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HomeMy WebLinkAbout0129 SOUTH MAIN STREET - Health (2) 129 SOUTH MAIN ST., CENTERVILLE A=208.138 UPC 12543 No, 53LOR HASTINGS, "N --13d 9 9- o No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zippfication for Migooal *pftem Construction Permit Application for a Permit to Construct( )Repair(r )Upgrade( )Abandon( ) Complete System ❑Individual Components Location Address or Lot No. `7? �®W 14, "eiye f/5^ �J; Own Name,Address and Te-No. Assessor's Map/Parcel CIAV�/_!/1/145 Cam" /5% Nam` Installer's Name,Address,and Tel Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms If — Lot Size sq.ft. Garbage Grinder(to Other Type of Building )0L510i r 6r No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow C4�1 gallons per day. Calculated daily flow ✓��� gallons. Plan Date Number of sheets Revision Date Title _ Size of Septic Tank �' ,�®� Qg Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) GL� 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 issued by t ' Board o Hea / / 5► Signed " Date Application Approved by Date .1 — Co- ?9 Application Disapproved fo a fo owing reasons Permit No. Date Issued .. ♦t � -n .. ...... .r° .r, r+:y;.r;i,+. '.;,r,p.... -�:.:K� .. .a.e.v�.. ,•��.r-..r..y..a. ..._ t� w,. 3 ,5 No. / — 0.5— Fee THE COMMONWEALTH OF MASSACHUSETTS Entered an computer. Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS 2pplication for �Di_4pozal *p!5tem Construction Permit Application for a Permit to Construct( )Repair(r)Upgrade( )Abandon Complete System L Iridividual Components Location Address or Lot No. ! 9 SOy .� 4%� gj; Owner's Name,Address d Te No. Assessor's Map/Parcel C eW f�j 41 Ile best y 7i4 l " `Installer's Name,Address,and Tel.No,� ^®�5� Designer's Name,Address and Tel.No.0 t i (, 7 7/' Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( � Other Type of Building o No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow _57_3_2� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 370 'epq Type of S.A.S. Description of Soil . r Ham;. / t Nature of Repairs or Alterations(Answer when applicable) ��1-1 e Lzz�- 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 issued Signed Date Application Approved by ' -Date Application Disapproved for a foltowing reasons 41 t ,. Permit No. 79 - D S- Date Issued —————————THE COMMONWEALTH OF MASSACHUSETTS� /`3 5 BARNSTABLE, MASSACHUSETTS QCertificate of (Compliance THIS IS TO CERTJFY, that the On-site Sewage Disposal System Constructed( )Repaired(W)Upgrad'ed( ) Abandoned( )by O` � 1 6©&Ir_'171-1 at Z G1. i1?�/+� .S Cc° �? �V/7/aas been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 79-Q,S' dated Installer Designer J The issuance of this permits a n t Ole construed as a guarantee that the sy f will function as d t/"ned. a Date Inspector Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mizpozar *p!5tem Construction Permit Permission is hereby granted to Co struct( )Re air( )Upgrade( )Abandon( ) System located at llti> Mtn �T 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 be completed within three years of the date of this permit. Date: / /� �- 9�' Approved by .-Z ,t 10/9/97 . NOTICE: This Form Is To Be'Used For the Repair Of Failed Septic Systems Only CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) I, Ifek1'fJ- AeOU41 / , hereby certify that the application for disposal works construction permit signed by me dated I����� ,concerning the property located at l Z F S®u747 ACZ! e- e --IAA ets all of the following criteria: There are no wetlands located within 100 feet of the proposed leaching facility There are no private wells within 150 feet of the proposed septic system .There is no increase in flow and/or change in use proposed V There are no variances requested or needed. r✓ (f the leaching facility will be located within 250 feet of any wetlands, the bottom of the proposed proposed leaching facility will=be located less than fourteen (14) feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation (according to the Engineering Division G.I.S. map) B)Observed Groundwater Table Elevation(according to Health Division well map) -Z--45✓ SIGNED : DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER (Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. V 9 health folder cert e ) Ci �6U` ,,O4rn1 ST I ^1 � • �I TOWN OF BARNSTABLE LOCATION IZ? SEWAGE # VILLAGE- C fd 1"e 1111dle ASSESSOR'S MAP& LOT �3 INSTALLER'S NAME&PHONE NO.