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I N S T A LLER'S NAME i ADDRESS
JOH,N A. AALTO:BACKHOE SERVICE
IbU Walnut Street
_ ablest Barnstable.Mass, 0266A
B UIL0ER OR OWNER
DATE PERMIT ISSUED
DAT E COMPLIANCE
ISSUED-, �/(/7
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
l..A2. . ...A'--1 ...........................
Applirtation for Bi_qpu,ial Workii Tnntrnrtion Famit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
__.............. ......... ."--.....
Locati n.Address or Lot No.
r� � .... ........................ ..........f�%gyp / r�.-arm On:.....� ti e e_v„t
a V d A/ • .� /!J caner................•---'-----....._.......... .....-•------/.-L l a!�.SAddregs�/� s..............................
��
Installer Address
d Type of Building Size Lot..ert�.,.0..O f lO...Sq. feet
U Dwelling—No. of Bedrooms................. ._...Expansion Attic (V47) Garbage Grinder (Piz)
~ .�// ....___._.. No. of persons.-_ '............... Showers — Cafeteria
p`"., Other—Type of Building _ p ( ) ( )
a' Other fixtures . ------------------------------------------•-•-•-----..........--------............••..
Design Flow....... .......gallons per �� ePday. Total daily flow--------- ..................gallons.
WSeptic Tank—Liquid capacity l':kMgallons Length................ Width................ Diameter____________•_.- Depth................
x Disposal Trench—No........... ..... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No...Z-__t. ... iameter........13.__..... Depth below inlet....0... ...:............ Total leaching•area. &q...sq. ft.
Z Other Distribution box (W Dosing tank ) /
Percolation Test Results Performed by.....A_t._. ,._. .4/WYikkl..................... Date_._....... ..`..l��r..�1...
Test Pit No. 1..<:7--minutes per inch Depth of Test Pit---Z®._°...... Depth to ground water.._.,e.1.,0..!..._..
Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.....................
-..
•--•-•'----•-------•------'-•••..................................•--•.........................................................
Description of Soil.......O...m-------•-.<...Y..s--------------------s.. ---. ----------- '-•-•- _e.04Ar.e_-_.5*/9/v�J
U
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 iIT s:'. 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.
Sig --------- --...................................................................... ................................
.... . Date
Application Approved By.. L`rfll -- a'I'Z
Date
Application Disapproved for the following reasons:............•---•------------•--•-••----••--•••-•'-•-•---••---•-------------•-•----•------ ••---•......----'-.
-------------------------------••-------.......----•----••••--------------------.......----'-------....-••--------------•-----•-------------•-•----......-••'•--•-- '........................
7q� Date
Permit No......................................................... Issued of— ........•• !-r•---•---'------- ate.......
Date
ce4 5•�
N FEz
K THE COMMONWEALTH OF,MASSACHUSETTS
BOARD OF HEALTH
OF.......
,� lirtt#io orDispa 'allUoru rCn t rnr iun pamit
'Application is.hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
... ............ ........................................................
.. .
Locatrqn� -Address o Lot No.
i
caner Addre s
-•_... __.. ..... •................. ..•-------
Inst'aller. Address 03''j
d 'Type of Building Size:Lot._ Q__4'9.'h_0...Sq. feet
U Dwelling—No. of Bedrooms._.:. ..___Expansion Attic & ) Garbage Grinder (#49)
' pa,, Other—Type of Building : No. of persons...'.r. ___________ Showers ( ) — Cafeteria ( )
QI Other fixtures }!�
W Design Flow......�_j!0...........................gallons per er day. Total daily flow----______11-�,y LT- gal
c4 Septic Tank—Liquid*capacitylSOOgallons Length................ Width................ Diameter................ Depth................
Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
� 1 � ✓ P .... ..... ft.Depth Total leaching area_._
Z Other Distribution box ( Dosing tank ).
Percolation Test Results Performed b .__. t._ _: ._ Date_____
a Test Pit No. L__4°_ :_minutes per inch Depth of Test Pit #.. .... Depth to ground water....e-AJ'!..I*.......
(s, Test Pit No. 2................minutes per inch Depth of Test Pit____________________ Depth to ground water........................
---•--....• ---•• -•--- ---•-• ----
Description of Soil------ ••--!°:....... 4........!-- -•--S. !" fd/'�;h[ .----- -`� ! l9/tLA L"►
V ;..
