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HomeMy WebLinkAbout0059 LOOMIS LANE - Health FLoomis Lane Centerville A= 139-003 i �rrr 2J�(�CY�C�pC p2m rill UPC 12534 � No. 2� 153LOR �srco HASTINGS. UN i TOWN OF BARNSTABLE r' LOCATION �� tts�+�`s �,,,`.� SEWAGE # jAd! ASSESSOR'S MAP & LOTV::�/—,61� INSTALLER'S NAME & PHONE NO. @� �., -�,� 2�,N/zgr SEPTIC TANK CAPACITY LEACHING FACILITY:(type) WZd (size) fAi -&,s NO. OF BEDROOMS—PRIVATE WELL OR IC WATER BUILDER OR OWNER �� � !�y DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No "e ��.'O �e� o� 3�r'� ,� ��. ,� � ,� ;� i c _ r ASSESSORS MAP N0: � -//3 No—.............--- ... QQ 0 l G� Fr�s.........�.�.... THE COMMC3ppi�pp A SSACHUSETTt, BOARD OF HEALTH TOWN OF BARNSTABLE Appliratinn for Ui►pwi al Wildw Tatuitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair (Y an Individual Sewage Disposal System at: --- --C wti�v I...L'..........-------- n Location-Address or Lot No. �.:M!....S_..... !!�.�h��- ........................................ •---------------------------•-------•-----------------.....--------............................... O T Address Installer Address UType of Building ��jj Size Lot............................Sq. feet Dwelling—No. of Bedrooms.-_..�±................----------------Expansion Attic ( ) Garbage Grinder ( ) aOther Other—Type of Building ---------------------------- No. of persons----------------..---------- Showers ( ) — Cafeteriad fixtures .....................................•-•--------------------------------------------- - W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons: 04 W Septic Tank—Liquid capacity------------gallons Length.........---_-- Width---------------- Diameter---------------- Depth................ x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area--------------------sq. ft. 3 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. I----------------minutes per inch Depth of Test Pit...--------.---_-- Depth to ground water....-------------------- (i, Test Pit No. 2................minutes per inch Depth of Test Pit..............--.... Depth to ground water........................ --------------------------------••---•--------...---.........-•----•-•---•--••-•--------••--•--...--•---.........-•--------------....._•----.....--------- ODescription of Soil.....................................-.................................................................................................................................. x V ..........................•.......••--------••-••-•------•-•-------•---------------•----•-•--------------------------------•------....--..................................-------•----...---••-•-------- W U Nature of Repairs or Alterations—Answer when applicable._. -------- �"T/ -------S�_ �........... e....................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Ihdividual 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 Com�Iliance been issued by t e board of health. Signed ........ .............................. '3 .�...�� ... Application.Approved - % :. e _ Application Disapproved for the following reasons: ----------------------------------- ---- ---------- - ............... . ..... ............... --------- ---- ---------------------------------------- ---- ----------------------------- ----------------------- ------------------- --------------------------------------------------------------------- -------------------------------------- Permit No. ... ....... v � - � Issued ----------- Da1e THE COMMONWEALTH OF MASSACHUSETTS_ BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of (fumpliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( }Gl y ------------------------------/----- In her at ..... LOO/f?i 5.......---L-f-r✓C�`.----------- C-------Jv�l -----------------------------------------------..._..-----_------------------------------------------------------- has been installed in accordance with the provisions of TITLE of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .;7. ---------�R.. dated ._ ' ". .....^, ..-.. .... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ATE ✓...'•,..... .....el- %- ...._......----------------- Ins ector .---- ------ � - .............. D p THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -- TOWN OF BARNSTABLE / No.......