��l`tl,✓�}�/ �S/` 27/7 y► SEPTIC TANK CAPACITY 4 V d C' & L/ LEACHING FACILITY: (type) VC G</ /_ �S C174.v, , (size)/,1,3 A 5�2 r? NO.OF BEDROOMS_ I 0p BUILDER O OWNE k'1a�✓A.r�l�Oh PERMTTDATE: —�y COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 5 f Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) wf Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) _1'6C� Feet Furnished by 00 /A//JIT��rS/ TOWN OF BARNSTABLE LOCATION EWAGE # 7 VILLAGE AS 'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) �/ 'T (sue) r U NO. OF BEDROOMS ? _PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE ,COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No c/ �. � 3: -,et r� �n a,v � � 1 �� � '� � D� �i � \ � � � i�' .� � '� � b � � .. •,t ASSESSORS MAP NO:— O No... _ r. 7 PARCEL NO: Fic THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ---.. OF........Ha rn s t abbe: own Applirativat for Dhipaii al Works Tow5trurtivat ermit Application is hereby made for a Permit to Construct ( ) or Repair (,) an Individual Sewage Disposal System at: 129 South Main Street Centerville . ............_ ._...... .... ---- -� -------- --------.... ........- ..... Location-Address or Lot No. ------------------------ -------------------------------------------------------------------------------------------------- w p._ Owner Address Installer Address UType of Building Size Lot............................Sq. feet Dwelling X 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 flow............................................. WSeptic Tank—Liquid capacity............gallons 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 ( ) ia Percolation Test Results Performed by.......................................................................... Date........................................ ,.� Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ fxq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-..-__--.--_-__._-_----. P4 ••-•------------------------•-----•----•---------•---•-----•---...-•------•......._-•-------•-...---......................................................... ODescription of Soil....S.an_d._&...Gra3l_el........................................................................ ---------------------------------•--•---------------- x w ----------------------•-------------------------------------.._....------------------------------------------------•----•----------------------------------------------------......................... U Nature of Repairs or Alterations—Answer when applicable--..--_---- OQ _.ZEL11q�_-- -pit-,---------------- ----------------------•--------------------------•---- •------•-----------------------------•----...-••-••-------•-••--------•-••----....----------••-•--------------------------•--•••---••- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TTIE of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued b t bo of health. Signed- ................. ---------- Date Application Approved By......... ._ _- Date Application Disapproved for the following reasons:----____•--___•__________________________•_-_____•-_--___--_____•_•__-________-___---_.-_--______---_....._..__ --------•---•---•---•-----••-•----•----------------------------------------------------------------------------•----------•----••••------•-----•----------••-•----•-•-•------•--------•-••------•------ Date PermitNo..... - ----------------------- Issued....................................................... Date No...E.7..r_..I Z 1cY ��..'.�-.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 4 ; ApplirFatiun for Uiupuuaal Works Tons rurtion 1hrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..-- .•--•---_-----.....'.....-•-... - f =..........-...................... ..•---•-•------------------.......---....... .---------.._......-•-----------......... Location-Address or Lot No. � . .. 1 .. . - ---•------ •------•--=------------------------------- -----------•--------------------•---._...... ............................................... Owner Address W J r Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d 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. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results ' Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water----------_............. fX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ix .---•-----------------------•-•--•--••-••--••-•--•-----------•-••--•-•-----------•••---•-•..._..._..-•---..._-_----••-------_•---........................... DDescription of Soil =.................•.................•.•--------------------------•---__-•-•-••--•--.x U -•--•---------•-•--------------•-------•------------••---•--...._....-----------•----------_•----•---•-•----------........-----•-•------------•-------•-•----------•----------------••----•---•_------ W U Nature of Repairs or Alterations—Answer when applicable____--._--�_-.1.c?...