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L0 CATION SEW A PERMIT NO.
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VILLAGE IV2- 0 ,7
IN TA LLER'S NAME i ADDRESS
e UILDER OR OWNER
DATE PERMIT ISSUED �� �..
DATE COMPLIANCE ISSUED S_ �� _9l
��
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---� r ___ .
�Jl A4Q _ ._
No.........._t
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® ,�'qF HE� TH
ai✓�✓.............OF....... / ��/`-
.......................
Appliration for Uiipnsal Works Tonstrnrtinn lbratit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at
Los ddress or Lo
............ 'iire �i..: ....... -�,•..................: .......................
a O Address
......
Installer Address
UType of Building Size Lot_ _�.7 :.....Sq. feet
�-, Dwelling—No. of Bedrooms........ ..................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Pa Other fixtures =
-------------------------------------------------
•--------
-....................................
W Design Flow......_....�'.e .?j ...................gallons per person per day. Total daily flow............................................gallons.
04 W Septic Tank—Liquid'capacity_/djQ(Igallons 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..t ! ...sq. ft.
Z Other Distribution box ( ) Dosing tank`( )
Percolation Test Results. Performed by.........,G� ___.__ � /p...
a �- -•----,...--•------------- Date. ....��._t°. .�f �---•-------
JI
Test Pit No. 40 minutes per inch Depth of Test Pit.--- ._5... Depth to ground water..................
fs, Test Pit No. 2/..........:..•minutes per inch Depth of Test Pit...................... Depth to ground water..':4—_ �ttL��
04 ..........••..... ------ '
,,r
O Description of Soil::----•f0_.`�-/-..----....j P �.......................... ...�.�1 /.c_JX1- -- ......................
x
U 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 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 issued by the oard of heal
Sig .s ' /f
te p
Application Approved By-•••. �= • •••--• -••_.. .... .. .--••• .....................•_. —..l
Date..............
Application Disapproved for the following reasons:.....................
....................•------•-----------•----------------------------------------------------------.....----••••--•...---•-•-----•-•-•--•-•-•••-••••....................................................
Date
PermitNo......................................................... Issued.......................................................
Date
r
r
THE COMMONWEALTH OF MASSACHUSETTS
r
BOARD OF HEALTH
_......................OF.............. . .�J
Appliration for Disposal Works Tongt nriiun Errant �
Application is hereby made for a Permit to Construct {11") or Repair ( ) an Individual Sewage Disposal
System at:
/ y ✓' Locatio Address.. or Lot No a
...........C --------t ' f 'C y 1'.P
^- -•• • ------- _.: ............... ............... ...
-�-^ � Owner .. -
W f'1 }l ..7 ..
lid'
✓ ..f .. i!✓�/�` .... Address ........._..
Installer Address � ',
UType of Buildings Size Lot.�'f_.G. ..........Sq. feet
Dwelling—No. of Bedrooms.......--..................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures ---------------------------------- --•--------...-----------•-------------------------------•--...---•----------------......--------....---.....
W Design Flow..........._-,+'v...................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity./QGQlgallons 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 O J /
.,
`'" >Tercolation Test Results Performed by___..____ !__ `'. '.__ . .. :.'....'.:.................... Date_?,_ _..................................
a
Test Pit No. 1,644.I`'-'Lmmutes per inch Depth of Test Pit.....L:-7:........ Depth to ground water._ ''%.........
(y Test Pit No. 2f ��`Z':minutes per inch Depth of Test Pit.................... Depth to ground water-�'
a' r ............................... ------...... ... -•--'---•----•••--- ----------------------------
x
•-- L». • -•-•--•..............3_....
