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HomeMy WebLinkAbout0042 RED LILY POND ROAD - Health 42 Red Lily Pond Rd. Centerville A=227-055 OYCV42% //// � UPC 12534 No.2a 553LOR 1lAiTlYpi.MM TOWN OF BARNSTABLE LOCATION !JZ —r-A &WJ SEWAGE# Zoo6 -3122 VILLAGE �'p �y�t( ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. Qk t✓#.�-- ��nl <j6 SEPTIC TANK CAPACITY - 20 LEACHING FACILITY:(type) na® (size' )NO.OF BEDROOMS OWNER RaC PERMIT DATE: _�— .4 0 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 'F:92 O-LV o,e i fZEi� Lip y Po oo'o R6A D No.. Fee �� THE COMMONWEALTH OF MASSACHUSETTS ' Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes l Replication for Bigo5al i§pgtem Cun5trUction Permit Application for a Permit to Construct(X Repair( ) Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. A102. � �'��"y ®�D Owner's Name,Address,and Tel.No. /e®ci�-r- P. �"p G�"/- !vlc lYlvf ®� Assessor'sMap/parcel /2'roGo 151-VP' ®3 Installer's Name,Address,and Tel.No. (08)-77S-04►7-' Designer's Name,Addres--' Tel.N0. . BR./R}N G fC/SSB—l"G LA." MWA4Gn- rV/G7,j /o 4-7 6�u/ i� fC /2�. f Type o Building: L r►®8� 7�tjl� s® J�!� Dwelling No.of Bedrooms Lot Size ' sq.ft. Garbage Grinder ( ) Other Type of Building zf g! J ,�� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) -3 -3® gpd Design flow provided �-�® gpd Plan Date A �20®4G Number of sheets Revision Date Title .a Ug-r o Size of Septic Tank P 4 6igl-- Type of'S.A.S. � 2 0 Description of Soil i 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 Certificate of Compliance has been issued by this Board of Health. ' p Sig d ' Date 'L. -I-0o (,v Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. o& 3 7 Date Issued J // No. b ^ �� � , '� Fee �V THE C.O GAWEALTH OF MASSACHUSETrso' '` Entered in computer: PUBLIC-HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpprication for Migogal 6pgtem Con5truction Permit Application for a Permit to Construct( Repair( ) Upgrade( ) Abandon( ) [Complete System ElIndividual Components Location Address or Lot No. A/Z R04P /—/L->/tCbAJZ) )V'�' Owner's Name,Address,and Tel.No. Assessor'sMap/parcel Installer's Name Address,and Tel No. ' Designer's Name,Address an Tel.No. 40/U /v�mN Type of Buii ding: Dwelling No.of Bedrooms Lot Size /.Q "F sq.ft. Garbage Grinder Other Type of Building G,� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) .3340 gpd Design flow provided 330 gpd Plan Date A6 ,23 . AQf G Number of sheets Revision Date Title Size of Septic Tank 4 -,rfy 64AA # Type of S.A.S. Description of Soil 1 61" AA /S S4,VD . —<00 DIZ9 W AJ eS . Nature of Repairs or Alterations(Answer when applicable) 11, �t,ya 4 Date last inspected: ' Agreement: s 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 Certificate of Compliance has been issued by this Board of Health. Sig ed Date -L I Application.App'roved.by Date Application Disapproved by: Date 1 for the.following reasons Permit No. 'c!��Oo 6 ,3 —7 7 Date Issued f -------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS y (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed (X) Repaired ( ) Upgraded ( ) j Abandoned( )by at 5 -g= 4,/" AW2 &©A p has been constructed in accordance with the provisions of Title 5 and the/for Disposal System Construction Permit No. A dated Installer ,CBI¢/AM C. K/,5�1�//� �� Designer LV>ot4" '�, /�'/yAjel'v/GZ, 11 #bedrooms Approved design flow to gpd The issuance of this permit shill not be c strued as a guarantee that the syror em ihl nct signed. Date Inspe ---^----------------- -- —— No. d©( � Fee —— THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS =Digpogal i§pgtPm Congtruction Permit Permission is hereby granted to Construct ( x) Repair ( ) Upgrade ( ) Abandon ( ) System located at / 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. Provided: Construction must a completed within three years of the date Cthis pDate )�J b Approved i Town of Barnstable P�OFtHE Regulatory Services Thomas F. Geiler,Director • ennivsrA,BM 9q, MASS. Public Health Division - TEo �. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Z6— 6 6- Designer: -fie 141. 4 ,. 1. ud 0. Installer: 13P, 1&) k 56.,>G Address: yo 4 gu/ sue- Address: 92 V4, „) Q,,(•ve, 't On &!