`........:. . FEE........................ Dispnoal Nforkii Tonotrutuan "amit Permission is hereby granted........!-A (e K-�= t ed`N'S<— to Construct ( ) or Repair ( an Individual Sewae Disposal System atNo.. a -oo�-� . ---•t .N ..- ........(!.=-^!------------ -----------------------••...-•----------------------------------------------------...... Street as shown on the application for Disposal Works Construction Permit,No�-"_'-- a d...... 3...--- � Board of Health DATE ---- -•---/ - --•----------- FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS No......._.`_....... �/ FRs.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE AVV iration for Mit-Vitittl Workii Cron itrnrtion ranfit Application is hereby made for a Permit to Construct ( ) or Repair (Y an Individual Sewage Disposal System at: ...-:a:?.......---�6---•-•-• ....--•--•-551 �C�i?.... ✓€-----------•-- --��rv_.�rz.....--.......--...-----•--•---------------------------------------•---...-- Location-Address or Lot No. ON ner Address .-----....r).)C i< � Installer Address UType of Building Size Lot............................Sq. feet .-t Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures .----._...--•-•----------------•-•---------...--.-•--- w Design 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. 3 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. I----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ fZo Test Pit No. 2................minutes per inch Depth of Test Pit-_-_---- _-__-_-_-- Depth to ground water........................ R; •--••-•....................................................••-------•---•---•------•--......••...•••...................................... -------------- ..... O Description of Soil.......................................................................................---------------•-------•------------------------------------------.........----- x U ....--••...................•-----•---••----•---...•---•--•-----•-•--•------•-•-----------•---------------------••-•---------------•------•----•----••----••-••-----•-•--••-•----••--...--•--•--•----•--- w U Nature of Repairs or Alterations—Answer when applicable....-.. .......... _%�•__..... 45 '' ---- ? k --------------•----------------•---•--------------•----------------•---------------------------------------- ----------------------------------------------------------........---•---- Agreement-. The undersigned agrees to install the aforedescribed Individual Sew,agq Dl1s�osal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The un'd'e$ned further agrees not to place the system in operation until a Certificate of Compliance has been issw-d'b he Bard of health. re Application.Approve B u...._.--- ------------------------_...._ ..C~Z%'/--...:..Y.......................................... .....Dare ._ .. Application Disapproved-.for°the following reasons: -------------------------- ------------------ ----- ----------------......... - ------- --------- - __ - -----.. ---------..----------------------- - - it No. .... .... ---? Issued -°- f^ Dace c /3 lit OF v%{ U� FEB 1 4 199 ?V SULI 1pjqr� 2973 ors 1611AI� .a d v ISTF..�4�.``,,A S.ONA Lc, I L w~ , v / z1v ra W . t t=xusn I'l 6, 1.c 0 7Ism� � • EkTENS�Oh� n ED GF_R E OF co f FG.96S LO cog 7,,FD04 , PETER U�. SIILLNAfl No. 29733 0 - :. r-r-Lp. .:�..��i. 4 .41•� (ns�) -" cal ayes oes MAP ,i Lo,- ' `3 1 , QC�"L 1C. ,NOTES: N $ I 'ITHIS PLAN IS VALID ONLY IF IT IS STAMPED AND 9$gv`l_`u v_v/�`' SIGNED IN RED. THIS OFFICE ASSUMES NO v RESPONSIBILITY FOR INFORMATION CONTAINED ON 2EvlSEp 9 iG V COPIES WHICH DO NOT HAVE ORIGINAL STAMPS /9y o i AND SIGNATURES, IN RED E2STANDARDS" SET WAS FORTH INRE250EDCMFiEC IG TO--NOT P THE 11 PLAN A^- BUILT11 PLO THEREFORE THIS PLAN IS NOT TO BE USED FOR 604 c I i . '\;Il- _ TITLE INSURANCE' PURPOSES `"� ,MASS. Lot L0cv,•A,, L�,.lc i I CERTIFY TO 6n,Q-0L_ SwgeT-� ',. AND To TIE Toy,,,-) or t�AR�,sT�c>�c- R. J. O'HEARk 4SURVEYOR THAT TO THE BEST OF MY INFORMATION , SWAN RIVER PLAZA 35 ROUTE 134 UNIT 3 KNOWLEDGE, AND BELIEF , THE +� 1--�✓r11��'L�1�10t-j SOUTH DE 4NIS I MA 0266b SHOWN ON THIS PLAN ` f HAS BEEN LOCATED ON THE GROUND AS JOB NO. INDICATED . AND THAT IT IS LOCATED IN 2-72- FLOOD ZONE G PER FLOOD INSURANCE DATE _RATE 14- MAP DATED . 