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HomeMy WebLinkAbout0064 WHITE OAK TRAIL - Health 64 WHITE OAK TRAIL, CENTERVILLE A=191-049 No. 42101/3 ORA 71 ESSELTE 10% O O O O y� .. No ..... -.._....... Fizz............. ........... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Uiipniia1 Works Tonstrnr#iun ramit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: ..64 White Oak �? a�1.--.�.�x1:t�x vi.l.l� �� ........_.... ..... .... ......--•---------------------------------------------------------------- Lo ation-Address or Lot No. Barbra D. Renard ......................--- ....- ......- ............................................... ............................................. ...---------•-•-------.-----•••----------....----- Owner Address ng----_----•---------------------------------------------- P.0 Box 7 Y a r m o u t h k?o r t Installer Address d Type of Building Size Lot............................ q•5 feet I U Dwelling—No. of Bedrooms.......Three Expans'on Attic ( ) Garbage Grinder ( ) a44 Other—Type of Building ............................ No. of persons....w°.--............. 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ W 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........................ W --•-------•---------•-••--••••-------•----------•--•--------------------•-•---------•••••--..__.....-•--••-----...._.........-----•-•--•-•------•------...... 0 Description of Soil............................................................................... ------------------------------------------------------------------------.....------. W V ......................................---------...----------------.....-------------•-----------•--------•-•------------•---•-•------•--•------••-•-•---------------------------.........---•----•------ W x ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------••-----------•------ U Nature of Repairs or Alterations—Answer when applicable..I n s t a 11 1 �_5 0 0-_._q a 1 hold-'n q_____________•-------• tank.4. c o n t r a c.t o r-_-3 3 Q- i.th...a...L o_t er-at.o n e's---41-1..-a r.'Du -d --------- Agreement•. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia s been issued b the rd health. Signed -....... . .....y - - ....�------- t Application Approved By �: ------- ----------------_------............. ................ Dace Application Disapproved for the following reasons: .... .......................................................................................................................... ...--. ---------------------------------------- Daze Permit No. 'V— 'e, ��---------- --- -------- Issued ..----- -...............................-- -------.�....... Dace 011q 1, No V FRic............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Uhipasal Vorkg Tonotrnrtilorn Prruat Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at': 64 White Oa.k Tai 1 C'ani ar��;_1.1�___M _ .... _..._..__. ..........r Tr .- .... -•-------•--------------•---•-.......---•----•----- .........---- Location-Address or Lot No.- - Barbra D. Renard ......................_.... ..... -- .............................................. ........--••--........-•--------......-•--•••••---•--•--•••---•--•••................••------•--•-- Owner Address _in, r.o.; o P.0-Box 7 Yarmouthport ...... -• ._ .. _ ..-•••••••........-•-••--••••...... Installer Address d Type of Building Size Lot--_------.... Sq. feet 1-4 U Dwelling—No. of Bedrooms.........h r e e _Expansion Attic ( ) Garbage Grinder ( ) at Other—Type of Building ............................ No. of persons___ w�....._____._._._ Showers ( ) — Cafeteria ( ) d Other fixtures ------------------------------------•------- -•-•----------------------------------------------------------------- ----------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'ca.pacity......_.....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 tank ( ) l Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 Test Pit No. 2................minutes per inch Depth of.Test Pit-_-_-_-------.__._.. Depth to ground water........................ R+ ........................................... .--------------- --------------------- •----------- ------- -------------------------- •------------- -----•- 0 Description of Soil.................................................................................................... W U ••••.....------•--•-------•-•-••---------•-•--•-•-•-•-•-••••-------------•---••...--•--•••....-•---••---•••••-------•-•••-•----•••------•---••.....-•-•-••-------•-•---•--................