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No......... �� �" Fps... �d� .....
THE COMMONWEALTH OF MASSACHUSETTS
_ BOARD OF HEALTH
............VC.7.C.c,3&...........OF........ ..... .. .. - ............................
Appliraation for Bhipoii al Workii Toaa,itrurtivat Frratit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at:
1'I ...P.0.0% wa--•I&Y....... EA 11,LE. .......................................... -----....... -------------------------•-------
L cation-Address or Lot No.
....... MA9�R_ r?'.Je...-�f.?'p........... •----------•---2._'L.._Vj d'YlA r�........
Own r Address
Installe Address
dType of Building Size Lot_ _5j. 1.7--------Sq. feet
Dwelling—No. of Bedrooms................ .__.__......._----_.Expansion Attic (x) Garbage Grinder ( )
Other—Type of Building ............................ No. of persons........._------------__---- Showers ( ) — Cafeteria ( )
a' Other fixtures ................................. .
W Design Flow............................................gallons per person per day. Total daily flow------_...... ...__.........gallons.
WSeptic Tank=Liquid capacity\?gallons Length._......m..... Width.-____......____ Diameter................ Depth................
x Disposal Trench—No..................... Width_................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No-------- Diameter.AO.—.0.._ Depth below inlet..G.7_0..... Total leaching area..ZJ&L..sq. ft /7g
Z Other Distribution box Dosing tank
'~ Percolation Test Results Performed by......
.!,.�12 :�...__ .............. Date_._.......__.____..............
.____. .
aTest 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---_....................
O Description of Soil.............. .' �''� t �'- �Sa
..................................-......................................
x --------------------------- �? �° i ,Arz�_ �. v -- S--
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 iIT .L
p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has beIMpoWd by t board f health.
Signed : ,-`t• ... .............-6•�•....Aj--�
Date
ApplicationApproved By........... ---- --- ---........................................................
APP P y ----- . Date
pplication Disapproved for the following reasons_____________________________________________________________________________ �____:__.._.._
............................ ...---•-•--------•-------•-•-----.............--------------------------••• .... ------............-................................. -------- ---------
I- Date
Permit No._....1 J T 7
.-----•-••---•-=•------------------------ Issued---`�-.-_.._-------= ---•-•---.....-----•---•----
Date
rJ "d
No....................... .......-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...................................OF..............................................I—........................................
Appliration for Dispoiial Works Tomitrurtion ramit
Application is hereby made for a Permit to Construct O or Repair an Individudll,.,*,�wage Disposal
sm-ci
1 C.57 W Ay (2 E^J-Ti�_QV I JL P -4` t
. ..... . ....... ..... .......... ............... ....... .......... . . .....
ss
Address PVJF_-4k V_y1 RK IC Q.0&m(�_Ac—1 1�\�
......................................................../....................................... .......................
Installer Address
Type of Building Size Lot............................Sq. feet
U X
Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder (
Other—Type of Building ............................ No. of persons............................ Showers Cafeteria (
Otherfixtures .......................................................................................................... --------------------j,/
Design Flow............................... -gallons per person per day. Total daily flow............................................gallons.
P4 Septic Tank—Liquid capacity............gallons Length................ Width___....._....... Diameter-_._____-___.._- Depth.........._..._.
Disposal Trench—
-10..................... Wi0Lh.r:.4_)_........... Total Length--.(,.-.(.3..... Total leaching area...tZ.E54....sq. ft.
Seepage Pit No--------------- Ta
Diameter..____ _.__..._..._. Depth,below inlet.._................. Total leaching area..................sq. f t.
Z Other Distribution box _<� Dosingqkr(R,t_ !-)(�V,. 10- ?_ - 7 ? .
aPercolation Test ResultsL. Performed by.................... ...................... -0.................. Date---.---------------
4-
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..n%.2--------- S .1.)....................................................................................
0 Description of Soil............. .........�.A"- ...... A-V-E------------ -------*............... ------*--------------------
U .... ..... N ........... .............................
.................................................................................................... ...................................................................................................
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 TITT L 5 of the State Sanitary C de gy The undersi led further grees not to place the system in
operation until a Certificate of Compliance has b ued er of health
Signed..... .........7..........................................-...................-.-.-.-----.-.-.-.-.-.-.-.-.-.-.-.- .- ..............
Date
ApplicationApproved By. . --------------------------------------------------------------------------------------- Date--------------
Application Disapproved for the following reasons:................................................__...........................................................
.........................................................................................................I...............................................................................................
Date
7 7�
PermitNo......................................................... Issued.......................................................
Date
4
?kTH]E'C,0M M ON WEALTH OF MASSACHUSETTS
BOARC[�X HEALTH
.................................OF....... .............................................................................
Trrtffirab of Tompliatta
T;h�6i&4di/uF"(eR t iVgos4-Sy0n&"o mWc(qk:��5( Repaired P
byT------------------ ................... . ........ R:....6117......... ----Li1 ----------U----- . V I,
.......... ..............................
at.........................................................................---------------------------------------------------------------------------------------------------------------------------
has been installed in accordance with the provisions of TIT� 3of The State Sanitary (�?jle Ap de? 'Ced in the
-/-/4
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................................................................................ Inspector...................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARDCQF� EALTH
(D-L4j A13 N Aj (3 LF
......................................OF.....................................................................................
No......................... FFE........................ .
lep,#tz lct<
Perm ssig 'herjb-y--jranteV::V:N ............
tto Construct or Repair an Individual Sewage Disposal 'System
c at No..... ;...........................................................................................Str-ee..................... ----------------...........
t as shown'o e ap�14tion f?r:%isposal Works Construction Permit No.... .•
....... Dated..........................................
......................................................................................................
Board of Health
DATE................................................................................
FCRM 1255 HPBBS & WARREN, INC.. PUBLISHERS
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LE'GEN0
,ETtIS'I�itdG SPOT' ELEVATIO„N OxO, 1 ' r; CEF2T'fFIED#• PLTF�y` `' PLA'N,� '
EXISTING { CON:TO.UR pFr '+ Lo l3 %� `Tlzto # '
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`)APPROVED aBOARD OFF HEALTH `pH fii�i� WAS' '
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bb►TE : �. � .AGENT SCAT E 6 ' _;so DATE �� `777-= -
• _-.. _� :�_._.. ...— - _ - .ate ti� IF
rE�®RE®GE: ENGINEERING CO. :INC F x
p— CLIENT WE - e_ CERTIFY 'THATTHE, PR OS .t
EGIST,ER•ED'j,,: : { REGISTEREDI
` • JOB N0.7i '- o9 BUILDING SHOWN ON ,THIS ' PLA
' CIVIL LAND CONFORMS TO THE ZONING a LAIIS �"f �'
J° I4NGiNEERS! SURVEYORS�J` DR. �IM _A_ UF ' BARNSTABLE MASS'_?- ."'-',' ( -` '� '
MA11IN 7 2 MQih ';'r CH By:
S'0".YARNI;�L;TtI, MA HYANNIS MA 2 �&
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r== f= SHEET OF ^ATE _ REG. LAN SURVE' C�
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