HomeMy WebLinkAbout0944 OLD STAGE ROAD - Health 944 OLD STAGE RD.
CENTERVILLE
A = 172 093 002
UPC 12534 '
No.2 5_Rq���s
HASTINGS, MN
TOWN OF BARASTABLE
_1f' L
LOCA'`30N 9y Q S/ �' SEWAGE # �
VILLAGE ASSESSOR'S MAP & LOT/7oi h3 94A
INSTALLER'S NAME&PHONE NO. 0- wl a c o!/, r tc•- yl�'. ,s' �t�f'
SEPTIC TANK CAPACITY o.v!
LEACHING FACILITY: (type) �'i. tc % �3e�I. (size)
NO. OF BEDROOMS J?_ L
BUILDER OR OWNER •I e T r '"Y
PERMIT DATE: `I'/�'"d / COMPLIANCE' DATE: Q'/2 -0/
Separation Distance Between the:
t ,
Maximum Adjusted Groundwater Table and 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
'I Furnished by
rl�
t v
0o p s^�� ,� ► s �,QuX y3 �
TOWN OF BARNSTABLE .
LOCATION q_LA L� Oda STOEE�2 SEWAGE # (Q0000"
VILLAGE Ce'�% (✓WC ASSESSOR'S MAP & LOT_EiRl, )�P_
INSTALLER'S NAME&PHONE NO.".C�r I /a�i IIiS%« `�O '�5d4
SEPTIC TANK CAPACITY 1500 GA
LEACHING FACILITY: (type) Cv)Tec 330 s C3� (size) la
NO. OF BEDROOMS 3
BUILDER OR OWNER Ct'C -%w1X
PERMITDATEq—GL— - h 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
a
6A",q
i9� -c3
�Ank
No. G —7 Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: `VV/ ✓
Yes
� lj' PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Q Application for Migpogar *pgtem Congtruction Permit
Application for a Permit to Construct(X )Repair( )Upgrade( )Abandon( ) ®,Complete System ❑Individual Components
Location Address or Lot No. 4 4-1- Oc ce Owner's
Name,Address and Tel.No.
ce_N ttr i I�¢ w t-%r �`rCGv14S9v
Assessor'sMap/Parcel t?o,f3°x 23�� CGv.tLrJ�I(e t1'IYl GZG�3y
vinr}%o I�Z (-XI �i3—L
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 4ZSs—i 13,1 ucd'13
A w i I svv, , 62b,
PJwc l�r AID ce Rci"13 s-Gv+
E3 Z ` re S c ce
Type of Building:
Dwelling No.of Bedrooms—rhr—ram Lot Size 7 1 5&Z sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 1 t o _Ira 6d em .gaaHerts-per- }. Calculated daily flow 36 gallons.
Plan Date� Number of sheets : Fum Revision Date
Title s S Plc.r
Size of Septic Tank 15CY0 aQ 1l Type of S.A.S. ZS'KIZ'x Z' L.tr�cdt C/w.�:hrvs
Description of Soil (2e ir,. 40 -soil l nsgA C., p la vt 9— Sf6 S Z
Nature of Repairs or Alterations(Answer when applicable)
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 the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issu by this Bo d of He t .
Signed Date 9—loz_ of
Application Approved by Date `13- y�
Application Disapproved for the following reason
Permit No. Date Issued `l��—
I
Ny 6 /
o. /._._ Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
' PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Q 01pplication for Mir og Y 4tem Cow5tructiott Permit
c Application for a Permit to Constrict{1C)Repgr f)U,ngrade( )Abandon( )-.'PS-Complete System El Individual Components
a.` � :.,.
Location Address or Lot No. 4 4-4 0t-Q eA Owner's Name,Address and Tel.No.
y cc"4-vrw Ita S-� G ,ce,,,arsys�
Assessor's Map/Pazceli �` I r OLL + 1�0, f3ox Z�yv GGNtCNJIIc fYlt1 vZ�.38
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. '4Z-S- I f�I
j: t S ki�tsh A W i I sa►� tr?�.
.... ._.,_. •.,_..., f31 Z. �{'VI G t v► S IYcct`'
Type of Building:
Dwelling No.of Bedrooms -1Pt v'=c_ Lot Size 411 5"' sq.ft. Garbage Grinder(46)
Other Type of Building No.of Persons: Showers( ) Cafeteria( )
Other Fixtures
Design Flow /b���^► gaper Calculated daily flow 3�G7 gallons.
