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'LOCATION SEWAGE PERMIT NO.
, VILLAGE
I N S T A L-LER'S NAME i ADDRESS
BUILDER OR OWNER
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUEDL 3
F, ® �'
LOS AT ION SEWAGE PERMIT NO.
a ° eZ
VILLAGE
d,4
INST ! ! R'S ME & .ADDRESS
� 2
I
tUKDER �
� OR _
DATE PERMIT. ISSUED
DATE COMPLIANCE ISSUEDr/ -
A6
C7.
�`3
f -
+ No.......3 ......... Fs$.......a..:....... .. ...
.t THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
............A-e>t JA).........OF....... ............ T pr;.�_.L�.---._............---
Appliration for Bhipoo al Works Toustrur#inn 1hrmit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at:
....... .lca.... ..... � .1 -.
•cation-Add r or Lot No.
Add ress
.....................
w er O
W
-.....•_•• c. � .I.S.$....._tom.....................
Installer Address s--
U Type of Building Size Lot_.,,f...���7....Sq. feet
Dwelling—No. of Bedrooms______________ .....................Expansion Attic (>4 Garbage Grinder ( )
aOther Other—Type of Building ____________________________ No. of persons_____..____________-__._.___ Showers ( ) — Cafeteria fixtures ..
W Design Flow............................................gallons per person per day. Total daily flow______ 10..................gallons.
WSeptic Tank—Liquid capacity. allons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No...........I-------- Diameter---10..'_ --- Depth below inlet...... , . Total leaching area__ _4�_.sq. ft.
Z Other Distribution box � Dosing talik ( )
a Percolation Test Results Performed by---- ........... Date•••• 1A...............
Test Pit No. 1.....;Z....minutes per inch Depth of Test Pit.....!_a__LC? Depth to ground water_.t_o?_E
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
� ---••••••••---• ._.... _.......
Description of Soil-----. -.. -)- •• s QD.1,501 L„---•-•-----------------------------------------------•----•---•----
' ' �...._�-t-� 1?,,,r1�_I_��1�------------------------
x ••-•••-•--•--------------•-•-----•••--- -"...t. ------------ fit
.T;------ --------------------------------------------------------------_________-------
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 iII= 5 of the State Sanitary Code—The undersigned furt r agrees not to place the system in
operation until a Certificate of Compliance has been i u y the b rd of he h.
_�Ig
• Date
Application Approved By...... >. • -• •-•...... /,J• - ---------------------- -•••-- 7�
Date
Application Disapproved for the following reasons------------------- --
---•------------------------•-----.....------------...------...-•---------------•-----------•-------------•--•-•_..-••-•••---•-•••-•---•••---•-••••----•--••---•-......................................
f
te
PermitNo......................................................... ISStled..-- .........../---�--•------...a...------
Date
r,
NO&...... Fmat
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........: .?A.........OF....:.� .. .:... .. .....................
, pplirFation for Disposal Works Tonstrnrtinn ramit
Application is hereby made for a Permit to Construct . or Repair ( ) an Individual Sewage Disposal
System at
location-Add ( g
- j �s --?' . i jos)d4..R kj or Lot No.
.Q _ ._ .f..... IA.....................
W t O�w raw j Addyres
r-a ........... -- "y...... -�'� 1F"'r -1_+�!? .: ... ......._..
Installer Address
Type of Building s Size'Lot.14: _-S �....Sq. feet
►� Dwelling—No. of Bedrooms..........................._.......Expansion Attic Garbage Grinder ( )
�`4 Other—Type T e of Building
yp g ............................ No. of persons..........................:. .Showers ( ) - Cafeteria ( )
Otherfixtures -------------•--------------------------------•-. ••••••.........••• --••• t
-.
W Design Flow............................................gallons per,person per day. Total daily flow :.. ._gallons.
WSeptic Tank—Liquid capacity. llons Length._::: ...:__:.. Widtli_: .......... Diameter............. Depth:: ............
x Disposal Trench—No ...... Width..r Total Length .. It ... Total leaching area.... _.. sq. ft.
Seepage Pit No........... ..........
Diameter••- Depth below.inlet (40-61. Total leaching area -sq:;ft.
Z Other Distribution box Dosing t'
''"' Percolation Test Results Performed by.. .`�' ....
W ..
Test Pit No. 1..... ._...minutes per inch' Depth of T st Pit Depth to ground water..1 .Q
P P p g �...
a Test Pit: Depth to round water ....
fs, Test rt i o. ..._ minutes per me Depth of
------•••-•:......••.
O Description of Soil.... " ' 1'�r1 .. L r �4-1" ------------ ..............................................
V
Wx t .............---------------------
U Nature of Repairs or Alterations—Answer when applicable........ ......................................................... .......................
------------------------------•-••-•••-•--.................-•--••••••••••••••-•-•..........••-•••......•..
...........................................
Agreement
The undersigned agrees to install the aforedescribed Individual._-ewage Disposal System'in accordance wit'
the provisions of TITLE 5 of the State Sanitary Code he undersigned furt ,r agrees not to place the system in`
operation until a Certificate of Compliance has been ' u y thee.b rrdd of`h h.
Sig _� ':.. ............
r Date
Application Approved By......... , / "'
`,�
Date
Application Disapproved for the following' reasons: ......:..
----------...........................
a... Date
Permit No.................•••....•-•••... > . . .. xIssued.
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Tntifirate of Tilm�rli�anr�e .
THISA TO CERTIFY, That 1he Individual Sewage Disposal System constructed or Repairedby
( )
e5taller
has been installed in accordance with the provisions of T ` o The State Sanitary Cade as described in the
application for Disposal Works Co,struction Permit No.. ___--••--_--_-- dated.... .��•-'.��'•...............