-- Z3-0 6 A -C was issued a permit to install a (date) (installer) septic system at yZ €1n7 v Leda C yi Ili based on a design drawn by ddress - ". Do 4(A "w: "'keguir� . < dated 9 `FC 0-C..: _. t (designer) certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changs (i.e". greater than 10' lateral relocation of the SAS or any vertical relocation of any cot6pJgnenC;* of the septic system)but in accordance with State & Local Regulations. Plan reviswn or'=., certified as-built by designer to follow. '�N OF Mtss�c u . DONALD, • g W. Inst -ler's Signature moN N o.20 20 87 s 4 O � � A9, GIsTE����� O.N (Designer's.Signature)` Affix De'si.�°` r's` aii Here) v_ _ . PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOT : THIS FORM' AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Donald W. Moncevicz, P.E. Q:Health/Septic/Designer Certification Form Civil Engineer 40 Pond Street West Dennis, MA 02670 h N N Oo N � � M b N I I � m . 0� N N IVN 4r cc M NMa . TOWN OF BARNSTABLE LOCATION 1 4. ,- F_4- SEWAGE# 2oD6=-39Q VILLAGE ('a, ,' ( —A"S'SESSOWS�MAP&TARCEL 2Z S.SS i �L t� '1 INSTALLERS NAME&PHONE NO, r�s�C� ,.i _sb9 2"9SP-6 y SEPTIC TANK CAPACITY ,T BBC LEACHING FACILITY:(type) (size) NO.OF BEDROOMS _3 Y OWNERDB PERMIT DATE: J— z3 — 0 6 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 8 Feet f' 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 I i 4-A i p cQ iMeotsr d � I -Z k _ 1 i ' 1 $BC�'OORI Z ati , �i Claw! ? b I'w 11�I1i I ' OMmer f Bob Macmaa Q \ __T ; Laundry gethrOoln I �' Dtntng Ir.Vu I rr-s br GFaeet r/-Ir . 10modelin aa l I y 1 r a lGltehsn ell First Flwr Plan I 10 DOW ra-s• GlOeet c 9 Gmar .ROOM i n �1 jBreekPe�t ,. gam; Mad F'vrch-- 1 k r ® ® F She*ft 4 Town of]Barnstable P# r Department of.Regulatory Services •_ ! // ' MIK : Public I-tealth Division Date ' y' �s$ 200 Main Street,Hyannis MA 02601 / w Date Scheduled A IKO Time Fee Pd. .. ' . ry Soil Suitability Assessment for age I)i a� Performed By. � RLI� Yam• �1G�V'!GZ Witness y: LOCATION& GENERAL INFORMATION MC Location Address'.y 2 RS-p L�Ly /Q�jl,�p /e a� Owner's Name RoBERT AND C191e0 1- MAhO�/ �CQwrrRVlttt Address i MA • gzl3 ��n6� BLv�s BRack 4rN, MY zoq: 62.03 Assessor's Map/P4rcel: 2.27/SS Engineer's Name'D0A L0 W. MON V1 GZ NEW CONSTRUILTION REPAIR I Telephone# S'08 .3 Qy- 05b t 'v�L Land Use lZ s�' rrie�.e' Slopes(%) 6 o Alit • Surface Stones Distances from: Upen Water Body ft Possible Wee Area 3.ZtS ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) � o t V x ib _ rc,l= q r JJ P,rec ns � yo�E' p fl • , �h • .o Parent material(gedlbgic) G 14 Ir A L I V' De th is BeclTack N A Depth to Groundwater. Standing Water in'Hole: All iq� i Weeping from Pit FttCe N.T�A IIj�F� I�f dilililiI Estimated Seasonal.'High Groundwater DtTERMINAATION FOR SEASONAL HIGH.WATER TAB LE Method Used. I.14 Depth observed standing in obs.hole: in.. Depth to.Sol]0191fh Depth toiweeping from side of obs.hole: __ in, Groundwater Aejustfit nt fr. ` ' tN I,,.,,_, yI � 11'� Z Index Well# Reading Date: Index Well level ` ' 'Adj.(Actor Adj.6roundwnterL.evel,,,_ q ';0 9a• �vlst,✓2 q �vlwrecrr;z� see6 �a.a �'.�.� i3.g C�6r. �� �" PERCOLATION TEST vote. , �rtmp /4 A.M. Observation �v }tole# Time et 9 I iry!n h 02 a 12I= Depth of Perc - ' Time at 6" Time(9"-6") >d a .�, Start Pre-soak Time.@ --- FI�, 4,4 GAS iav>o t✓oL � � I End'Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed; Additional Testing Needed(YIN) Original: Public Hehlth Division Observation Hole Data To Be Completed on Back ***If percolation test is to be conducted within 100' of wetland,you must first notify the - - . - V. .._.__-W 4,.lannie,ninc►. DEEP OBSERVATION HOLE LOG Hole# / Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) GD (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel ` Lsa PAY /0 IM�Z �vo .40 " 1s ��qti /0Y,e I've /aO ,. C SM�ivwt /0'y GG /vo a 6 00w 7-0 v DEEP OBSERVATION HOLE LOG. Hole# 02. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) G,eDt/�1D (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel l� Rs 41D " 3 A,�y S,��ua /0 ,@ �y /V /ay,V G 6a G,�Ov Nprt//'T TAI&_ ';DEEP OBSERVATION HOLE LOGHole.# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) , (Munsell) Mottling-'.