Plan Date Ili 1 cro Number of sheets .Tc„ro Revision Date
Title t k- S ph P1a
Size of Septic Tank Type of S.A.S. Z5'11IZ 7c 2.1 44—A CA-whvr-s R
Description of Soil R L- 4- 5 o i i '` l g f A C., r la n c P- 8r(o 5 Z
Y-
` Nature of Repairs or Alterations(Answer when applicable) �E
Date last inspected: #5y
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 the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been iss by thio d of He
Signed _ Date 9-1�- of
Application Approved by / 1 Date �l- - ? �
Application Disapproved for the following reasons
Permit No. 'G-7 Date Issued
---------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( V)Repaired( )Upgraded( )
Abandoned( )by
at 9 y 0/ ' has been constructed in accordance
with the provisions of Title 5 and=the-for Disposal System Construction Permit No. -G 7 1 dated /�- 3_ �
Installer - Designer
The issuance cof/ s pe it shall not be construed as a guarantee that the syste will function as def igned.
�. Date / l !`a /0{ Inspector I t:�.K Cj t'
No. —v c/ 7�------------------------------Fee
----------------------- --Fee "Ice
THE THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
a
lwigpooa[ 6potem Con!tructton Permit
Permission is hereby r ted to Cop stru t( Rep ' ) pgrad ( ) dndon( )
System located at f y,41 U /P 15 f�
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.
``a .. Provided:Construction must be completed within three years of the date of it.
Date: � � �/ Approved 15y,►�"-
D gSIG N OATI°! _ z 12'
Jlh�lc Farrlt�� 3 rnptfl FINISHED GRAD
GBrlad G Grt•+dC+r- 36"MAX.- 127MIN. jy\ \ �/\\/\�/ /\�\ \y\\\ \/ COMPACTED FILL
2_t Daily Flow = 3 X!1a 9p't�..� z 330 -- - - ------ -- - -_ a- PEASTo NE
Scpitc.Tanis' _ �3a X 20070 = (� 30 5" 3/4"70 7 1/2 "
USE 150o GALLom TAWk DOUBLE
WA+ 'm SHED STONE
L�hcH1UG SYSTEM D�sz6N
Appltca+torf Arca, Rci"uirc-0
GPA ,79
_ GPD/ 446 SF SECHON
3c� -- .0
Appl�cahcr. Arc& V-s 3n NO SCALE
S.dawt►Il AKO 2't25')z Z- -A 2' 146 S.
Re .•-+ /4rcat IZ'x z5` .3 6 s!= 1-1.5" WASHED STONE
Toi+.l Arca 448 SF. 1
Qcrcelsfien R-fc 4- S wwt/tack 12.'
s. k_.f�
STEP E( yG / J t ` PLAN OF LEACH CHAMBERS
//ems P r25 I �;
y ; . 2 74 � . NO SCALE
No.30216
SISTER
sS�ONAL ENS' 11-ece-Z:oo 0
TQ F'
el /o1•o
IC $i kOLL�
P- 8 .52
i n 7.2 DtST ISob
�--FCp��6 G� c c✓S r;
�x q7� GAL. ct7+?g !►:
32°= Sege
.•
:G' 1510 Teylc v
.Suvtr9 DeVLeLaPEp 1liie1=11"E
I Ccrf.f-,� T"4 The Ptapese-A Dwelltw5 Skew" SITE, SEPTrc PLAID
H-crcor, Cew.plds Ws44� Tf►e StAc-line At,et Set LOCATION I GLa Spa R=91Ceri1•-�"v��
bode (���wrr.nenfi5Of 'Tkt Tocsn . o SCALE' . I I'= So+ PATE : (Ile.Ate_
Bans+able- Arid. Sa Lac-o+ace Wt+§%%^ A PLAN REFERENCEI_L-CC 3Z$51
Spcc�al. FI�� Ha:kara zone- . ASSLSSoRS, MAP: 172, PARGEL: 13-Z
APPLICANT c (;rrc..%"Q.JQ
1 J-Ct.-Zoos _
BARTER,NYE &HOLMGREN,nic,
frsaia fan./ Sar�x�er 812 Main Street
Osterville, Massachusetts 02655
O�'sc♦s. "ir�eM buildulSS s1+e�Jlo! r�et be usc.�
36b No : Z0C.)0 —9 t
to csi�bl+st, �rop<.-i� 1�nis.
