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Home My WebLink About0090 WHIDAH WAY - Health 9n ihi-otah wn Vl ((� SMEA® No. 2.153LY UPC 12934 r.mead.eom • Made In USA tcvc" SUSTAINABLE FORESTRY INITIATIVE Cortified Fiber Sourcing II �.durroerarnnro THE COMMONWEALTH OF MASSACHUSETTS // BOARD I-IEA . .._ Y e.�'l ..............OF... � .... ................... Appliratiou for Uiipniittl Works -Tanotrurtinn Frratit Application is hereby mad�el for a Permit to Construct (=y or Repair ( ) an(Individual Sewage Disposal 7Sd;L ... ............................................. Location-Add r - o t No. ............. �e .. �.��-.... ��- •.--•-•-•--... .�GF..s.. . c:,n----e .�).,l..e..........--- C Owneer^ /f ^- M Address ]...--- - 4r_i15-�.5�..1.. ................................ .............. �........................................................... Installer Address t� Type of Building Size Lot��5....7.....Sq. feet U Dwelling—No. of Bedrooms.._._________________________________Expansion Attic (ilU) Garbage Grinder (4 `4 Other—T e of Building .............. No. of persons...._....................... Showers — Cafeteria a' Other fixtures,_..................................................... W Design Flow............. .. :...................gallons per person per day. Total daily flow____--�5&Z).....................gallons. WSeptic Tank—Liquid capacityjo.o.t.gallons Length................ Width................ Diameter-___-__._.__---- Depth................ x Disposal Trench—No. ..............•..... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area.... _____.......sq. ft. Z Other Distribution box ( ) Dosing ��J aPercolation Test Results Performed by..... - �! -__ , �f��!7 � !rl__ _._. Date_._ Test Pit No. .Q.............minutes per inch Depth of est Pit".Ap.1... D;p to ground water--•. _- lx, Test Pit No�... ...minutes per inch Depth of Test Pit Depth to ground water.��.�.. r /....................................•---------••..........•---•--•--•------•--...---.--••- O Description of Soil•-•..... .... �.4.�1 -. � 4 j l ...................... -,------ 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 iITL U 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 oared of healt Signed-- - -- - -- ---- ---- - -.... ......................... Date Application Approved BY•••............•• --•-•.............................................• -------- R � Da Application Disapproved for the f of ing reasons:.............................................................................................................. . ................................................... ------------------------•-----------------------•---••---------------------•-•----•-•-•---•-•----•-•--------•••--•-•••-•------......----.....•- Date PermitNo......................................................... Issued....................................................... Date No..... Fpsv�... _. THE COMMONWEALTH OF MASSACHUSETTS . �.. BOARD H EA Appliration for Biiivoiittl Works Tonstrartion ramit Application is hereby made for a Permit to Construct ( or Rep it ( ) an Individual Sewage Disposal Location Add P i ._........._ Owner A [J {r. p ddress ..._Do_1t..d_.1..&-----------------•----•--------- `+...d.�:!_''s._i� �`►�. ----•-- Installer Address .+**• Type of Building Size din .-Sq. feet Lot£ Dwelling No. of Bedrooms-_____ --------------------------------Exp an ) Garbaion Attic ge Grinder (40 aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixturres,�.,.........................................-...-•------._._._.----•----•-------•-•--------•----....--•---._... WDesign Flow............. ___ _...................gallons per person per day. Total daily flow.......3 .._ WSeptic Tank—Liquid capacity)Z a.0-gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing j�( tom- '"' Percolation Test Results Performed by--- ......+ .�° _ � °� "' "�: r % j Date.... .................................. Test Pit No. r.,.,...,.!1-.minutes e �__._minutes per inch Depth o est Pit---- __�__�.f___ Dep to ground water« a44 Test Pit No. per inch Depth of Test Pit____________________ Depth to ground water____......... .---------- G i -------------- •---------- . --------•--------------------------- D Description of Soil � t�'�l r Y tom • --� 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 TITL% 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued by the ' .argil.of lealt Signed = d• % _ .. .•• - Application Approved B " Dace Application Disapproved for the f oll ing reasons:_--•-•----------------•--------...__....-------------------....--------------•--._....•••••---••...._..••-•••-- -------------------------•-------•------=-------•-••---------......-----------•------=-----•------.,.-----•....•------•--------•....-------••--•--•-•------••••-••--•--••-•••••••-•-•••••--•-----...•-•- Date PermitNo...................................................--•-•• Issued................---..................................... Date THE COMMONWEALTK OF MASSACHUSETTS - BOARD OF ; HEALTH .....lag # ............oF...!�✓�>�%�.��5...: ��... �.................... ... Cnrrtifiratr of Tontphattrr THIS IS TO CTIFY, Th t the Individual Sewage Disposal System constructed ( r Repaired by----- _-_----Ins♦ ---------•-------••---•------------ •---------------------- at Instal has been installAd in accordance with the provisionsJof TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE,'SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNC ION SATISFACTORY. DATE...............•---- = Inspector � ._. -----._...-•-• -- -•---•••---•--__•- " THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA Tlj..............OF;:... .'"" '_ ._. ..:.:.z. ............................ g;L No..... -5`:-j�?'� FEE. ... ..Q...... . �i��ro�ttl nrk� �on�#rttrtuan �.ermit Permissionis ereby granted..................... ':....-------•-•••'•••----•-•--•-•-•••--••••••-----••...._._..•-•-••••-••.......__........ ...._.. to Construct ( or epair ( ) an individual-, wage Disposal S tem at No...--C� �1._t_ t_ .. r ............................................ Street as shown on the application for Disposal Works Construction Permit No��'___�f Dated...... 3 j k ................................... alth --- DATE L " " and of e ..: ................•-•-.. FORM 1255 A. M. SULKIN, INC., BOSTON ' ,e n tarp1-36 LOCA! % O , SEWAGE PERMIT NO. �VILLACE INSTALLER'S NAME i ADDRESS � 42-40") Vol t�s 8UILDER OR OWNER. Y DATE PERMIT ISSUED ' 2. I-36 /S-- S- DATE COMPLIANCE ISSUED Lo G �-IiO� W ti✓�y ; W PA / S ROBrEF fB. ca VVi ' OT C to _\ RCS 0 2,vEr. (gin . S^?'1lfLC si Sol 6 - �.-� - 1CP`�� IV s �� 5 �• 7 LEGEND EXISTING SPOT ELEVATION OAO CERTIFIED PLOT PLAN EXISTING CONTOUR.--- 0 —— FINISHED SPOT ELEVATION W , �;, „/n - FINISHED CONTOUR . O ° r Z NOTE: The location of any existing underground. wells, or other utilities shown on this plan is approx- IN �Zcvis�iJ �S imate onl as determined from records and/or verbal r =, nformation. .The contractor is res onsible for the SAAkI S J AJ-wAJA 10' verification of the .existing locations in the field. SCALE, / "_ 1-D DATE 6 �� `�.� Doil W4 REDGE ENGINEERING Cat IN2 EweR` CLIENT. i CERTIFY THAT THE PROPOSED E013TEAE REGISTERED J08 NO. y3 a 1 ( BUILDING SHOWN ON THIS PLAN CIVIL LAND' A A Aq CONFORMS TO THE ZONING LAWS` E 0 NF,� R RV DR.BY, OF. BARNSTABLE-, MASS N _71:2 MAIN STREET WWI, � 27 �� MYANN I $, MASS; # — SHEET..' OF Z E REG. 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