN G�P,4pc� �� �•bansN G7tAL�LF�S-- ' ( pt�G`R -r4 /VK ox Flux IN r OU r. .,• phY�,,+l�'��'�NWi;�I/,.,7�i�LjYl.�i'J. t,r�K;� `- '.., - - 3 . T D 1ST 15 { N., / -G 1 _. < �" a�yl ;4�F \� J ✓� f ' ---To C3E LEVEL d �_ c ,•~,SYS - DES t Gh/ CRt T"ERI� . /YO of .UE77k'og3Mj = -ge _ GAG. PEA vw y - ...". .d. .:. f r L rah T ,A Tl1l ,��,,��Ra �i ,/�, � ,�4 1r ( ,r•� , . � �•-�" '1'•'�{W �i,i-,.JAB t� � ,�r.>�) Crbi.. � � '!T �� r �� '� } ":26 tj Co 42"t ; +tea 44 M ' 4)10 L L /-MSPEC TE.Z� ��° - �A i.,1 `.. }'+[i(JI:m�.F'C''�f4,•/� � � ,f����: 7r-°3.,.� �':::-F�.s�� � ,,, DA -7 �"'''�,r,, .. ��-�'. �'�•���'"• . �.���..�r. `sc� "�'/�fi�N+1 ��;1r�' k4'`)- _ r qL va Y xCST l� itl .. •tom+ ✓ - . l ., YJ �d No....:3^d...y....... Fps... .... .. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH r701ul I ..................................----.....OF..........................._.....I........ I Appliration for Ui ipaii al Works Tomitrurtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individuaall�Sewage Disposal System at: !1..:�_ I(� ...........La..a®.auc.Ks:t im......i 1�+.� --•---------------------------LOT v I Location-Address or Lot No. .................................... ----- r e .S /(�1 .: t�A...r.�l.�'� :....--•--- Owner Address W ....................1 C..h.N.._..s�.._i?'l19rF 1..---•-----•••----•-------. �GY- ,34 ,Cl�.N� 7�? ........... Installer Address Type of Building Size Lot__g).kQ.......Sq. feet U Dwelling—No. of Bedrooms--- _....��..............................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building ............... No. of persons....._...._.........._...... Showers — Cafeteria Q' Other fixtures .d .-...-.•...............n...... r. ---------------•-------------------------d-------------------------------------------- ...... -----•---------------- WDesi n Flow........... ----•------ ----------gallosPe person per daY• Total ail flow.....3..3.P........._----•---.._..gallons. WSeptic Tank—Liquid capacity_.Ij4 gallons Length............ Width._A._......._ Diameter________________ De th..J.-._____._.. x Disposal Trench—No. .................... Width...I................ Total Length.................... Total leaching area.... -sq. ft. Seepage Pit No.....1 ........... Diameter.....(----------- Depth below inlet._:.D_t._...._... Total leaching area._. ......sq. £t. Z Other Distribution box (L,'� Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1.../7.;.^.minutes per inch Depth of Test Pit...... ....... Depth to ground water----A"Ve..__. Test Pit No. 2---/.-.2.----minutes per inch Depth of Test Pit------- j....... Depth to ground water......1VQ/ .e_. �.... .......... .... _.- b O Description of Soil-••--•-••••Z-' --�i-.- -,►r C .-- .9F.. tea. ......... - UW ........................................................................................................ •-----••-----------------•••••-•----••••-•-••-••••-••••.............-••-•-••--••......----.••- Nature of Repairs or Alterations—Ariswer when applicable............................................................................................... --------------------------------------------------------------------------------------------•.-••••••--•-•-•--•------•--------•--•-•••-••-•••••-•••-----•-••-----••---•---•--•••••-•-..........-----•••. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI:LE 5 of the State Sanitary 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 .............. �ur--- --. 1 _ Date Application Approved BY .......�1• •---••.... 7y......---- Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------•----- ---------------------------------•-•------...---......--------------------........•...--•------------•--.--•---•------•-•--••••-•••----••••-•---•-••-••-••-•---••-•-•--••-----•-----•-•---•-•-•---•----- r� / 7 Date Permit No....... -•y------••----•-•----------------------- Issued------•-Y ` \` �--•----•------- Date No........0..ef....... F�s..r ._.*-r ..... THE COMMONWEALTH OF MASSACHUSETTS 7. BOARD OF HEALTH .................. . ................OF......................-........._...... Appliration for Dispooal Works Tonotrnrtion ami# t Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage 'Disposal System.at ----...... .. `U �'s ..t3J ' .! ..ram`.. ..._..