\ �► SHEET z OF 2
Sc.4 Grcc»wcn x
Rc Za'/ion/�a� O
O
rrm,.p 172 ,PcI.93 p
49' �o
—- ^ 99 1 tov. i.
4?� S42 S.F,
✓ J , I
OF
PAP. I Prop \ �> TEPHE
A N N
i rn
Zo
No. 0216 v�
o W s'cGISTE����.ji/
/ONAL EN `
h
a
1
�5
LIS
29674
ff J n I ay �FaR
I � 11-Of.-too o
� t 41 i
p
Q r
.,a a
1 rl
3 I 35'
1 I
P o`A�30
o t135�/K�
5C I-rt : " = so'
2000-98
Nci&�.... Ficu d,
THE COMMONWEALTH OF MASSACHUSETTS
BOARD.'... .f
F HEAL7�T—H
_40�1, .._..........OF...... n% ` � .�Ir .�...................
Appliratiuu -fur Riipuual Works Tuu.itrurtion Vrruiit
Application is hereby made for a Permit to Construct j(ol'�) or Repair ( ) an Individual Sewage Disposal
stem
`1 l Sy .a ........ ?-_!.)' � &A+,fV /V..................................................I...........................................
-
'\ Locati Add s or Lot No.
.....�.�_ ... ..t..I.._ ----------------------- ........... _'1_-1 cf.L—).......------......-------- --•----......................
Owner dd s ��
Installer
Address
UType of Building,-- 2— Size Lot..__ 7.:_ C.. q. feet
�-, Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic Garbage Grinder (�
Other—Type of Building ............................ No. of persons.--------------------------- Showers ( ) — Cafeteria ( )
Q' Other fixtures --•----------------------- -
WDesign Flow�__ � .........................gallons per person per day. Total daily flow-----------------------------------.........gallons.
WSeptic Tcuil _Liquid capacity_1 _-gallons Length...... .------ Width----- ..-tom-.- Diameter................ Depth................
x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area-- _--.__-_.--__---sq. ft.
Seepage Pit No..................... Diameter-------------------- Depth below inlet._ ...........
�Total lea ping area---_.--._.__......sq. ft.
z Other Distribution box ( ) Dosing tank ( ) dh- S``/•�_74, -
Percolation Test Results Performed b Date------------------------------•-_--.---.
Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........-_---.-._:.__..-
(l Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.---_._-__----_---_-
R,'
O Descriptio of Soil ...
W
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 Article XI of the State Sanitary Code— The undersigned further agrees riot to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
igned- `'-
W
Application Approved By------ ..... -------- ------1.... �� -•--------------- `� ate
Date
Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------------
----•-•----------------••---••--------•••-----------------•------•-•---------•----............................-----------------------------------------------------------------------------------------
Date
PermitNo......................................................... Issued........................................................
Date
Fj
Ng 6®.... ............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD QF HEALTH
1............OF...... ... . .......................
Apphration -for Uhivoottl Works Tonotrnrtion Vrrntit
Application is hereby made for a Permit to Construct �r Repair ( ) an Individual Sewage Disposal
System _
Locati Addr s or Lot No.
Pc( .2 ._.
o- ..1.. ---------------------- = ,p...........------............!----------................
.
w .c t ly Owner /f q 5 6 "`"'A.!T ddjess'` '
t!/� /�( .......................... -----------------------
Installer Address r
UType of Building...,— Size Lot....� ..4.�'� Sq. feet
�-, Dwelling—No. of.Bedrooms--------------------------------------------Expansion Attic ('"�j"'�— Garbage Grinder
aOther
—Type of Building ------------------------ -- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
dOther fixtures --------------------------------------------------- ------------------------------ ------------------------------------------------------------------
W Design Flow,.__ .. ..............................gallons per person per day. Total dail flow-_________2--UZ_--.._-_---..------gallons.
W Septic Tan4' Liquid capacitv_L_-_--__gallons Length------6-------- Width------
Diameter---------------- Depth---.--.---.-----
x Disposal Trench—No. .................... Width-____--__--__-----_ Total Length.................... Total leaching area--------------.-----sq. ft.
