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Home My WebLink About0015 JUDITH EVE LANE - Health (5 �vdf Eve L,J 19 3 � Zug S M E A D KEEPING YOU ORGANIZED No. 10334 2-153L wjj"'W MU RECYCr WRIAM CONTENT107 CoMedRhersoumfng pOST.CONSUMER mom MAM IN USA GET ORGANIZED AT SMEAD.COM 1 /z e' i 1.e�"� ZI C)' Finic...... . -57 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ow rv. jArz �..�6 �, ...................OF............. .......... > ------..._.......................... .' Appliration for UiopooFal Workii Tomitrurfiota ranfit Application is hereby made for a Permit to Construct (K) or Repair ( ) an Individual Sewage Disposal System at: _ �b �:.r — �1! c .......................................... . v� Logation-Address or Lot No. ............ --••-----Q/i:v Y- Owner Address Installer Address of . feet V TypeDwellingingNo. of Bedrooms..... ..................................Expansion Attic Size Lot_-Garbage Grinder S Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures ...................................................... W Design Flow... -3... Z?` _.................gallons per person per day. Total daily flow----- 6 -----_--------__---_......gallons. WSeptic Tank—Liquid capacityA.�...gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No. .................... Width.................... Total Length Total leaching area-___-----__.__------s . ft. x P g g q Seepage Pit No-----2............. Diameter.._...1Q--....... Depth below inlet................ Total leaching area..s �....sq. ft. Z Other Distribution box 441 Dosing tank (Vl c) _ Percolation Test Results Performed by....ZX-.C.U'JG_�------------------------------------------ Date........................................ ,aa Test Pit No. 1..4�.......minutes per inch Depth of Test Pit.... .......... Depth to ground wate44_t.G_lSmR1?t'!�k2.1ti J (i Test Pit No. 2__Gz......minutes per inch Depth of Test Pit...__li.___..... Depth to ground water........................ a --•------------------------------------•---....---••••......--•-.....------------------•... ------------------ -- -------- 0 Description of Soil....0.'3...\4 1- SUwa I.lo_:�.'.�_lrA .a s.Q.� .A l�L--,_._.__. w V Nature of Repairs or Alterations—Answer when applicable_______________________._-____----..--______--------____---------__-____________----•---------_. •-•------------------•----•--••-•---•-•--••-----•----------------------------•--..._.._.....--•---•-••-----------------------•••------•--••---------•-••---•-•-•-----------------•--.--.-------- Agreement: The undersigned agrees 11 the aforedescribed Individual Sewage Disposal System in accordance with ITT t State Sanitary Code— The undersigned further agrees not to lace the system in the provisions of �y.� . y g g p y operation until a Certificate Compliance has keen issued by the board of health. Signed-` ....4;--: .......................... �¢-` �\ Date Application Ap o d B -------- a 'ire Date Application Disapproved for the following reasons:-----•-•-•-•-_.....-----•------------•••••-••-••---•---------•-•-------...--•--•------------•-•-------------•- ......................................................................................................................................................................................................... Date Permit No..--•--ot. ............. Issued.............................................