8 --1—,- 8s �4 CLIENT c: Swd12T� SCALE I t ik DA E REG. PR9FESSION_ L LAND SURVEYOR ' _ SHEET I 'OF_J / A ' 4AxTMW-4 >J F- 1Nc. :. 17CSiCx't�t. \=c,r���c{ Z�"Teevtu..E Mre�ss (Zl otAl.S I4a �cr�►moo C,? 2. x\1 O Caa -�-U►�S�i Ert �A�{ = 220 G?V S E PTl C. .1So9'o = 330 G—AtLLoI�.IS MI►.k 1 REcEivEO �x"s-'►r4cm A.4N 1boo C7r,(-LouS d� FEB 4 1995 L C-A-QK ''l e Ll 2!GO ZA LE kPPLLC% � V cs\6 W o� to + ea� T few �wrl•.,..,ti 1 �E -F► EL.D �QESEti1-(' i��ELp Cg+I� k C9ti) _ �1p1C 7O 'STDI,I C � I �STA�,tCA2D InAFILTtLA�� GµA!',�ER,�C,' n L Gt Et'T}I Or r 1 C L D V Z%L(- Pe Ta Bp q � 6ct p -l0 H of 'PKG 'F2bM Dw ELLI 0 fit 7C.) PETER S LC>PF „�E2�6 SULLIVAN NO. 29- 3 `0 0 ISTF,.nS� 4J .�4n1 18i 1995 S�kEET 3 DF3 t�Ltit OF AF ° K TER ate- SULL WAM � h I No. 2973, a s,.y�A N6 TbP O F Ex"s n Al CK FO U"r?A- to KA L'p ^� i oQ E�. 44 •o0 EL C> EL.EVA=tO►rl 08Sce\fE� �C' 2oc�un�z.0 32�5 ��S Oe'seerEo tit /Zo!9q Cc,uTCLOt,LaO L�►c� 3�S SsS� Vic..- C �•9 t + ++�►z' b0 s rn �iZSJ�St �� 1 �oF�1 CT�S�21G �ES16/.t �d S, cot Esc vaTtoti.t J -�- 1� �dO�t ap � g tt . QLcdMMeca��D 39•Q> a�Z ' _\y {�E fie? u Q Ll ET 'flEai6w� �Lt V�T101.�{ co 'For-,, 7].A oiT, u TOWN OF BARNSTABLE Q� wy OFFICE OF = sA"9 L MADD. BOARD OF HEALTH � � 0 Mnr k�e0 367 MAIN STREET HYANNIS,MASS.02601 January 19, 1.995 Carol A. Swartz 45 Loomis Lane Centerville, MA 02632 2 RE: 59 Loomis Lane, Centerville Assessor's Map 231 - 16 Dear Ms. Swartz: You are granted variances to install an onsite sewage disposal system at 59 Loomis Lane, Centerville. The following variances are granted: Part VIII Section 10.0. Section 1.13: Proposed leaching facility will be located sixty(60) feet from the edge of the vegetated wetland in lieu of the 100 feet separation distance required. Section 1.15: The bottom of the proposed leaching facility will be located only 4.2 feet above the maximum adjusted water table elevation of 34.8 in lieu of the five(5)feet separation distance required. These variances are granted with the following conditions: (1) The dwelling shall be connected to the public water supply. loomislane r (2) The septic system shall be installed in strict compliance with the submitted plans dated January 13, 1995. (3) The designing engineer shall supervise the installation of the septic system and shall certify in writing to the Board that the system was installed in strict conformance with the submitted plan. These variances were granted because the existing septic system was installed on May 27, 1992. The Contractor, Rodger Roberts, stated to the Health Inspector that the bottom of the leaching facility was installed four (4) feet above the water table at that time. However, during the Spring of 1994, the elevation of Lake Wequaquet rose to an elevation of 34.8, the highest recorded level. In view of these circumstances, it is the opinion of the Board that the leaching facility shall be relocated to at least four (4) feet above the maximum adjusted water table elevation prior to reconstructing the dwelling.. Very truly yours, �atr'_'Wp CS-Osi 6, Brian R. Grady, R.S., C man usan G. Rask.A.S. Board of Health Town of Barnstable BRG/bcs loomislane .�� EAGLE SURVEYING & r= �� ENGINEERING, INC . .a 10 Seaboard Lane Hydrinis,Massachusetts 02601 Telephone 778-4422 C.FRANK WHITING,P.L.S. STEPHEN A. HAAS,P.E. November 8, 1994 " Ms. Carol Swartz 59 Loomis Lane Centerville, MA 02632 Dear Carol : As per your request, I have reviewed the information available for your existing septic system and made a field investigation as to its elevation in relation to the pond. I have found that the base of the existing leaching facility is approximately three and one-half (3 . 5) feet above the assumed high elevation of the pond (Elev. 34 . 5) . Vim. .. Since the building sewer presently exits the foundation three (3) � * feet down from the top, there is an opportunity to raise that pipe and the entire system at least one and one-half (1 1/2) feet . This would bring the base of the leaching facility closer to five (5) feet above the assumed high elevation of the pond. Enclosed please find a sketch plan showing the relocation of your existing system. Should you have any further questions, "please. call . Sincerely, ...r EAGLE SURVEYING & ENGINEERING, Inc Stephen A. Haas,. PE A !4.,,. k ' .