--•-.......... W UNature of Repairs or Alterations—Answer when applicable_I n S t a 1-1 1 , 5 00 g a l_ ho 1 di n u_________ tank-4 contractor--_ i-r,rct- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued I the board of health. 457 Signed_: � ?------- -' .%1. ------------------- .� .3 , `� ; Dates•.(. Application Approved BY Application Disapproved for the follow Date ing reasons: --------_---------- -------------------------- ------------------------------------------------------------------------------ - -------------------------------------------- - ------------ E pate Permit No. -^ - Issued - ---------------------------- --- ------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (ferttft ate of C�omyliance THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) b Y �✓, j �� ---------------------------------------------------------------------------------------------------------- ........... �� Installer ----------------------------------------- has been installed in accordance with the provisions of TITLE -5f-The SLta Xnvironmental - de 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 FUNCTION SATISFACTORY. DATE---- ------------` 13 - Inspector . ---------------- --------................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ......................... FEE........................ .-Rap anal Worho Tnns#rur#ilan ermit Permission is hereby granted - ----- -,� .---------------------------------------------------------------•-••-----......---••--•----....•__.. to Construct.( ) or Repair (_Van-Jndividual Se, :age Di po Streetsal. System, D / '` at No. - ........... ------- ------------------------------------ ------ ,_.... T ...... ��as shown on the application for Disposal Works Construction ermit-No_,_---_--------------- Dated.......................................... -J� Board of Health / DATE---...--•-------..'�-'.-••-------------------------------•-------------------- FORM 36508 HOBBS h WARREN.INC.,PUBLISHERS 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 DESIGNED PLANS) I, Ensign Cash ,hereby certify that the application for disposal works construction permit signed by me dated February 4, 1997 concerning the property located at 64 white Oak Trail , C e n t e r v i 11 MA meets all of the following criteria: There are no wetlands within 300 feet of the proposed septic system ire There are no private wells within 150 feet of the proposed septic system 1-9 The observed groundwater table is 14 feet or greater below the bottom of the leaching facility There is no increase in flow and/or change in use proposed �• There are no variances requested or needed. Gam" SIGNED: DATE: 7 7 LICENSED SEPTIC S EM INSTALLER IN THE TOWN OF BARNSTABLE NU ER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. jxert TOWN OF BARNSTABLE 64 White Oak Trail LOCATION SEWAGE #��� VILLAGE Centerville ASSESSOR'S MAP &LOT � INSTALLER'S NAME&PHONENO.Cash' s Trucking ( 5,08 ) 362-3221 SEPTIC TANK CAPACITY 1 , 500 gallon holding tank. Q C 1(;?c)C LEACHING FACILITY: (type)4 Contactor 330 (size) W/ 3 f o o t e r s t o n e NO.OF BEDROOMSt h r e e BUILDER OR OWNER Barbra D. Renard PERMIT DATE:0 2—0 5 0 9 7 COMPLIANCE DATED 3—1%—9 7 Separation Distance Between the: 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 Furnished by Cash ' s Trucking 1 �- �� .w7 �,� �1 2 TOWN OF BARNSTABLE LOCATION64 White Oak Trail SEWAGE # - 6 VILLAGE C e n t e r v i l I a ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.Cash Is Trucking ( r08 ) 362-3221 SEPTIC TANK CAPACITY 1 , 500 gallon holding tank. LEACHING FACILITY: (type)4 C o n t a c t o r 330 (size) W/ 3 f o o t e r s t o n e NO.OF BEDROOMSt h r e e BUILDER OR OWNER Barbra D. Renard PERMTTDATE:0 2—0 5 0 9 7 COMPLIANCE DATED 3—12—9 7 Separation Distance Between the: 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 Furnished by Cash ' s Trucking -4 Sturdy Built Mfg. P.O.Box 187 East Freedom,PA 16637 814-696-7911 Name Address ap 0 ' � � �l �..} �.