THE ISSUANCE OF THIS'CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANT. E THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.`:
DATE................................... Inspector... ......••••....----•.._...•••......................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF- HEALTH
?.. A,.......OF..... ', .. � ,
N 7 .......
FEE........................
......... ..•....._..
Bisposi ]Marks Tu trnrtion antit
•• ..
Permission is herebyanted--•-••• ...........................................................
to Construct or Repair ( ) a Individual Sewa a Disposal,System ' r
at No. .......0...... r'. .....-. 0.` ..& _. .
Street
as shown on the application for Disposal Works Construction Pe o ated ..I`� :...--.-....
„ax'= _ x _ - •• •••-••....---•.............._
?' Board of Health
DATE
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS -
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LEGEND r .,
CERTIFIED ..PLOT PLAN
EX�Ik$TING POT-: ELEVATION 0x0 ,.
' i.! r;.XItT.ING ''CONTOURi -- -
,.IyNI-SHED -;SPOT ELEVAT'IION jd.U��" � 7
Y
FINISHED ,CONTOUR 0 ---
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� ') ) 1 INu y r,Y ;
APPROVEp- BOARD OF HEALTH '
�P��� r�,,f�a,�I o 'mot t. •, •.ri I,i. � r. � �
J` ATE AGENT • SCALE l If=So j DATE
t, DREDGE ENGINEERING C.O. Iie] CLIENT I�✓L=1zi✓ 2 I CERTIFY THAT THE PROPOSED
fEGISTERE REGISTERED 7�/0: BUILDING SHOWN ON THIS PLAN
*x�t JOB NO. __. .
ty ;GLVIL LAND I CONFORM TO THE ZONING LAWS V
r x � DR. BY R '.
ENGINEER SURVEYOR -- OF BARN`STA LE M S.
a 133t Nt';'MA11N ST 712 MAIN ST., CH. BY: f/
�. HYANNIS` MASS. Z � —
50 4ARMOyjHn, MASS. ,
.� ,r,r SHEET-L OF DA E REF. LAND SURVEYOR
7'E. E/TNLRE ` TANk.SiO v pR
FT M/N
M LEk/�1G P/T .4RE .MOItPE THAN 72'•'®ELO4V
a;. r x: v Gi i1 DEj fr. IP4"D/AM.ETZAP C0Ni7mioTA�- Cop&- '
=4 � y " = • ' 'q'PVC P/PE `_ _. �+J�IALL �.1F il94DUC5/yT, 7°•'D GRAOE..�i�JIN .EXTR/4
R r _' jYEAVY CAST'/RON C0V,&R SHALL &E. 4/SE•O_,.
EZ-:/O O O coI�ERS M/N. P/TCN %f/N;OR/i/EJ./.4 Y
2.. eltN. CONCRFT.E
A Gh.�oE COVER CLEAN SANG
- L/4)3v/D Level-
.... . . . - 2 LAYER
4"CAST SIB
IRON P/PE t o
MIN.P/TCN `D O o GAL. ° 'm� • • • • o • •• • e °,• WASHED SMIVe
%a"PBt: -pow-TrSePT/C TANK D/ST. o n • • • • • • • • v a
BOX o • • � o . • • • � ,.°a •
..: o v p • •EFFECT/VE ' ` . v 4
• DEFT!•/ • • • ' • o WA5HED STONE
•� .,. • • • . • . • • • e goo • _
e a. u • • • o • • • • p •ja PRECAST SEEPAGE
1Nli,�'RT e`LE✓A7"/0/VS ff ° o ► • • • o s • • • e sx o P/7 OR E4/J/V.
/NVERT AT BUILDING 9 7.0 FT. 6 D/AM.
JNLET SEPTIC TANK 9 6,5 FT• i_ / O F7 O/X1M. _ CSEETABULATION>
--
Ol/TLET SEPTIC TANK 96.3 FT.
INLET D/STR/BUT/ON BOX 96,0 . GROuNo yt/,�ITER TALE
OUrLETD/STR/Bl/T/ON BUX r�9 SECT/ON 4F"
INLET.LEACHING PIT 9 s s FT. SEN/AGE O/SPOSA L SYSTEM PA ELATION
LEACHIMCP PIT 3
t �• _ /•_O D/MEN,S'/O N A FT.
DES/GN CRITERIA scAL E /4
NUMBER OF 46EDR40OMS 3 D/NJEN /ON• C FT.
GARe.4GE DISPOSAL UNIT � - SOIL LOG '.: • ,
TOTAL E37/MA7'Z=D FLOry 3 3 0 G.44.1DAv SO/L TEST SOIL TEST 2 p SD./L TEST
il(UMBER OF LEACNlNG PITS�._L_ . f`ELG`Y. 277 D `-ALIF4 GATE OF SOIL .TEST
S/OE LEACH/NG PER PIT RT. . _'. RESULTS h/ITI1e'ES5E0 BY ��M/�t-S
a0TTO^f LEs4CN/NG PER P1T�so. PT. �M PERCQLAT/OJV R'ATAr 2- d mj V,I/NCH _
TOTAL LEACN/NG AREA ZOO �' SO -7.. Sv/3svic. AEXCOL.AT/ON ROTE ik2 - M/N.//NCH
RESERVE LEACNI MCr AREA FT. 3 _ 6' • r
UF,y��s F T G2�-✓Et, x O 7 !p 1; q 7 - JT '
Y ROBERT 6/ Cc/'►/T�/2✓/ -�--•�_ LnP.
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