�a...... ::_ :....: t�_................... --------------------------------------------•---•-----------------------------------...._..-------•-•......--_-_---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance,with the provisions of iTT .a. ; p S 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. Signed=- = 1 ------------ " ---------------------=------------------ =-==-� ......1---._...... �,� Date Application Approved BY . -_--•-...... . __ �. �. Date Application Disapproved for the following reasons:---•------------------------------------•---•-------•---••--•-----•------------------------_..---------.....---- __•------..._..•-•..............•--•-•-••--•-•--•--------•-•-.....-------_-----•--•-----.......---_-_-----•----•-•---•-•----•------------------•---------_--•-•-•---------..•---------•---•----_---••-- Date PermitNo._- 3_7.:-...a--�z-------------------••-•- Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... ..........................OF.....-::...:.t r..c....s...:.... .................................................... Cnrrtifiratr of TautpliFatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired C�o by....u . : ._<. 0 _ L X-.. _.. �^ '._. ............................................................•_•---__-•_--_-___--__-_----_-__-.-_-__---_-_-_-_-_-_.....-__-_-___-_-•----•---•----•-----------•--- 1 C�...................................................... 1. (F Installer has been installed in accordance with the provisions of TT i1E 5 of The State Sanitary Code as described in the application for Disposal Works Constriction Permit -�'_.......... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................. 1 G.---1.2.............................. Inspector--•-- --------_---•----••--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH k.,. },d ............ .. ,a E Disposal luorks Tonotrur#iun "anti# Permission is hereby granted -.c.:.. `..... .................•---------..........---•-..................------. to Construct ( ) or Repair (�� ) an Individual Sewage Disposal System atNo.......................................---------------_---•--------...._...--•_---------------._........................................................................................ Street as shown on the application for Disposal Works Construction Permit Noj7-.__,';Z_ .. Dated.......................................... .................. -- --•---------------------- . �Br ar�Hea�ith DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS i^g ASSESSORS MAP NO: No................--....... PARCEL N0: � Fim .................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH -•------ `0.�"l..'�.........OF.....a� .... Applira#iou for Uiipniittl Workg Tonotrurtiou Frrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: .. ��.... h Z '�2n/sT�.�31 j Loca i Address or Lot No. ------------- .............................. � _ ......------•-- --....----- --..................-----........-----............. Owner Address a •-••---------- ...n. ------------------------------------------------ Installer Address UType of Building Size Lot___-...Z3_:�........Sq feet Dwelling—No. of Bedrooms___..._.....-3...........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures . W Design Flow............................................gallons per person per day. Total daily flow____.__.....33o.___........_........._gallons. WSeptic Tank—Liquid capacity.6b .gallons Length..!f�6`'... Width__ 4����_ Diameter________________ Depth_S"BN.. x Disposal Trench—No. .................... Width.................... Total Length............_....... Total leaching area....................sq. ft. Seepage Pit No........./--------- Diameter....... Depth below inlet.....4............ Total leaching area__3oZR_sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.... G✓ -1�_.._. - Date..!! ��c�7, - Test Pit No. 1___ ___minutes per inch Depth of Test Pit---- �......_ Depth to ground water____•-.""-'_•__-.----_- 4s Test Pit No. 2................minutes per inch Depth of Test Pit.... 6 a--- Depth to ground Water------- ............. 9 --------•----------------------------------------------------------•----........-------------•----•-•-----•-------•-••--•••-•-- Description of Soil..---.. -_��..---iNoo�loi�r�r._Sv;g-=rS�iG---- --'S 1 D f !0Y,/X---------------- W U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ••-----------------------------------------------------•-----------•----------------.....------.....------------------------------------------------------------------------------------....._.....•--- Agreement: The undersigned agrees to install the aforedescribed I ' idual Sewage Dispo ern in accordance with the provisions of TITr. . 