+ ry r 1 - �,�_ t,., 1 ��� C, •q�4 r `� •ss�s.,y �� _ _ � �-�-- :� � � � Y � _ � _. `:� 1�` � / � � ��x� .,, J �� 'L��,v G L .� � .: � � � . i �-� _-moo �L,6:�� iS� L It-��E o .. _ � 3=� r ' �-�- . � � � � � � � , � :� © � „ � .. . .' � n �t� R��� � � � / ,��` � s� � � N L � � ,. :. C .€ ,� � - . 4� r .. f' Ne".. _ � 4 - .- __ - _ _ . . f TOWN OF BARNSTABLE �laP 014 LC`{- . N� ��aT� ��i a SEWAGE - t fjLLAGE e-4�•' � 1 ASSESSOR'S MAP & OT INSTALLER'S NAME Sz PHONE NO. (.OAA SEPTIC TANK CAPACITY .LEACHING FACILITY:(type) jR:f.1 I (sue) 1�' x c NO. OF BEDROOMS PRIVATE WELL O PUBLI ::W� ER BUILDER OR OWNER DATE PERMIT ISSUED: j DATE COMPLIANCE ISSUED: S/X7 VARIANCE GRANTED: Yes No t/ oao oaao SF���twwX Old 0 3 }4-�(J �P(FiCTYLf�T6QS w}3'S�ba�.o try _rfo/� THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ®ern APDgftFO stab►e {�,�� . TOWN OF BARNSTABLE .! 'e °-i►ion Depa' ApplirFation for Uiip.as al Workii Ta n.s rur 0 Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: •. -�--C1--- -t�C? z`� r"� ------•------------------ --•--........-----G::�v�......------....... • ..... �a Location-Address / or Lot No. .............. ................................................. �15�._. _dOL1�1 5...__.L ............................... Owner ddress a .............. .. Q L. t� ►o� °'�...... . n'1� tPl'tt�.S --------------------•-•-•--..... 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__,__' _�............................gallons per person per day. Total daily .........................gallons. WSeptic Tank A Liquid capacity_IM..gallons Length............ Width....L .... Diameter................ Depth................ x Disposal Trench—No.a..:Tk(F.ifTYer idth.....I...-_...... 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 4Test Results Performed by.......................................................................... Date........................................ 14 Test Pit No. I................minutes per inch Depth of Test Pit..........._........ Depth to 1� .ground water.___............._..__ P P P (s, Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ P4 --------•------------------------------------------•---------------•--------.......----------................................................................ 0 Description of Soil........................................................................................................................................................................ x V .---------------------------------------•-•--------........-•---•-•-•--------.......--------••••-----....--------------------------•-•----------------•--••----------------...--•---•-------•------------ VW ----------------- ----------------------------------------------------------------------------•------------ Nature of Rep rs or Alterations—Answer when applicable.__� � t`--.__ _.__ ._ �`---'--------------- -----.�=�`- .------.. max.:------.... -rf -���nS � � ` 6 e'' . 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 Comp has bee issued the b and of health. - Signed ► �' Date Application Approved By ........ � .. .,a,� -----------------------------.......------------------------------------ Dace Application Disapproved for the following reasons- ..............................................----------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------ ------------------- _ Dare Permit No. ......... -.:'....��-.�... ................. ... Issued ......................... Cry r 7 No....��..1.:�..l:�.. a 3 r ( ry Fims. � �... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Y Appliration for Uhipvii tl Works Tnuiitrurttor- pir-mit Application is hereby made for a Permit to Construct ( ) or Repair ( ),an Individual Sewage Disposal System at: ...• `• gg??��..a... ------•--- • -........... bca4�o�T1,�1•�`c C'YftiT or Lot No. it r J .- •dCrpssL caner '�'� f1 c �- rr: -h VLl 1� A W _ i.A n a �f�t ia3'L jK\it1 ���f --------------------•--•--•--• ^t eL............................i.............. ......--•--•-----....•-- Ynsta•CCe;�� ��G� (rj L K ddress Size Lot- Type of Building �� �S a Dwelling—No. of Bedrooms......