Seepage Pit No--------------------- Diameter-------------------- Depth below inlet_.nn......_.._.__... Total leaching area...•-..-------___-sq. ft.
z Other Distribution box ( ) Dosing tank ( ) vb- PC//!�.- 5`-/,;) -7 G
aPercolation Test Results Performed bY.......................................................................... Date---•----------------------------------..
Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water..-.-_-_.-----_.--.--_-
w Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_-.-..-_._____------.---
W -•-- ---------- -
G - --- --...---•...-•••-••---.. ..
J -
Descriptio of Soil Q`- 11 Q! �a .. ! --------------------------------
x
U -------------•••-----------l --...-_..``�llr - � � '^ <'� --- -------------------------------------------------------
W
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 Article XI 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.
igned- ,0 ........................- -_.-.-�lx✓r !A' •---------•-•--- -_---------_-
Date
Application Approved B �-� ..-................ ... �7:-..7�..----
PP PP Y
Date
C/
Application Disapproved for the following reasons:........
................. •--•--•--•------•-•-•---••------•......-----..__............ ---------•••••
•----•----------------------------------------------------------------------------------------------•-....----------- -----------------------------------------------------------------------------------
Date
PermitNo......................................................... Issued--------------------------------------------------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.h L.........OF........ .. /J� . /............ ............................
Trrtif irntr of 0,141ntpliatta
H Ij S-TO CERTI , That the Individual Sewage Disposal System,constructed (�or Repaired
by ( )
Tv// l
J -
--- ------- - - --
- Install
has been installed in accordance with the provisions of Arti e'XI of The Zate Sanitary Code as described in the
application for Disposal Works Construction Permit No."__ _1. .1�'(�_—-------- dated-.-,3..:7-/...7.--,7-1....................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
d Inspector DATE . ------ ---- ---
THE COMMONWEALTH OF MASSAC S
76 BOARD O H EALT�t �..........O F......... / Cv�,i1��61 .........GL�E
No. :�--.. FEE. .................
� ork,� non�trttrtion �rrntit 1
Permission�is hereby granted-------- - 1 - ...............
•--•-••.... ...........
to Co s r �/) or epair ( ) an In 'vidual See;Z Dispo0//.�a1 System '/
(/
at No ' E' 7- •-----•--
Str
as shown on'the application for Disposal Works Constrution P it No-----------�ated_....-• � � _��- -�
PP Construction �---- ---
` � � Board of Health
DATE--------------------------------------------------------------------------------
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
r)' :7i Gar 7?CAZ
407
f
w
S/L L fl-E✓ _Ff.E T 400 6 E0AZ)
ti
PL_ O T' oL A IV
L O CA T/ON
C>Y-AN 2E FE,LE�/CE: SE ING LoT
-49 AS G140 \IAJ OAJ LAND COU)27
I A16265Y C4A?r/FY 7,1-/A7 TyE 6X1,5
/NG F041AIDA r/ON LOCH'!T/ON /S C70,eeE -
; .45 SNOh/N gyvD_ �7 _C`ONFOQ^*J Wlrq
�t ,` Tf-/E SU/LD/NG SETQ.dC�PE�JC//,e�'MF�/T
Y F OF 7,,V6 TOWN OF
"A/ you
lsmcrH - 290 92 W1640W.5/ VA1Z"O.U77/X'10 T MA.
o�-
LO CAT ION SEW . PERMIT NO.
42J 6 Z!zz ...
VI Lt AG E�,� q•Vl
' IN.STALLER'S NAME A DRESS
C Ae,
B U I,L D E R OR OWNER
cAatl mom,
DATE PERMIT. ISSUED
DATE CO-MPLIANCE ISSUED
:�0�v
�`�` (���
�aDx _
��
� 7� � ��
Y
� -�_
at
�� ��+
No..----.. ...... Fps. ..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
7_V_0Z4._) ..............................
.....OF......IF��
�-(� Applir-ation for Disposal Works Tonstrurtion Prrutit
Application is hereby made for a Permit to Constri&t Rep it an Individual Sewage Disposal
System at*
C_
5 ..........................
dr or Lot No.
Location A dress.....k ae
. .....LAJ.. ................ _!?4...(ed•.....M/.\).AJ-.-,L........K 1/.,el.kYV . ............
W- Address
. . . ......... F.........................................
. . ... ..... ........ .....................