- FRic THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH w Appliration for Diipnsal Vorks Tonstrurtiun erutit Application is hereby made for a Permit to Construct (.I ) or Repair ( ) an Individual Sewage Disposal System at tc- 4 � 1 Location-Address or Lot No. .... -•- ------------5,� .----••---.......Jl.........---•--------...................... •- �•---.l. t!1. ._y2�....:... -- �� Owner Address W lY.... ... Installer Address d Type of Building Size Lot___:-_..`...................Sq. feet �wfl Dwelling—No, of Bedrooms....... ...................................Expansion Attic (K,\�') Garbage Grinder a`4 Other—Type of Building No. of ersons-__________-•-____-•-___ Showers YP g ---------------•---•-------- P ---- ( ) — Cafeteria ( ) dOther fixtures ------------•------------------------------------------•-----••••-•---•-----------•-•----•--•--•--••-••-•---•-•-----••--••-••--•-•--•-•--......••--•- Desi n Flow_. _` _ :..:: iv ...........•..__._gallons per person per day. Total daily flow.....Ed'== -' W g g P P P Y Y ................................gallons. W x Septic Tank—Lignid capacity` .__gallons Length________________ Vidth__.___._._-...._ Diameter---------------- Depth e.pt1 ................ Disposal Trench Vo. ridthr Tog Total leachingrea.................... ft.�Seepage Pt No.. � _____.. Diameter Depth mlet.... a- Total leachingarea._> ...... ....sq. ft. Z (�C Other Distribution box � Dosing tank ('`' ) Percolation Test Results Performed by.... �Test Pit No. mnutesperr inch rDepgth of Test Pit...._ ............ Depth to ground fz, Test Pit No. 2-_•_r-1......minutes per inch Depth of Test Pit..._.a.:a......... Depth to ground water........................ -- -------------------• -•---.....__ O Description of Soil--- `% � %- "A"'fl_ ` a�,�"; t y '. s > .M: >r z x / 3 -- ?-•F i r. �. i, )R-�'kk grT'+A r f tt6' °""" " 4 6, { a 'h,.if-t 1 .ham' A..^..�.b�_ 'S�tp s r �+ :. a. . W _____________________________•- ....................................................................................................................................................................... Z. Nature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees. eW:I s the aforedescribed Individual Sewage Disposal System"in accordance with the provisions of TIT,= )J t tate Sanitary Code—The undersigned further agrees not to place the system in operation until a Certih ompliance has,been issued by the board of health. u r- � Signed-_. _.�.`!�.------- Date Application Approv BY .�"- '' ��- . ........ �z Date Application Disapproved for the following reasons:-------•--------------•-----•-•-----•------------------------------------------•--------------------------_..._ --•........................•-•---•--•-------------...._....----------------...---------......-------------••--•-••---••---•••----•--------•-----•--•------------•-••---•-------••-------•-•-•••-----•--- _ Date PermitNo._......�1.....L- .../....--••--....•--.. Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH UTrrtif iratr of Tuutpliatta THIS IS'TO 4ERTIFY, That tote Individual Sewage Disposal System constructed ( ) or Repaired ( ) bY----•--••-----•.....•---• -5y-r/.. =-•---•---•------•--------------------------------------•----------..........}...---•--------•-----•---••---•----.•...-------•--- / �-{� Installer (�� Q at- Fir` �'.`.r r .-t,.11r!:� �:> �- := `r= I' _�'./�-------------------•-•--------•---------------. has been installed in accorance with the provisions of TIT E 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......... ........ dated................................................ TIME ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE®AS A GUARANTEE THAT TIME SYSTEM WILL FUNCTION SATISFACTORY. DATE........................1 •= " A. --------•-•------------•---- Inspector.................. --------------------•---------•---------•--•-•-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............OF................(:� . . ..:5:....m l..?f-............................. FEE E --� — NO._......... . E....................... 11iopasal Workii Tom urtuan Vverutit Permission is hereby granted.......lj Lo- . _�c......... t ' :.,..-------••---•-•-•-•---------••----•-•-•...................................... to Construct (>) or Repair ( ) annInd vidua Sewage Disposal System �` = ............................................ ` Street �(' as shown on the application for Disposal Works Construction Permit NoA._ . Dated.......................................... •----------•.......•--•--•--•---- l Gtj Board of Health DATE---------------------- _FORM 1255 HOBBS & WARREN, INC., PUBLISHERS S/,✓GL E 1=4/ lL U '.1 //t� GA�/34GL- Gr2/NpE�2 A. ZoIi•4u Ada. G.P. -> /So. C/�E /.Soo G4L,_ __ - • . zo' � �40�t._ �o• f>/S/?aSgG Pi— 2-/dDO 1"1'Sr,9A45- 5/OE IOA L.G_ 4,e,6,4 - 3 7 Co P2r,dosE-� s c. x Z•S = 9�10 G.�o. r.AA.1 Q-A-I ti c* ,uc)A 0 j crT-QL- DO'S/la�cl = lO 9 S G_Pf� Q " r A' L71A . • . . i 15;COO sF Z O/I O/1(7 \DO,0O: TEST ALOL.E t , ell — I 3` /� G 9G i3ox /niV GAL- SH vstsoc a Ler qe/l _ osn o , t t Pi TM r11;•I�' / � RICHARD 3� k�SHEO /.V✓ /,�lV No 29733 i CAV6l. �� •• � " BAXTER N �i '� +,.`'/c�• C•v' '�eB,` P No.24048 i 9 EL�jp O nFi� d, DfC/STEREO env EL, p' CE,2T/�/EO G,LO7EL D go WATE fZ T`2o�oS6D � J �1 E:t e Z T.UAT 7-/-/,C- t bunaC�An0t,., S,�/OWit/�jE.eEO,C/COis-1 dL YS W12;41 ,SCA L,E 0.4 TE 17 •$$ /,c/E AA/O SETBA Cf< �EQU/.2Fi�lE,vr s aF Th/E Tvw�t/aF F»L .4AI 3ArznasTAC2,c.cv 32Co. �a..Gk r 2 "7 i . . ,BAXT,E,2E �t/yE /PVC. T/�/S O,C 4X A5' .V,:: BA.SEO d ,4�f/ ,2EG/.STE.e�1� Lf1:�/p SveY6YO�I /NS7-,2Uitil.�.t/T SU,e��Y€ h'� �sTE 7' A 1- 4:::'1-./2,4/V7� S/wGL E AA/'rl/L Y f�E/�.2po�s'S _ - � ._•oz' -- - - - ---- $ - Ito,o -- --- ------ - / - ro x 4a ,u' X Z =�!' G.P.D It o 4t;t 440 a� - co• - �o .12 STo111,c- /oeAL� q,e�,4 3'76, 7-C-17 4L C.P. 0. 98.2 •. Lc-T iA S;Coo sF �o,U�tiUt 2C 2O�lO�I(7 A'.. 93.3 99 0 \DO,Oo, TEST .401-E' -- �9soic Z o/sr. _ 3r /COO G4G ex.� � � of .Z P TE Aill SULLIV °o laASftEO '- I✓ /NV J No. 2973, zr BAXTER f.AV 6 1. •y cn g t _ N0.24048 77— t—%'C9ECtSTE(tEO cv.,D 4 ¢Av6L. p' �E,'• CE-A22 CLceT/.cJ T.4�1-1.r T,�!G toV.�,�AZ1O� ZOC.4r )AI �t r �Tr;t"..`•1ti�[u Nln.s� I JS lawn/ ':.SCSI L �E'QU/.2Fi�lE�c/y"S of T.S/� Tat�t�it/dF l�,C.r4�t1 .eE�-�,e`c'�C/G"`c. I 3A�2nasT��.v AIt/O /.5' 1No•� �Uoo� 32 Co. � r 2 -7 I �OC.1 TEr:> W17-1111V TyE' FLoa27Pl.4/.S! �J .4S4X7;g,2E 71'11S G.LA�i//S �t/oT BASSO d ,4�f/ �2�'G/S7 e,2Ep Z- Ip /NST,eviLl.�.c/r,Svei�'Y€ 7'y� osr'E,2•��;c.l�a M.4Ss. � Ow OFBARNSTABLE LOCATION LUV sv4. Lk. SEWAGB # S / VILLAGE C 1 L ASSESSOR'S MAP & I. �OINSTALLER'S NAME & PHONE NO. f-1 lC lc-5-� CO -:4 c ??(�q o IM SEPTIC TANK CAPACITY-1 0 KEACHING FACILITY:(tgpe)_2 i 6� p> C--S_(size)------ ND. OF BEDROOMS PRIVATE WELL OR P �`I�-WATER BU OR*R�_ j _ DATE PERMIT ISSUED: I DATE COMPLIANCE ISSUED: 10 -) 7 VARIANCE GRANTED: Yes No_�� 3 1