-o7................................Expansion Attic ( ) Garbage Grinder q feet aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ...................................................................................................................................................... W Design Flow...... _.------------------•-___-----gallons per person per day. Total daily flow............................................gallons. 0� Septic Tank rt Liquid capacity... _,gallons Length................ Width................ Diameter_(.�_......... Depth................ Disposal Trench—No.--,............ ��'Width...._ ,._�_.___.. Total Length...........I.'�_ Total leaching area....................sq. ft. Seepage Pit No..................... 1°JiameteM...............--- Depth below inlet... ........... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit..........._........ Depth to ground water........................ fs, Test Pit No.-2:...............minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -•--•-------------------------•-----.....-------•--••-••------•--•---.....-••----•-••....-•-•••-•---......................................................... 0 Description of Soil........................................................................................................................................................................ x U ---------------------------------------- •----------- •----------------------------- •------------------- •---------------- --_--------------------------------- ..........----------------- •-------- •------ -------------------W U Nature of Repairs or Alterations—Answer when applicable-- __._,......,. ._._ ............................. P- 4-1\------if CC � 1�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 Compliance.has been issued by the board of health. rSigned ...` ..:,.--. - .... ------------- - --------- Application Approved By - : t ---------------------------------- --------*---.. ..... Application Disapproved for Afollowing reasons: .--_-----------------..............................................................----------- -...................--------------- ------------ -- - -- ------------- ------------------------------------------------------------------------------------............................................................................... ...................................... Date PermitNo. _ Issued -----------------................................. ---- -------- Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of GrapCiance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( �) by -----------------------------------------...ik P'E.�'�-r 0----�r'-- f_'-_ -i�SS i �/) >ti.................................................. .......... taller at ---------------------- - --------- ..Do M'!-S L-.A N C-E K-T E-(L�i l-1-.E.:....... 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. ....... .L dated --------------_---.-.--..-----_... .-.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE -------------------' -_ ?.? ' Inspector .. J 1 _................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Disposal Works Tottuirt iott rrutit Permission is hereby granted........��_`�.�_.Lt.4�w c p�1(. to Construct ( ) or Repair (__�an Individual Sewage Disposal System at No. < rl 4-op m i S L A• `t,e C.6'P-(-t ------..--••• -••....................----• •--•----------------•--•-----••---------•---.._..--------•-•-•--•-----•--...•••......... Street qq as shown on the application for Disposal Works Construction Permit No.��7-.�./.�._ Dated.......................................... ............................... ------------------------------------------------------- oar of Health DATE---------------J - ! 1 ---------------------------.-- (y � d FORM 36508 HOBBS&WARREN,INC..PUBLISHERS ,. TOWN OF BARNSTABLE LOCATION � - �v ,rt�ir5 _SEWAGE # VIGLAGE �►:�,i�•��i ��� ASSESSOR'S MAP & OT p- INSTALLER'S NAME & PHONE NO. <` LOAA SEPTIC TANK CAPACITY L.E'ACHING FACILITY:(type) 1 IT72R`tz7f`Z S (size) �$' �c cl NO: OF BEDROOMS �' PRIVATE WELL O PUBLIC _ ER BUILDER OR OWNER O Z DATE':PERMIT ISSUED: DATE. : COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No cllo7' f; t X. ,Y. o.vais if,`.n ��oidUt 1'.j NS pia £ f 77 o p ��di�\D3S 6t" 000 '` ' ��