........... :
Installer Address --
Type of-Building Size Lot....1.5410M.......Sq. feet
Dwelling—No. of Bedrooms...........IL&.20..................Expansion Attic Garbage Grinder
a
Other—Type of Building ........................ No. of persons............................ Showers Cafeteria
Otherfixtures ........................................................................................
W Design Flow.........................................:..gallons per person per day. Total daily flow.........._3110...................gallons.
9 Septic Tank—Liquid capacity)4=.gallons Length................ Width................ Diameter._.____......._. Depth................
Disposal Trench—No..................... Width.................... Total Length........_. Total leaching area....................sq. ft.
Seepage Pit No.... ---------- Diameter.....10.10... Depth below inlet...6_-0... Total leaching area.. .sq. ft.
Z Other Distribution box W ( )
Dosing,4nk
P-4 Percolation No. I................minutes.Test Results- Performed by.... ............. Date..
Test Pit
Test Pit No. 2...............minutes per inch Depth of Test Pit................._.. Depth to ground water....................__..
: per inch Depth of Test Pit.......
. Depth to ground water..
-------------\.............. ----------------------------------------------------------------------------------------
on
0 Descripti of Soil----------. 2. .4�;Zob_s, X. .......
W 1-11------
------- ------- vJ
-----------------------:---------- -4-:!n.1- ........ ..........Q�_ - ---------------------------------------------------------------w---------
U Nature of Repairs or Alterations—Answer when applicable..............................................................................................
.............I..........................................................................................................................................................................................
Agreement:
The -undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
L the provisions of TITLZ 5 of the State Sanitary 'Code—, e undersigned further rees not to place the system in
operation until a Certificate of Compliance has been y the undersigned
- of healt
c . .......
Sign ...... . ...... . ... ... •. ......... ...... .........?9. ........
Application Approved By..!n... ... te
pp .....
Date
Application Disapproved for the following reasons:................................................................................................................
.........................................................................................................................................................I...........I..................................
Date
PermitNo......................................................... Issue(i.......................................................
Date
r
No........ ...... Fss........ ... .......
THE COMMONWEALTH OF MASSACHUSETTS
,. BOARD OF HEALTH
App irFation for Di"au al Works Tomitratrtinn Frrutit
Application is hereby made for a Permit to Construct ( oar Repair ( ) an Individual Sewage Disposal
System at Ary 'cr
--.. :rZ...d. ..sr._. �. . . R�f_�.c .. - ..�..... .-z......:.
Location-Ad
T.et .2....! C'
r Lot
N
.
...................... ER.--- .-�(---�----- -•
assr- :A w �. .. ...... d� .... .. �
Installer Address
d Type of Building Size Lot...15jf� ......Sq. feet
aDwelling—No. of Bedrooms.___.__..__kLAJ_0..................Expansion Attic ( Garbage Grinder ( )
Pk Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures -------- ------------------•--•----•----•------••------••----•--------
W Design Flow............................................gallons per person per day. Total daily flow......_... 3L0...................gallons.
WSeptic Tank—Liquid capacityl.olXjgallons -Length................ Width................ Diameter..._............ Depth................
x Disposal Trench—No_____________________ Width_____....._._.___.. Total Length................... Total leaching ea
leaching ft.
Seepage Pit No.__._..__I.......... Diameter._._.�1,,_o... Depth below inlet___ _.' (,,�.__ Total leaching area._ ft.
Z Other Distribution box ( j Dosin nk ( )
`"' Percolation Test Results Performed by.... L1�Y�F.I jE_. �1 �! .:............ Date....___fl..:'"_3_'75.__..
a � � ll
Test Pit No. 1......Z___minutes per inch Depth of Test Pit_____ ::A_ Depth to ground water.____N/, ._ .
fT Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
...............•--------- 1..............�--•--.... ._....
O Description of Soil..............0__-�..........`..�Y�.__..�+�'rl.. .-�•---�`--�� --�-1-----------------------------------,._......-------------------------•----
V ....................
x •-••••••-•------------------------•-----•-----ki-- • --- -
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 TIT;-.:, 5 of the State Sanitary Code— undersigned further rees not to place the system in
operation until a Certificate of Compliance has been i-ss y the boar "of health �J
Sign :..- -•- ±-= -•-• _•• ..............................