5 of the State Sanitary Code— undersigned rt . r s not o place the system in operation until a Certificate of Compliance has ' sue y the board o h Signed....... ....... ................. ---•----•-- ...... -- ---•----------•--- ................................ Application Approved By_....__..__•-•=--=------•-•----••---- ate t -----------------------------------------•....-------••-•-. 7 Y Application Disapproved for the following reasons---------------------•-----------------------•-•-......• Da e•----- ..................•----•--•-••---....-•-...------....•--------------••••-------•-------••------•••---•-----•-•-•-••-•-•---------•-----------••-•••-.--------------------------------------------------- 9 - Date PermitNo.---...... ...................................... Issued_.................. ..... Date No..�� ---••..... FEs............._.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .------.....-%Hit/...--....OF..... a z/✓Sri9 G. ::... AVVIkation for UhipasFal Workii Toustrurtion Prrmit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: . ...................... --------------- -----•----------------------.......--...... -------------_..-----------......_..-••------......••-- Locatio- -Address T/2. or Lot No. 17 �_7•/ 5 Owner Address Installer Address Type of Building Size Lot.... q feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria Design Flow.-Other fixtures ..........................gllons per person per day. Total dail flow__._.__...330 ______ ........gallons. W g g P P P Y y . WSeptic Tank—Liquid capacity._--•--_--gallons Lengthy,., A...._... 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.A?7*--.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by,_'- ' .....4.< J L�__Z-�-.�.��..-....... _.l W ,.a Test Pit No. 1_._!4_. -_-_minutes per mcl'; Depth of Test Pit... - ...... Depth to ground water___..:""'............. Lz, Test Pit No. 2................minutes per inch-. Depth of Test Pit...14j .`.... Depth to ground water.___-_-^—........__.. .-••••••--••--------•.........---••••••• ---••---------••••--------------------•---•-......._...----•-••••••......................................................... Description Of Soil.....°...... --56!_G�___ __-S/ 0----C �......... lX V W UNature 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 iT LE' 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. Signed...................................................................................... s _ ......MF, ._ Date Application Approved S ...... .._•__ ----•-..-. � D __-- Application Disapproved for the following reasons:-------•---------------•---•-----•----------------•---------•--------------------------------------............. ..•--••---------------•---------------------•--.....••••--•---••-••-•----••---•-------......••-------•••.I•--------........••-•••----•-•-----•-•--------••••-••-----•-----••--•------•---•••-----........ 1 Date PermitNo. ........................................ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �.....w..✓........OF.....�-.......h.."z.�Y-S7 3' .C.' ........................... Trrtifirate of Toutpliattrle TH'S IS TO CtiERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) Y- �o 1 n a --------------------------------------------------------------------------------------------••-----••-•----•--•-.....--- : Installer has been installed in accordance with the provisions of Ti-5=4 5 of T e State Sanitary Code as described in the application for Disposal Works Construction Permit No.__ --- ..� ,..... dated------(��.//.2_Pn........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. ^� DATE................... . -. !- ..�. ....................... Inspector_ •_-d� --------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - � ............T.a ir!...!/..........0F...... ............................................... r 1� ................... FEE ........................ R.Splark Works Tontrn.rtiun rrmit Permission is hereby granted t ir� ------------------------•----•-•----•...---......••..._..---------••--------••--......•••-•-----.....••••-•--..........••--...... to Construct -�or ,Repair ( an Individual Sewag a Disposal ystem atPTO..........isIC•-C ...................`-'`Z.......... .�-- -- ......................................... Street as shown on the application for Disposal Works Construction Permit N .: ------�.__ ated....... ............ lk Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS TOWN OF BARNSTABLE I:,rXATION /z'7 �®M/4 4'10 v,- SEWAGE# �MLAGE C e-Of Ye I IIIII!�- Zd /� ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. 