�'� «�}' ��� Date City C r ,,, I k P Y x It 6 State , Zip 01('2X Home Phone (5J) ` 7)-1 9% Day Phone AO P q Excavation, Stone and Equipment Allowance Lineal Feet of Footer @ #of Blocks @ $ per Sq. Ft. of Concrete Sq. Ft. ' base Price of Package Optional Overhead Doors Z: Extra Entrance Doors Extra Windows Dormer Other Charges 3 r / ' ka Siding ` E-I Color N Color Shingles W Y} g .. Type Entrance Door Sales.Tax if applicable Size of Bldg. Modelf �t�crw Freight #OH Doors Size 7X 11 Model �c7 Total , ) Standard series (A) Builders series ( ) Options 30%with Order rr 60% (Certified) on Delivery of Materials 10%on Completion 96 1 — IMPORTANT NOTICE—An additional charge will be made where site is not level or if wheelbarrowing of cement is necessary.Sturdy-Built Mfg.does not furnish paint or do painting,backfilling or landscaping,electrical,plumbing,heating or water connections,or trashremoval except at an extra chargewhich must appear above.Total balanceis due on delivery of material if site is not primary residence. Ifpower is not available,an additional charge for a generator will be due whether shown above or not.Final payment is not contingent upon inspection by any government agency or independent inspector. Customer is responsible for securing all required permits. Customer Agrees to Sign Completion Certificate When Work is Completed. "You,the Buyer,may cancel this Transaction at any time prior to midnight of the third business day after the date of this transaction.See the attached notice of cancellation form for an explanation of this right This order constitutes the entire contract between the parties hereto,and no representation other "In consideration of the costs and expenses incurred by Sturdy-Built Mfg.in the execution of . than those contained herein will berecognized.All orders are subject to acceptanceby Sturdy-Built this Agreement,it is hereby covenant and agreed that ifpurchaser or purchasers shall cancel this Mfg.Delivery of materials will be made as close to the building site as possible.All claims for agr cement for any reasonwhatsoever,that purchaser orpurchasersagreeto pay Sturdy-Built Mfg. damages or shortages must be made within 24 hours of receipt of delivery.We are going into your a sum equal to 10%of the total amount of the contract as set forth above.It is further agreed that yard at your request,therefore we do not accept any responsibility for damages which may result. the purchaser or purchasers hereby authorize any Attorney of any Court of.Record to appear for me/us and confess judgment for the amount of the sum total due with an attorney's fee of 15% IMPRACTICAL OPERATION for collection,with release of errors,waiving staying of execution,inquisition,exemption and Nothing inthis tariffshall require the carrier to pickup or deliver shipments at locations at which, right ofexemption.This agreement shall be binding upon the parties hereto,their heirs,executors, on account of the condition of the street,roadways,or alleys the carrier deems it impracticable to administrators and assigns." operate motor vehicle.In the event of fire,strike,act of God,shortage of materials or supply,or any } cause beyond the control of Sturdy-Built Mfg.,performance shall be excused. Customer's Initials a t. Co-Customer's Initials �~} /n{ White-Original Canary.-Mgr.Office I'itilc-Customer PAGE 1 OF 3 GENERAL CONDITIONS 1.Time to Complete.Sturdy Built will commence work as soon as practical after this Contract has been fully executed,but not until the Owner has demonstrated an ability to pay for the Work to Sturdy Built's satisfaction.Sturdy Built reserves the right to revoke this Contract if the Owner fails to demonstrate satisfactory financial arrangements within thirty(30)days from the date of this Contract.Upon the Owner's satisfaction of the conditions set forth elsewhere in this Contract relating to the Notice to Proceed,down payment,building permits and approved plans,and providing weather permits,Sturdy Built shall use its best efforts to substantially complete the work within 60 business days.Sturdy Built shall not be liable for delay. 2.Change Orders.The Owner may request changes,additions or alterations in the Work within a reasonable scope,by sending a request for a change order in writing to Sturdy Built at the Home Office.Once the Owner and Sturdy Built agree on the cost of the change,they will execute a written change order describing the changes to be made,any extra work to be done,and any changes to the Contract price or Completion Date.Change orders received after the Notice to Proceed may incur an additional charge.The Owner agrees to pay Sturdy Built for changes in the Work upon delivery of materials.The Owner acknowledges that during the course of the Work certain changes may be required by governmental authorities having jurisdiction over the property.The Owner hereby authorizes Sturdy Built to undertake such changes,without the need for specific authorization. 