----------------------------------------------------------------- -----------------------•---------------=-•,------------------------------------------------------•---------•---------------------------
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 iIT .;•.
p 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.
�- .
...........................................•--•---•---------•----•-•••--- ................................
Date
Application Approved By..... = !r -•� .,. �a T ....
p Date
Application Disapproved for the f ollo'ving reasons:
..................................... ;----------------------------------------------------_----------------------------------------------------------------------------------------------------------
Date
PermitNo......................................................... Issued------•---•--------------------------------------------
'. Date
THE COMMONWEALTH OF MASSACHUSETTS rl
BOARD HEALTH
....... ... ...�i.... ...........OF....... . ....... ............................................
Currtifiratr of Tomplitanrr
T S S TO R That the Individual Sewage Disposal System constructed ) or Repaired ( )
hby.... .._....•. .--• -•----• •--••• ..........................................................
-.....
---•_ ° Instal •
has been installed in accordance with the provisions of T j f�The State Sanitary Code as described in the
application for Disposal Works Construction Permit No'__ ___::_.__ -�T-- --•------- dated_._ X---- ` '_______________
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL F�V�C�1 N SATISFACTORY.
DATE.......•.) ..... ........................................ Inspector--- U.
/..........
-T;HE-COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
€.w• ._. .... ....................................
No:_._.:0" 'f.:... FEE....... ..--•-----
•- „ ,
Mop 1 or. . o '' ion Vamit
Permissions rebY gra _ •. • ............. •'• ••--•-•-------•••••.............................
to Constr t ) or AR ipai �an dual Se a e Da Sy em
Street,; F
as shown on the application for Dis osal Works Construction It oY _. :- ...... Dated_._ _ _.'.� ...................
PP P
/ Board of He ✓
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x. DATE-------- -----•-� x
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS ��"-
t e:" SEPTIC SYSTEM YiVIl1ST BE. ON.�Tt��LLE I'!.!
c 8NSTALLED' 1N C ,?IPL ANCE SANITARY
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EXISTING "SPOT ELEVATION.. OxQ ; - = (CERTIFIED PLOT
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FINISHED SPOT ELEVATION L0.0�
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;APPROVED ;BOARD, _ OF HEALTH s 4 IN '
DATE 'AGENT : ,. SCALE —'¢0 DATE_
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GE ENGINEERING CO. lNG
€ -- CLIENTHAsK��� I CERTIFY THAT THE PROPOSED `Y
' (iEGISTEREt� REGISTERED� JOB NO. ?�°9 BUILDING: SHOWN ON THIS, PLAN
CIVIL" LAND CONFORMS TO THE ZONING LAWS
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�ENGINEERS� SURVEYORS DR. 9Y :- '_. OF BARNSTrABLE MASS.
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S' ,YARMOUTH, MA ,S.I'` 'HYANNIS, .Y SS: SH'EET_.L OF ___ DATE R'E�G. LAND SURVEYOR
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/D FT MIN. — uRAOF, 24 I�/AMETEK CONCRF_ T,e-- COVER
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OU7LET SEPTIC TANK
1A( .ET DIST)gOB6'T/ON BOX q °s FT GROvNo, hov,4 T 0,ZfE'
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NUMBER OF BEDROOMS 3 FT. Mice•
GAR9AGEDISPO.SAL UNIT ,SOIL L'.OG �r f=
TOTAL E3T/MATED F'LaH/%3 Q G,4L.1,oAy; 'SO/L 77E5T IbE/ SOIL TEST #2 SD�L TEST
,VU141 Ei tJ�F � CH-I/a/di P/TS_ f^ELEY. 9�•� ��"ELICY, DATE OF so.':c TEST, 9 ��5�7 8
S/DE 4eACH/N6 PER P/T >7_�_3Q, FT..,
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BOTTOM L--ACH/NG PER PIT SQ. FT.' , { �; "Lt/tCOLAT/ON !e TE�E% Z— M1NyfINCH
TOTAL LEACH//YG ARC-A 3'3 D•SQ, FT. �GR VEG F /�ERCOLA7"/a'N k'AT� 2 I+�!/d.�INCH
RESERI�ELEACN/NG AREA 3_3 0 $Q• FT.
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