1 SEPTIC TANK CAPACITY 2 Z ��L LEACHING FACILr Y: (type) —to &I Lcuef (size) ,t'? NO.OF BEDROOMS /l pp BUILDER O OWNS Ar444-7n 9A PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility J`f 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) l`� / Feet Furnished by 00 LOCATION SEWAGE PERMIT NO. VILLAGE INSTALLER'S NAME ADDRESS /t B U I L D E R OR OWNER o� DATE PERMIT ISSUED T`/ ODAT E C0 M P L I A N C E ISSUED ;l I' � �' �� �` � ®` ,, � � � rr �. � i 6 � i �� � a ® 3 . . �,.�,_ , ' �3b -� ,� .a too No.._. Fimic ......... ._ . THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 00-0 T�w ............o F..7 ,LS--------------------------------------- Applira#iun for MipasFal Works Tunitrnrtiun ramit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at: -- ....................1-!--)��'11.U.:.�.1 ..�..��V���`���.......��..... ......-- Lo tion-Address Lot No. ..... . off %...._ .. •�^ ('owner A dress a -•--••........ ,7...(-.......(_�_&N'nz a---------•-•------------------- -�'ci ftN1F3....•.�� .r.�f ? t �1..L...... Installer l � Address Type of Building Size Lot.\llii 1r �.___._Sq. feet Dwelling—No. of Bedrooms......... .............................Ex Attic Ou a Garbage Grinder fV 6 aOther—Type of Building .......................-... No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures .----••--••------•--•--••-----..•---------------•--------------------•-----•---••-----•---•------------•------••--••-•----•--...........-•----••--••. 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................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........................ a •-•-•-•--•.............•-•--•••••••-•••---•--••----•-----•....•••-•--••••-••-•---•--••------..----•-......................................................... 0 Description of Soil......................................................................................................................................................_................. x U W 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 b i sue by e board of health. Signed... ... •- ...... -- ` t7 D e Application Approved By..... . ... ..... ._-______.1__/i ���/-•-------- Date Application Disapproved for the following reasons---------------•---------------------------------------•-----------------------------------------••----.....----- ....................................................................................................................................................................................................... Date Permit No.......__ �..:-� ...................... Issued-------- -......--------- Date • ys Gam./-- YA t CJi. '; No.:-•-•................... FE$.............. ............. b THE COMMONWEALTH OF MASSACHUSETTS �`�,� BOA OF HEALTH ...--•- ---- ---- --------------------OF..................I..,.......__....__......._.... Appliration for Disposal Works Tonstrn.rtion ramit y Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal SystemWMN t .... ... . - - (75� ...... ......... eviQ%-i. �= ...................... Installer Address Type of Building 1D Size Lot____�_____________________S eet Dwelling—No. of Bedrooms.................................._.........Expansion Attic O) Garbage Grinderyl� a'4 Other—T e of Building No. of ersons____________________________ Showers —Type g ---•--•-•-----------•------- P ( )--- Cafeteria-(-----)- 44 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. 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. 1................minutes per inch Depth of Test Pit____________________ Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.................,_...... ---•----•--•------------------------------------------•--------............................................................................................ Descriptionof Soil.......................................................................................................................................................................... x c, w VNature 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 T IThL 5 of the State Sam itar Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has, n"ssue byt, oard of health. d 1 ,Sign e a�-` 8 �� ate ApplicationApproved By----•--------•------------------------,----...--------------••--...._.. Date Application Disapproved for the following reasons-------------•-----------------•------•------•--•-------------•-------•------•--•-------••-•••-•------••--•••-•-- -•-•-•--.......--•--•-------••---...