3.Differing Site Conditions.The Contract Price is based on the assumption that soil conditions are such that post holes for post foundations,decks and sub floors can be dug by hand and that there are no unforeseen subsurface or latent physical conditions at the site of an unusual nature("Unusual Site Condition"). If an Unusual Site Condition is encountered,Sturdy Built shall notify the Owner of such condition before disturbing the condition.The Owner shall investigate the condition as soon as practicable,and shall compensate Sturdy Built for any direct costs associated with the Unusual Site Condition. 4.Workmanship.The work to be performed under this Contract(the"Work")shall conform to the standards found in any one of the following publications: "Residential Construction Performance Guidelines(NAHB)";"Central New York Standards of Performance"(by Home Builder's Association of Central NY); or"Handbook of Construction Tolerances".If an item is not covered in one of these publications,industry standards shall govern. 5.Materials.Sturdy Built calls the Owner's attention to certain inherent limitations regarding materials.While Sturdy Built makes every effort to match textures,colors and planes of all materials,factors beyond Sturdy Built's control,as a manufacturer's discontinuance of a color or product,shading differences of products,and changes in a product's manufacturing process,make it impossible to provide exact matches of materials in every case. 6.Notice of Unacceptable Work.In the event the Owner believes any part of the Work is deficient,in most cases a simple verbal communication with the on-site foreman will be all that is necessary to cause any such Work to be corrected.If any Work believed by Owner to be deficient is not remedied to the Owner's satisfaction,either during the course of the work or upon substantial completion,then Owner must send a"Notice of Deficient Work"to Sturdy Built at the Home Office within 5 business days.Owner agrees that Sturdy Built shall be given the opportunity to correct any deficiencies.If the Owner fails to notify Sturdy Built of any alleged deficiencies and to give Sturdy Built the opportunity to correct said items,then the Owner shall be deemed to have accepted the Work as is. 7.Acceptance.Upon completion of construction,the Owner shall sign the Completion Certificate(attached as Appendix 11).The Owner shall not take possession of the project before inspecting the project,signing the Completion Certificate,and making the final payment to Sturdy Built.The correction of minor deficiencies that is delayed pending delivery of materials shall not be grounds for postponing or delaying acceptance.The Sturdy Built Warranty,which is attached as Appendix I to this Contract and made a part hereof,will become effective and delivered to the Owner when Sturdy Built receives final payment and Completion Certificate in the form attached to this Contract as Appendix II. 8.THE STURDY-BUILT WARRANTY IS IN LIEU OF ALL OTHER WARRANTIES EXPRESS,IMPLIED AND STATUTORY.STURDY BUILT SPECIFICALLY DISCLAIMS ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. 9.Late Payments.Buyer acknowledges that late payment by the Owner to Sturdy Built of progress payments and/or final payment will cause financial damage to Sturdy Built,the exact amount of which would be difficult to ascertain.Accordingly,if any sum due Sturdy Built under this Contract is not paid when due,interest will accrue on any unpaid amount at the rate of 1-1/2%per month until paid.If Sturdy Built is required to institute legal action to collect any unpaid amount,a charge of 20%of the unpaid amount shall be added for the costs of collection,in addition to interest. 10.Buyers Responsibilities.The Owner and Sturdy Built agree to cooperate with each other to make the project successful.Additionally,it shall be the Owner's responsibility for the following:(a)to carry property insurance in an amount sufficient to cover any loss to the project;(b)to locate and be responsible for the accuracy of boundary markers and provide a survey if necessary;(c)to provide electric power,drinking water and toilet facilities;(d)to provide access to work areas for workers and vehicles and allow areas for storage of materials and debris;and(e)to dispose of any debris at the end of the job.(f)to notify all utilities and state agencies before work begins,if necessary:and(g)to notify/verify to Sturdy Built any curb height and masonry opening placement.Owner understands and accepts that during the course of the project inconveniences may occur from time to time,and Sturdy Built agrees to keep such inconveniences to a reasonable minimum. 