(Stmcttire,Stones,Boulders. Consistency,%Gravel ;DEEP OBSERVATION HOLE LOG . Hole# I ' Depth from/ Soil Horizon_' Soil Texture Soil Color Soil ,Other Surface(in:) ' (USDA) (Munsell) _� Mottling (Stntctute,•Stones,Boulders. Consistenc Gravel /.; f i Flood Insurance Rate Map: Yes Yes Ao year flood bounds - Above 5 . boundary No____ • - Within 500 year boundary No- , .� Within 100 year flood boundary No Yes -"Depth of Natuta Occurrin Pervious Material 'Does at least fbfir feet of naturally occurring pervious material exist in all areas observed throughout the ' =;area proposed Or the soil absorption system? If not,what is,the depth of naturally occurring pervious triatel ial? • - • Certification I certify that on. I MY- '= (date)I have passed the soil evaluator examination approved by the 'Department of environmental Protection and that the above analysis was performed by nke consistent with the required training,expertise and experience described in 310 CUR 15.017. Signature P"qk�/ P• Date AJ` LA 2/ 2006 QMEPTICIPERCF'ORM.DOC 9 �- v aU � a a� An Master O i; Bedroom , U u� rl e � 3 kr-loset 2 Closet I I � - s I I Master Owner. T T Laundry Bathroom Bob Macman k� Dtntng �ni°le"MA r- i Bedroom 3 Project Name:Kitchen Remodeling& 3' 3'- 4'- DN Addition Ba4Drawing Name: ME OIO WInd—..e� s I I "'-I° First Floor Plan 0 10 I I � cUreet vem ga.r lace Date: o Revisions: Closet - Great Room Y s Review 0v11M i Breakfast II Scale: 114"=V.O. Front Porch Approvals: e �' °° Sheet No. 4 _ a I co � a O Existing Crawlspace Owner. Bob Macman I - I I CerkeMllo,MA ——————— ---------------------- ———————— - I Project Name: I Remodeling$ Addition I I I I , I pak� --- -- Full Basement I ! I DrawingNae: ------� 4"m�rseu dab I m r--, r—— 'l a Foundation Plan 1 I LVL Beam � I - LVL Bsem - I LVL Bsem r� LVL Been r I LVL 9°°° L--J L--J -8I/2' 3o"�"AV'deep I bete: I I forj@ W I/7"tl /3 telly UP I . I I Revisions: I �I coWen Nylcel `a I I I I m I Ravlew 0H1U06 _:� B"concrete uell ° �:•I I I I e"deep a Ib^Wide I '- I I I concrab rooting . 1 I 46•-o" I � I Scale: I--------------------------- -.----. ------------- � 1/4. =1.-0.. *"[nip er potted /bN eu]e -------- ---- ----- -------------------------------------------- B'-b" B'-6° B'-8 1/4" 8'-b° 0'-6° i'-B" Approvals: a 8°dianeter x 48°deep w, conc.e eenoWba e/ Foundation Plan NONE concreu toeling�tt�llceU , I 1/4°.I'-0w Shoot No. 5 CI) O it o� �.0.1 w cornlmous ndg.v.rn erchhectt4al roof 6hlrglee Owner. 6•bulldog Peps W Cox P4-"d h-thi.0 r r,r -u R-30 high d.nity I—I&L V2•Ghf.11 Ire.flp fIN —hIie i .I root Wrlglm Centerville,MA PY builcilre P�J_ W COX plywood seething 2c10 roor 1,irt— R-30 high d-4 I—i tlon VI'drywall Ile.rlor nnl.h Project rare: Remodeling& Addition 1st Or cop late P! Drawing Name: vifyl i H au g a' p— tyv.k buliding wrap 1/2°COX plywood ShWth ng Great Room Bedroom 2 y' 2.4.a11".d..16•o... Section R-13/tbmgl—I_1AF n W drywall I.Wlor rinieh finish floor 1 auit 3ia°T.�pyiwod..bnoor 2r10 floor Jelet..16"o.c. R13 Irmlleupl E)dst First Floor 0'-0' Date: Revisions: �I I I III II I II I II I II I ' ace 1— LVLb.e. Graw►ep — — Retrlew ovwos a �fowdel on.e � I I=1 11=1 11=1 11=1 11=1 I I: I I I-1 I MI 1I1I— B'x16°concrole fooling _ =1 I I I=1 I I=1 I I I I--I I Ed I I-1 I I-1 I I—I i t=1 I I— I I—I 11=1 11=1 11=1 11=1 I E — III—III 4' .l..lab en 6' 11—I I I-1 I I—I I 1—I I I—i I I—III—III—III—III—III—III—III , wm.am c;,Md gravel 6 .11.Poly fit. 111=1 I I=1 I Ed 11=1 I I=I 11=III-1 I I=1 I I=1 I I-III III=III: Sale: �—III—III—III L-11J=1 LI—U 1=1 la=ll l=LI1=11_1=1IPro Basement -III—III—III=1 _ I I I—I I I-1 I I=1 11=1 11—I 11=1II—I I I=III—III=�I 51n1= I I: 1l4"=1'-0" I—III—III—III— I i—III—III—III—III—III—III—III—III—III—I i I—III—III— I—III—III—III—III—III—III—III—III—III—III—III—III— dating.ar.pl t, d hag—1. Approvals: Section I V4"•f-O" Sheet No. 6 5 L01C'ATION -0 SE AGE ERMIT NO. 22� _ Fox. 2�-20 VILLAGE t1I,e INSTA LLLER'S NAME i A- -DRESS BUILDER OR DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 1� �-7l� r 1 Oghoo LO CAT ION B A�,, � SEWAGE PER. M N0. VILLAGE r lt�G✓l - i 1 INSTA,LLrER'S ME i A00 ESS j -�M a—U Lw-01R OR OWNER t n _ GATE PERMIT ISSUED DATE COMPLIANCE ISSUED � ,_ ,Zj ,- b=C) �. � i_._.,_______.-___,_ °--� \._,, G � � � � ��' ��� ' � /J ,� �� � %: .�µ-`.