-----••--•----•--------------------------------------------•---•--------------------------------------------------------------------------------------- =`a-------- Date R„Permit No. 1 D e ��- - ____---------•-------- THE COMMONWEALTH OF MASSACHUSETTS B ARD OF HEA ''t°e ..........................................O F..................................................................................... PS (�rr�ifirtt�le of fl�unt�r�i�nrr THIS fS14F&"6RTIFY, That the Individual Sewage Disposal System constructed (X) or Repaired ( ) by......... --•---- == -----------------------••--•---••-----•-----___________-___-------------------------------- � v/ "°'^-��•-' Instal� at ------------------•---•- ------. `fit k'X' �����-----------•---••----------------------•-------------••------------ has been installed in accordance with the provisions of TITLE "of The State Sanitary Codl as e-cribed in the application for Disposal Works Construction Permit No------ _^_f v_!__ _. dated-------f:�._.�,_ _4___............... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GU RAN EE THAT THE SYSTEM WILL FU CTIO SATISFACTORY. DATE................ _ .. Inspector.......------ •- ---• ---- ...... -•------•••• ... THE COMMONWEALTH OF MASSACHUSETTS fBQA,R D OF��F� op� I ,rt� �-!0 t OF.................................................................................... `Upa No...�3... .. FEE........................ Elispos t,,k nrks Twllns#rnrtuan rrntit Permission is hereby granted--------. ': ~ t.trn'`-_....-----•--.-------------------------------•---•-----------------..._....---------....-•---••----•--•--•--- to Construct ( )),,or,Repair ) an Individual Sew"�agge Di s Sys --m atNo.----------- = ,.. .......---Q�:....�:--•--------------•---••--•---- ... Street as shown on the application for Disposal Works Construction Permit No....... ��-tG?±b.ted...... DATE. Board of Health -----------••------------•--•-•---..._.._....-•--__•_---- FORM 1255 A. M. SULKIN, INC., BOSTON T-,<�•.,, 13 --A)-L EtEBB. 9"oujAj Al2F .)A/ AnlA15C��uf C. j 01 —�- •-* W r -- / Ptlk--W ALL LIdES A MIU,MI>r� OF I/rb'/F.�-t I _ _ 1 UwtLE�� CITNE )CSE 3�GxIFtED. ALA- P%Pf-'5 -finAWO td T44E SYSTEM SNa�L NA G►ST it2t�►.J Cie- SC.ti•1DUL E AO P�/c_ Ail. 'SEPTIC TASKS, PVST205LYTI,0 J gox, A"D �/ l..E�•C�-1�.JG-� Pt� SHALL >�E �E.StG..JE� { WHEN INSTALLEPUNDER PAVING. A�J 7 s { -- - --- _- 1(J CS�-- QEMO✓E Au- U..1Skit -A3UE MATE�tAt- OE+JE�TI 1 30 C, ( 00) THE 11J�/E2T' ELEt/ATIo.,1S of t_EAC1-41 _ ._ Q Ac.AaQS of AJC) �n��FtLL �tTN cry a~�c�E � - - rr\\ Se.�D �.n.►D C�2/a�lE� V U C) E �., •Y O T NE A P,L t��z.o o F HCAF U 10 L-T'H M ST i - i I ` �' �) riCsrt�,ED WHO T►�� �ySTEM VS (VEAP- _ IPA _ t O c' c r r�c� `'A. O c 0 �, �oNkPOnitEtJ'>5 S►t�a.t� �'iE t.tSTc.�`co t+,.1 TYPICAL (� J ITp L'y C1JUE Aw1D tieJy t►C)CdL 2L>�ES IdcTYPICALDIST2lr�uTlc9�1 F3©x O �� 0 @ C' (D ; NfJ 1lf.4j C .: (.CGuZ/TG1ZErJ ► orr T4p §GALE — r----- v I 'r tJarE 'o-wresavr-aJ am- 'fiw664a 'IGao 6t.� 1-" _ -�'►� - =EkC VA no A/ P/rs QE►,,iFoec�>a se;vr-lc tsy Awtt`elc�J MEC-..Sr ►.1oT -V!� SGe.L.E wtc�r ca Sc.•�E OfK- E Q lJ�L w;am I ' -r^*4 K S "U Fr-o G V TNC,�uG N pa-T Are C04A r/O A/ 4A7X- 1141n /.mac h tti/IY1a EI.ECTP-%C. tiL/El.pEa vriet 11ifT"1-1 OB3�CV•1T/OAtS 6y: TS/ Fi..T 24 - *` F"SEODE0 s'T�L- Caz>S #.1 ScvTr�c �fr►�c� A 004AZO a. - Ae. 4 r,0/ boTi cM. Cd�c. 16 400o pgl. TEST To *,e a0I�T UP Ta I'L'•�+c14t"_'S eeGtf% +�AAr,,,u c/Ale /AJ[ 8et��nl F rutSu Gti"�C�L� Tor- Fc,wtDATtOw� n F11,115l4 6RI►orE l: I061/St1 64E,a..t7E Fttt,ll'31r• bc^ DL G'J�L �F�NtSt/ G[�►DE • ,�a G/ER T�►�4.K �= bvlEit"T�ISK:x `- z {,.E.O.GH•�-tG i • �" PC�.STo�E �� •� � - � ;4�I tJ l.d T r • � 1 5�, w� gLbG .� t �' {` tMe/• ► O ® O titA�►IE D Torlt SUitOz� 1 ` Er��.. � m I � O � too b N t I 5e ! ✓ iLC I►j FOCGC t7 CAW1 C �i- � • • • Q ® O ® �. •• !Zts, j � -----�.- --- _ 'TY►'1 C..A L E.�,,WE S TE M t�It7►'F 11,..E ---- NdT TO SC.�►.L 6 LE�►.CN IKJGx �'� 14 7 7;:. _ 1�770 Lo l 14 MAP SECTION PARCEL, LOT ADDRESS F- FL J i I Ar 51 k S'9 MA A 1 SD ( P, E i- , EY/ST C'avrove PROPOSED OW&L l NG ZOCQ TION � r•- OGES/G/K/ G2/TE!/� _ �Ieosbxc� c'avlduG ��°''� ��,y��"s� 4 G v`�' 3 D E PROPOSED SEWAGE PUPOSA,L SYSTEM AlVA.!O EAe OF A%".0 C 01W s ? EX/9T 4'G1r 64J"V- r a E ✓ T- L ' q PE�ISON/S i?E�C �DQOOM � /pitGt�. 4oOT ELEL' C� RpYMDND 4 i c JO � H I�1 ,41 N -S 6Al[4(1S fKC.�'+M )W A4 Y _ �Pt�[ilTlav P r ',.� 110 j� C t 41 T r� LE.4G.y/N6 �t'EQ _. P t� 4a �[J�t�?Tiwv , f s r:ay,�� �"� �.. r/� - L.dACWr vG ,prd W10 *., + PROPOSED LMAGH ItJC+ P I T Ft'1"�L.k�AI►>)1'% il.td 11.J+ Amma tWe Ada !NG 100 C A PA ht 51 O N 40 r' 1. 14 4"1/A " w Ved .• .. rir.r•rY �O RUB ERTF w( j F cg i t- 7rr itAYMONp �„r rra zlsa� AS NOTED t�l� # ' !` 7 OF] S�`��� ,16, PL.If.�.'1•'t 4!� Imo, �`� 3vq'�fi�fsrE��` � tia i� 'trr: ter ww Ma •�GA�l.. _ ' .,suss ' - i t�E '