-•••-••-••-•-•••--•..... ,. `�r'�.�------------------------------------••------•---- Locat ion-Address or Lot No. a eOwner Adrss ... 5 Z6. a � Installer Address Type of Building Size Lot. r _�03.......Sq. feet �-, Dwelling—No. of Bedrooms.._...._ '7 3.............................. Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria' ) Q'd Other fixtures = w Design Flow........... ,.........................gallons per person per day. Total daily flow..... .13P.........................gallons. WSeptic Tank—Liquid capacity.11 gallons Length.0.......... Width._.,........... Diameter________________ De th_1........... x Disposal Trench—No..................... Width..r.__...._......... Total Length.......... Total leaching area.-----:_��,..._..sq. ft. SeeOther Pit Distribution box .. Diameter.....Dosin tank Depth below inlet....."):............. Total leaching area.-I:�.'j......sq. ft. � z ( ) g ( ) Percolation Test Results Performed bY.......................................................................... Date........................................ Test Pit No. I.../:. _minutes per inch Depth of Test Pit......:... ....... Depth to ground water.... a ...... Test Pit No. 2..�:.'2 .___minutes per inch Depth of Test Pit.......pf.....____. Depth to ground water----- ,f ... x ---------------- ...------....r- --------•-•...._•--•- ---- Description of Soil N__ -- o. ._._ ._. y� 9fr�n- ....... t.. ..... ........ ........ .•------ ......---- w VNature 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 TITL.: ; p 5 of the State Sanitary 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........... --------------------- ------ - Application Approved BY Date ( --=�•--••...................................-^-•-----.....--•--------•-------------- ------....... ""�= . ..... Date Application Disapproved for the following reasons:-----•-----------------•---•-----•-•----------------------------•-----------••-•------...---......._........_. ............................................•--------------------.......--------...-••--.._....•-------•• .. Date Permit No.......... - Issued '7•----�-. ................ Date a.rr r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .r r/G�Lt +�/4Jf�+ •d OF...........:.. .............................................................. Tnrtifiratr of Tontplittnre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by............... .......... /&61� f---------------------------------------------------------------------------------------------------------------------------------- Installer at•-----------1-•A r ... C/G S/1l1: . ••.l=• 1'h. ( �c �'� (//zz 4. ----- -- . • -••------------•--------------•---•---•--------•--•---•------ has been installed in accordance :with the provisions of TI'+LEI j of The State Sanitary Code as described in the application for Disposal Works''Construction Per" :OW...................... dated------------------------------------------------ . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION 7SATISFACTORY. DATE... I = Inspector.------..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF= HEALTH U. .......OF....... No....Jml........ ?s$lc1T�l,�GC. ......... .......•---••-••-••----•---------.............. a FEE Uispaoal Works T-onotrnrtion amit Permission is hereby granted................. to Construct ()<) or Repair ( ) an Individual Sewage Disposal System at No............. c!: .......7r/.=......... .N ✓ ,, '� .�` ......--•-- ---------------------•----------------•----•--•----------------•--------.-----------.-- ' ti_ Street 7 as shown on.the application for Dispdsal�Works Construction I,P,efmit No..,�,I.�-------- Dated.._.-. . �' ................. ...............ro.f DATE........................................ Boar Health F'. FORM 1255 HOBBS `WARREN. INC PUBLISHERS . ,.0+hp^ �1.`.,•.�E+- t�'r.•�:,_t E :e�•r i.r.,ti._:'. £ ,"fi'r. "- _.rt�:1s„,�. .,....._.. _.... -i. .. .r S 2'�+dt l..ti( FLAW = I lb � '3 : 330 G•Rt�. , 1G-'P't-'1 C Th+,•.i K = 330�t I r7G.% • [1-��J eS.P D. T - i C9 f�•OG? 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