J Date
Application Approved By--- ---- - L. ..---���_.tom' �.. � _ �_6.._�....... `a ._..
Date
Application Disapproved for the following reasons:--•----•------•--
P
.... .. ... ...-•-•---....--••---•---•------•-•--.......••-•---...---•--_.___....-•••••-•-•••-••••-•- •• ........................................................
Date
Permit No_______________________ ._. _.. Issued.-----_.-.-----
•---------- ----------------- -Date•-•-•---...._._..----------....
THE COMMONWEALTH OF MASSACHUSETTS u-I
k : BOARD OF HEALTH
1...c .�.�....l......OF.......... �C�.�..............
(9rdif iratr of TompliaanrrM N
THIS IS T�-9t,CERTIFY,, That th Individual Sewag_e,Disposal System constructed (- or Repaired ( )
by �._�l._....... -..:J_ 1?,A� '-- ----------------------------------------------------------------------------------------
Insta er
at �___...
has been installed in accordance with the provisions of T � 5 of The State Sanitar Code as described in the
`� � :' : .
application for Dis osal Works Construction Permit No ...... d•tted__-..-_�.
THE ISSUANC(OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUCTION SATISFACTORY. �
;;SATE................. -_---+6-.----2 ...................... Inspector---•-=----- _....................................................................
t THE COMMONWEALTH OF MASSACHUSETTS '
BOARD OF HEALTH b ,
�.1¢C.i1. . ....0F..............:� Y�• . : tom.�.. ...._.
Noy . .. _1^! FEE.."# .. ...
Disprratai orkii To uan r ntti
�- ' .__ `�. .Permission is hereby granted--------------- ---��___...----•--._ ��?.1�.:�... .....----------.......-----._....._.........---•--•
to Construct (><0 Repair ( an Individual Sewage Disposal Systgrn
at No.. ..hSa 1-- ...- F ------��-: --� �.1► l -7 ......
Street
as shown on the application for Disposal Works Construction,,Permit ..................... Dated...... _11.7..9
.. _ d_ _A_________________________________
DATE..... ��...�'"'::=-- -�................................................. .•_�t• -, ,
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
ai
r+t5
f i A �"�, ,'' N F 'p .�s� 4 r t' � ,• � ! .' - � ,�� r - e,t}p + r � s.
{',�Myx tflinT/I ItifS. fi7 X� 's }t ✓`,r :' + i, , �.
�t I�(� lYl���k ak a.$ ''} t 9.• j"_. ,1_ Ir ,.�1 t . s� n.'d yq,t � i � {
lie }{�.A f 3/1••• 11 r 1 R
*t
«
}F Mllw;IJ5 I ! n pr if
V
x �" pl1
t ! 1 ,bOo9�r q I s Fcfl y �r
k t ScP}��� G PVIi w ;
a4
hhh
+� I it 1 1 i
�mt '�rsYYf /
t !y r
It zt z Wk
.1 a� a�h��'4 t f-�'ik�Yt jY 1 �. 2y - 1 A !f 7 �(�• 7' i
(/-�
OLD
� ,�TA t-/ -E.
114
EXISTING '. SPOT ELEVATION 0,0
1> ,� CERTIFIED PLOT, PLAN
EXISTING CONTOUR 0
F9NISHED SPOT ELEVATION
.1NISHED "CONTOUR _ 0 „� ,; �s> :; C 2 ►,'f" �l-. .V /// � t `
x.APPROVED ' BOARD, OF HEALTH ' .._.' r'� _.:I N.--�—_—
DATE AGENT SC-.A1. E - P'=' y0 DATE
----- — --- — ----- — — -- — ---- —
t� .OREDGE^ ENGINEERING CO. ING` ^ (,U�� n Pr
CLIENG- �. I CERTIFY THAT THE PROPOSED ,
' Rr�GiS,TTERED �'REGISTERED) JOB "No ®y., BUILDING SHOWN . ON THIS ,PLAdV {,
LAND CQ.riF ORMS TO THE ZONING LAWS
�ZE.PVGINEERS.' SURVEYORS DR. BY __ UF RRNSTAhL E M S. }
MA
V: �. M 1 tit CH BY
1 ' Y,
Ft nn 0. ?, t�: Ni F . 2.. / � '
SHEET . 0 DATE REG. LAND' SURVEYOf?