11.Costs to be Reimbursed.The Owner shall reimburse Sturdy Built for the following costs which are not included in the Contract Price:(a)costs incurred for building code and regulatory compliance;(b)costs associated with an unusual Site Condition;(c)costs for an electric generator or port-a-john if those utilities are not at the site;and,(d)unanticipated extra costs to get materials on site if access is not available. 12.Protection of Property.Sturdy Built shall make reasonable efforts to protect driveways,lawns,shrubs,or other vegetation.However Sturdy Built shall not be responsible for damage to any of these items unless the damage results from their gross negligence. 13.Allowances.If a dollar amount is shown on this Contract as an allowance(usually excavation and stone)it is the maximum amount of cost that Sturdy Built will be responsible for.Any costs in excess of that amount will be the responsibility of the Owner.If the actual cost of an allowance item comes in under the allowance amount,the difference will be refunded to the Owner. PAGE 2 OF 3 E�/-0- /�,1 - aV 7 l 0 LOCATION ��` .� ��� SEWAGE PERMIT NO. VILLAGE 1/ INSTA LLER'S NAME i ADDRESS BUILDER OR OWNER 6 am. ,r v;l e GATE PERMIT ISSUED DAT E COMPLIANCE ISSUED /_ � �� C/11 ON Q0 Tj C CA Q, No Gf W No. .............J....... FRs.............................. .. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF F-I TH Avv trativu for Dhivvii tl Workii Tow5trurttnn Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: /'((n`r �/• /T Location Address 4iex O er Address a ••••....... -- •-----• -• • ••• -- ...................... ..----.._ 45 f? ...................................................... Installer Address Type of Building Size ......Sq. feet U Dwelling— o. of Bedroo s...--.....1...............................Expansion Attic ( ) Garbage Grinder V/t/)— aOther—Type of Building .'j............ No. of persons...... _--------------- Showers Cafeteria ( ) Otherfixtures .------••---•...............•--••---------••--------•--•-----•----------......•---............--••--•--•-•-•-------•-•-------•-•-••-••-•-----•-••--•-- 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.......j........... Diameter.._. Depth below inlet......-_4....... Total leaching area..-`.4./4 ..sq. ft. Z Other Distribution box ( ) Dosing to ) Percolation Test Results Performe( c ._ __ ' j_______.�-. d__.__..._.. W - -•-•----••-•---•-•--•--._ Date._.. � Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f3 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------••--•--------- • •• .............................- o Description ,/,of Soil- r--------- .... .u-..�-r.._c •4�� -... .---� ��_. !!_�('l�l�P� V -----------------I--------a --------�-�G�-L•�_ .-------------------•--------------........................................................................ w x U Nature of Repairs or Alterations—Answer when applicable----------------_-----------------------------------------------_................................ •-----------------------............................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Dispos 1 S tem 'n ccordance with the provisions of,L i p of the State Sanitary Cod — The un gned further ree of p ce the system in operation until a Certificate of Compliance has been ittsue by t oard ealth. SigneNe- ..... \ ----------------• ----- •-------._...---.....-•----•-- Date Application Approved BY .._.._. ��- 4A �P.L = •----�r- .��. Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------- ..-•••---...•---•••...............•-----•----•--•••------•-••••••••••-••••--•----•-•-....._... Date PermitNo......................................................... Issued....................................................... Date No.. � .... ........................ T THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF H TH ............ /'lrtl�------.........0F......�?,,.44,'W - '.. ApplirFation for Disposal Works Tnnstrnrtinn rantit Application is hereby made.for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: _ ..........--•--•-----..l.. 4/:( o'./'�_�Y2_ /', 1 1t ::-'-�.`._I.N.L�l..J�=�._.C�!:!!.� .... ... Location-Address or Lot No. .....................e%✓,� :, a. l �/ .0 .r�?,h_1....✓.::1. z ' .. ' - O er Address a ?U�' --------------------- ......... W.. Installer Address Q Type of Building Size Lot_,.? ?,,__1.......Sq. feet U Dwelling— o. of Bedroo Expansion Attic ( ) Garbage Grinder �)_ a ...-•r ------------ P `L ( ) ( ) Other—Type of Building�tl::.�"�...._..:.... No. of persons............................ Showers — Cafeteria � . Other fixtures -----------------------------------------------•-----•••••-••------•-----•••-•---•-----••-•-•••----••----•-----•-----••--•---•--••-•-------.....-•-• WDesign Flow.