--------......---------.-•---O Description of Soil.. f 7'
-----•---•�----•----
..... ------------------------- .......................................................r .... a.. �•:�i�
W 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 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 issued by the,board of health. Z"
/r
A Sig d ( Sri '" '1 1,d ' fe°C ,�✓/j!,♦ /
' Date
Application Approved By �• ... � /
,. / x..------------------
Date
APpiation Disapproved for the following reasons--------------••.... --- --•--.........-•---------•-----------------•--------------•••-•--.......---
..................................•-•--•--•-•-•----•-•-•-••-•-----•---•-......••------•....-••--•-----•-------••-•--•••-•----••----••-....--•---•...........-•---•--•--•••••......--------•••-•---------
Date
Permit No.... Issued-...............................:.......................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
i
.4 OF...
...............................................................
(9rdifiratr of T.olntplianrr -
THIS'IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by 1�, r '- /j-------------- -------------............---------------------------------
Ins aller
/
-
has been installed in accordance with the provisions of 5 of The State Sanitary Code as describ d in the
application for Disposal Works Construction Permit IN ...... _._` ........ dated------- j..� "__1 ��..........
THE ISSUANCE OF THIS CERTIFICATE SHA NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTI N SATISFACTORY.
DATE... ....L,M1Y....••......................•••• Inspector-. /��-_-..........------..............---------------...---•-•---
THE COMMONWEALTH OF MASSACHUSETTS
BOARD PF HEALTH)
.......................... ......................................✓" . p->r/
OF ...............................................
No........... ............ FEE ,.... "
Disposal Workii Tnn.strwtion rnmit
Permission is hereby granted......... �llj 79W"%C ell
..._., ' _ ---• •••..._...--•-•--•-••-••••.......--• .
to Construct (.4' ) or Repair ( ) an Individual Sewage Disposal S,Ystema ,
at No.. ...til'., r ---
�Street
as shown on the application for Disposal Works Construction P No... ..... ......:. ted•___�ttl--7'�� _--.---
.•....- .�✓... .• . d-• l L� .......................
Board of Health '
DATE...........................-..............=.................................... L/
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
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LEGEND
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ExaStoNG SPOT ELEVATION Oxo ��; - ;�. CERTIFIED PLOT PL
;EX't8TiMG CONTOUR --- 0` — i���, ALLERT
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FINISHED SPOT ELEVATION
FIWJ_SHEa CONTOUR . 0 U h70Rc;E C&�'I is7rf�l L ,
► ROVED j BOARD OF HEALTH ',
k iSAAASTA
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f E AGENT .art SCALE:
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."EDGE ENGINEERING COIN
CLIENT
I, 'CERTIFY ;THAT
EGISTERE REGISThRED 9iv
C JOB No. -� BUILDING SNO'WN
CIVIL .
ON THIS P Z, �r
LAND CONFORMS TO THE: ZONING
DR.®Y-
� MAIM
4 ENOINEER� SURVEYOR OF BARNSTABLE,` IrDAB$r ry m s
712 MAIN. ST. CH. BY ��], lz �, fe
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HYANNIS, MASS. » ti
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CO VER CL EA Al. .SANAo
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MIN.P/TC/+�
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SEPTIC TANK BOX ° " • • • • °e
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I AWPA EL ENAT/ONS p e a
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DUTLET SEPTIC TANK J 4 b FT,
BOX �4. FT. / 0,�. GROuNo hG`1TER TA9LE
D S R SE O N CT/ LET N
O(/TLETD/STR/®UT/ON BOX 1% FT SEAV AS.E5 D/SR"A L SY. 7'&M
/A/L.ET LEACN/NG P/T SFr. Ti46lJL.�T/ON
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DES/drAl CRITERIA t
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NUMBER OF LEgCgJIVa P/T.Sh �+LrLEY. 9 ,K� LEY. L2ATE,�F SO/L TEST 3
Sl1�E MEOW. S IV/TNESSED
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90:TTOM Llzr9CN/NG PER P/T f $Q. FT G 014�''� �iE/QCOLArTdO/V /l.4TE / t �sS 1rJJ/1Rj9/INCN
TOTAL LE.a1GH/NG AREA Oil
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