� -.Yc L o Air iior /1 E w c E PERMIT N0. VILLAGE INSTALLER'S NAME ADDRESS tl+ J3 CrSSpUO/ `�erylC'5s; GUILDER 0 OO, WlLER . P Y DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED ��9 � Oct `,p UNf�fee � o �. a (fd Pond A)qj- No.l�/ ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ­------­--- -----OF... ................................. Appliration for Uhipogal Works Tomitrurtion Vrrmit Application is hereby made for a Permit to Construct or Repair (k-) an Individual Sewage Disposal System at, ?C)................ .................................................................................................. o d ss Lot N............... ........../. ...t�. .T­. . �d"Ojls ....... O ner Lot 405; .................................................................................................. Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder ( Other—Type of Building ............................ No. of persons-------_------------------- Showers Cafeteria ( Otherfixtures --------------------------------------—-----------------------------------------------------------................................................ Design Flow.............................................gallons per person per day..Total daily flow............................................gallons. P4 Septic Tank—Liquid capacity............gallons Length................ Width__-___._________ Diameter__._.__......__. Depth................ Disposal Trench—No. .................... Width-------------------- Total Length._............_..... Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter..__._...___._..___. Depth below inlet.._.............._.. Total leaching area...................sq. f t. z Other Distribution box ( Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit___...._............ Depth to ground water.._................_.__. Test Pit No. 2................minutes per inch , Depth of Test Pit----------_-------- Depth to ground water_.__-_-___-_-__-----____ ......................................................... 0 Description of Soil......_ .......................................................................................................... U ........................................................................................................................................................................................................ W ............... ...................................................................................................................................................................... ................ Zl U Nature of Repairs or Alterations—Answer when applicable._.../_/.0V&.. ............ ,A. V--------I......................I................................................................J:: 9 e) 6 xe-f Y,/'azxv. L.)..................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with ,the rl P ,provisions of TITTLE 5 of the State Sanitary Co —The undersigned further agrees not to place the system in operation until a Certificate of Compliance has n 11 ued by t�hboar health. Signed.............................. .................................................. .. ............... Date ApplicationApproved By---_. A.............................................................................. ..........t ............Z el.......... Date Application Disapproved for the following reasons:---------------------------------------------------------------------------------------------------------------- ......................................................................................................................................................................................................... Date !L& _ q PermitNo......3.. L ..&................................... Issued- ..... ............. ..................... Date No......... Fps-�1Z. .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...... 44,,%i0......o F.. ................................ Apfiration for Diipaaa al Workii Towitrnrtiaan Prrmit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal Systemr = sf E § - R..... �.. . .. ..: --••----••••--• ••.....-••---•••.....................•••••••••----••••-•--••••••••---•--••--•--••...............•. r atron-Address r Lot Nva _ ) Owner Address a '" .