-........... .................gallons per person per day. Total daily flow...........•7.-.:)...................gallons. WSeptic Tank l Liquid capacity/ gallons Length................ Width................ Diameter---------------- Depth.............. x Disposal Trench—No. _•__-----__-_----• Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------/------------ Diameter----�f�.,�y. Depth below inl`t........ ........ Total leaching area..2.X-V/�....sq. ft. Z Other Distribution box ( ) Dosing tank ~" Percolation Test Results Performed by._. �-—t- .� �...................... Date.../} "k.� d a Test Pit No. I................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........................ ----------- W/................ Description of �o� ".�..r. 9 Z .....-.-� �'��- •�..-•-•-•-�. ---------------------------------------------------------------------------- W ••-••---•-••-------------------------------------••-----------••••--•-.............-•--.••-----•--•----••----••••----•--....----•••--•••-•---------••-••-••-•••--••-•--•-•••......-•••••-•-•••......•••. U Nature of Repairs or Alterations—Answer when applicable--------------------------------------------•-_---_____--__-____-_-------•_--___-_-----------__. --------------------------------------••--•;-••-•••...........•-............................................ ........................................ ......--...................................... Agreement The undersigned agrees to install the aforedescribed Individual Sewage Dispos 1 S tem in ccordance with the provisions of TTL— p S of the,.State Sanitary Cod — The un gned further ee of p ce the system in operation until a Certificate of Compliance has been sue by t oard ealth. \ . . Signe Date -Application Approved By.......... �- • ................. . ..... ...... Date Application Disapproved for the following reasons------------------------------------------------------------------------------------------------------------••--- ...............••-•----•---...•••------••-•---•••----••••--•------•---•-•--•--•---••.........--------•------•-----•----••--••---•---•---•-•-•----•-•--------------•-----•••---••-••---••--•--•---------- Date PermitNo..........................................................^....:........................... Issued-....................................................... Date e, Y 1. v ? THE COMMONWEALTH OF MASSACHUSETTS �+ BOARD O HEALT rdifiratr of TuntpliFanrr SAITO' CE I h the Individual Sewage Disposal System constructed ( or Repaired ( ) byr ==----------•---- alter •... at.... ---- -------4"'_ a ' has been installed in actor ance with the provisions of > of The State Sanitary Code as described i the application for Disposal Works Construction Permit No._ f------------ --- --x�.__. da.ted_._._, _ _2.,�---.-a :. ........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM .WILL FUNCTION SATISFACTORY. r' DATE..........................................�'�� a ....................... Inspector............. ............................................... THE COMMONWEALTH OF MASSACHUSETTS 0 -- - BOARD OFHEALTI�, 15 No . FEE..'..17e........ Disposal Works Tnntr inn "Trani# Permission i her y granted............................................................................................... .................... ........... to Constr ct ( ortelfir (' ) ndivid S age Disposstat No.- aV ---- -- r =-- t- --e [ ' Street as shown on the application for Dispo al Works Construction4PPermit7No............ .... ated.._...,�_'s���...."�_........ ..----.....••--.. Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS •i D gvr0 Cot-OMAN Je. ET ,vL- N890-43`-OO"E e, ,R J 63 29,341 5.F l la'L�fttAGc� 1«E Q6 +� / 3 Grp 1 2� � z Pi4- G F er-f- A( 8 9°43-00"E �i Ct 2 �ar N A'� QQ • /7;q 80 -- \9 p v 20' �.7SRMFsNT .a o - 318•�1 i - � LY J ' F TOWN OF SARNSTABLE t,ALTER DiSP©SRL PLAID OWNER i , "9r�i k$k 8� h:, DANA WE.THERBEE �• v� r �.�sir E�1or d 't�-; y. 65 TF READ NEEDLE LANE CENTERVIL HO5 EN4 Assoc.jNc. 622 NO.MAN Sr. RAymHRNt 3iJ :� �*' ?r SCALE=1'`-4r� DEc.9 19�G 44 D 43.E p I ST•.BcK 4 s S S 25� 0 0 GEC-. D(A A4. l o0o C-tal. Cac 2 a da e a aa. TaK v- 4 S.0 4 a A6o a a e ZAAA 3 7 5 AVA 80T. PsT Lz I! OLD GRoUN spa.. 0, A Des l ArA ; S O L-So i I PE R C-O L-P. r l o N R,n,-r1=.'. 2 m oj Dom© p �3•S Z40' TEST F-oRvA ez> I 3 E3eDRoomS K. I10 3"50C Pp LEACIAil : , � �u�r✓► CA PA C 1 T y Pp o\/ /C> E f> : TT- SZ'y ( , Q rig ''; C7 rauC 471 —T-cr o,LC-^FACIT`i Tf�oVIP'eD54-9 ,7 �1 �(_. pT �- D15PoSA1 S\-lST NE1> �cGc�RDA%NCE: w 1 T1-4 -7tTl..�. 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