IV07',- Zr/7-NeR 7-A!A-- -6,�FP 77 C 7-Av/< OR
--ZO PT -Ml
ZE,4 CAVIIVO t A Me
?A
7'
pr, w/,V. C0eVCR'-= 2-
-5wq 4 L. CAE C/SEv
co/vc'Q&rR ll",6-4VY, CA S7
OWN. IP17CR
J. y 1 11 - /,=-/,Ov
y
po
A
CC) 1ll.67/c? Cl-,FAIV .SA NO
-D 2�- LAYER
.... . . .. .. .. OF J18"
OA4.
WA5HED 5701V-x
77C
rA AW
A9 O)e o 0 a 0 6
WASNEP STONE
C'
PR'ECA5 7-
V 00 4 a ;)
SEEPAGE
J� a 0 0 0 0 d P1 7 OR �50 L11 L-�
Ab
INXERT AT ffv11-A01tv& Fr
C,(5ZE-7,.- OA�)
INLET .SEPTIC 7,4AO'k 52, 'cr F7. A91A M
OU7'1-,-- 7- SEPTIC 7-ANH F7-
hVLF;rVi57R40117-10N BOX 1, 0 lc7' GROuAIO WA7,ET TABLE
ou7-z-,-7-,D15-rqla&-r1-ov Box 11, 9 F7
lAlL—=7' L.E'ACH1,Va 4C;"/7- S.=AVACw.= O/SROSA J- Se--57-&1W
ZZACW"a AVT -rA 8Ul-A 771,0 IV
DIMENSION A 3 ,=,T
DRS164V CRITERIA SCALE T.
D11-7ENSION C-F77.
A14/Af 8.=R 0,F SEI>RO OMS
GA R45A GE A915.4705A-L 41N SOIL 1-04C7
7 -A 4 6571MA-r.-D S011- 7-1=S7-02 SW/4 7
70 7 FLOW Y SOIL TEST
NUI-18ER 0,0- 4A-ACHlIV4 P/7,3� /979
Lev -re OF .SO/L. TES-.T. .
'ov •
-DA t
gy
4907-rOM LaACNIAla icp_-R PIr S'Q Ar.- -10JV RA•r,-
9%A 4AAA A&WCOXA7 101V RA7 -2 7'07.4L 4e.4CH1AoCr' AR5A SQ. c 7.- -RCOLA 7MIJV. INCH
ARE-1 FT. -�lrk OF
o BERT
P.,
BUNKS
N i2 0 o.221E
&4-
Z'
6NAU
7WA 5
-s 3 -1V0.,WA11V Z
-2-
leve
.4V
Ix
wo
11046
0
NE
w�,L r LOC+��- Ol`1 WAGE # aC C� vffi__m� yr M
:VILLA GE-' i�/�li' �� ' ,ASSESSOR'
IN 1)AiLERS;N"AME&PH.ONE NO �,` 1a �I,S%cr y SSaQ
;, S£PTIC'TANK CAPACITY:�/.560 ��/.
LEACHING FACILITY (type) CWLTec 330} �3� (size):: f xa S
... : S SF
- size
s NO.-OF BEDROOMS
BUILDER OR OWNER
'PERIftDATEQ`�a w( COMPLIANCE DATES
Separation Dis... ,..
tance Between the
M-' 'um Adjusted Groundwater Table,to.the Bottom.of Leaching Facility Feet= r;
kvate Watef Supply Well Leaching FaciLty" (If any wells exist
onsite or within 20f)feet�of leaching facility) Feet
witiin 3e00 feet oflauid anf leachingf anality(If any wetlands Bust:
Furnished by:
r
A , !
l
S if�hl 1
/S 97Z
54 ? =nO i
3;
v IA.- g(�
MA
l? CeZ 093- ao z
Ar ,
rl5 r=3c ?_ Q Y;�
c�ba i��n�► � � � u N�
} 1}ry KO T roc,c -,,,14?•/3
4 .
J
v
• r
s
v
2 a
/tl•rJ•�tir�.v� S Rcr
Yl
ICi 3
Q�
s
210 o Cl
• ����'� A'A � � aft-�
s �
�{J0 ce
t
f �
r
1,41 o -L '�r• ctS'
try
V2, If
AJfAA
t ,
,.6
b
d_
C ,
Y�
T �J
y
v
t
' tM
l
X444 3
'o r4*cP
.A 0� N