✓ .:�..'' ' ". : � ---- ------------------•-•----..............,- Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------------------- -•---------------------------------------------------------------------------------------------------- W ' Design Flow............................................gallons per person per day. Total daily flow...........................................gallons. Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ W 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 ( ) Percolation Test Results Performed by........................................................................... Date........................................ .. ,al Test Pit No. 1..............:..minutes per inch Depth of Test Pit.................... Depth to ground water_-___________-_.-_.-_--. (T4 Test Pit No. 2.............M-'rninutes per inch Depth of Test Pit.................... Depth to ground water......................... w O Description of Soil = r't ` '_ / ' �fi '_C ....---•---•--------------------------- V ----------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------- tiy ----•----------------------------------•--•-•---•-•-----------••---•------------.-._-_.------------- rr -rd `4r •-* .i-----•------•_•-_------- U Nature of Repairs or Alterations—Answer when applicable/ :' � 'C'�gJ6� �;p� .B!«�°'�' (,e'1---- --=------------------- .f A f�✓.�yJs`/ ¢fi�3 A'.Y ts...jy-..!{/Afs'� -"N' . .....................................................................................................9_____.L....S..c______..d'_-r.___...9___._..__Y._n_...__._.__..F..._____._.A'---------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT LE y g g p y 5 of the State Sanitary Code— The undersigned further agrees not to lace the system in ik operation until a Certificate of Compliance has heen sued by the board ......................... f health. v r . ........� Signed � ....�... --'......--�--"--- --------- ------------•--------- ......... ApplicationApproved By...... . _--••------------------------------------------------------•--•-----•--------- ----------...- -__.Dace ,....-'-..... f Date Application Disapproved for the following reasons:---•--------------•------------------------------•-•---------------------•-----•------------••••-•-•--._.....••- ---------------------•----....---....----------------•------......-----.......----------•--••------------'-------------...............................--=----------------•------------------------------ Date PermitNo. `..�...........................••-••••_. Issued....................................................... - Date 'THE`COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH y •p•; ;,..�f.,sg �¢ ..QF.... ,t^ '✓'".a c.. >'.&' MRdd"®ww.......................... Tratifir ab� of TaampliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by ••..:a �, ' €. ®�",r 'f~` � Y ..Lz��s�' .......................................................................................... Installer g aat �y'� 9 s - has be installed n aoclancewith tlie provisions of The State Sanitary Code as described in the *3 p > Y application for Disposal Works Construction Permit No-------- . ...................... da.ted_-m_----- ~THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE t SYSTEM WILL FUNCTION SATISFACTORY. DATE............................................:................................... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS Ae4 rz vit /G'C •> /" e4 !—eet° . BOARD OF •HEALTH ............. v, :�......OF.... ar �. ..�., ,� .. ................................ , _ Disposal Workii 0-ynmitrudiaan t1grutit Permission is hereby granted... ., ,� v+'f" �� �' h''= .f br,",-? � ,, x -- to Construct ( or}Repairg(�,,) an Indlvl�3ual Sewage`Dlsposal System '° j i 'r y at NO.. "a".¢ff ' p '. ..... .......... as shown on the application for Disposal Works Construction Permit No '- .-.___ Dated.._ '.'" �.:....... ' r �d=" DATE.. ---------------------------------------••-------- Boardj/df..Health FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS ,. G/v �5-014 ABs&.s P T/©/v 0OMS -3 Q. /10 G��./�"��. = 330 CAA/-. /0.00 x Z`�.40 Loo vG w/rH -3 OYLYAM 20 ,�7„q, � /�lo (a,4ec�r. ,E ,D/sP©ss�.[- ,�i4cN Gfla+M.B.�R Gd 58" w/ram x /d� .�oNG X 3lo'�f-✓.s'/G/-/T j"OD GA/.. S��Ti c 'T.6,/.tK (4. 63' )c R. 54'x 3.2 00') //-g 1(16,o�/0,-,2942D)(.2-6000) -h = 4CP 4 sq.Fr - � 446 s4. A-l7 4-2 m.7.4 G,qe.. 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