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THE COMMONWEALTH P_F MASSACHUSETTS �r"
BOARD C
�...........OF........ .. - -
-----------r Appliration for Disposal Workg Toustrur#ion ramit
Application is hereby made.for a Permit to Construct (& or Repair ( ) an Individual Sewage Disposal
Syst t
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- .. = ---...---• .--• .....
Jaogation- ddre ` J 7a,t cSl...&joN�
Owner �--� or -•-•-- Address,-
........ ....................
.................._.............•.... ..........•••.. f................._..-•-
Installe Address
Type of Building Size Lot............................Sq. fe t
a . Dwelling 1 No. of Bedrooms___................................Expansion Attic. ( ) Garbage Grinder 7)—
pa Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q+ Other fixtures -----------------------------••• .
W Design Flow...............�_.5__............_ gallons per person per day. Total daily flow-----;M�.a..._ ................gallons.
WSeptic Tank V Liquid capacity gallons Length................ Width---------------- Diameter---------------- Depth................
x Disposal Trench—No.•--------•--__.-_-- Width.................... Total Length.........._.. ._... Total leaching area....................sq. ft.
Seepage.Pit No------,f--.._-___.•- iameter--------Id...... Depth below inlet.... To al leaching area._2.4.1!-.:sq. ft.
z Other Distribution box ( Dosing t ) d /�� 2,— -7j�—
Percolation Test Result Performed b ...kt� .............•................ Date..._._-_a- ..7�. _:
Test Pit No. LZn-----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- - :.. ��
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'JIT .:. y g g p y
5 of the State Sanitary Code— The undersigned further agrees not to lace the system in
operation until a Certificate of Compliance has been issued by the board of health.
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Signe ._ �.. ...........••. �4_4-7
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ate
Application Approved BY47--------------- ! -�� -----------
Date
Application Disapproved for the following reasons----------------------------------------------------------------------------------------------•-------------•-•--
---------------------------•-----•------------------------------------------------------•-----------•------•--•--••••-•--•••••-•-•-•------------------------------------------•------------•--•---------
Date
Permit No......................................................... Issued•--- /Z -•�-
'----••-•------••------•----
Date
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THE COMMONWEALTH rQfF MASSACHUSETTS
BOARD HE
ppliration for Dispag al Works Cnnnptrnrtinn ratrti#
Application is hereby made for a Permit to Construct (44 or Repair ( ) an Individual Sewage Disposal
Syst at• C
. . .._.. --.... ............••.-• .. .....
+ LQgation- ddr //� Y : Lo No
+ram -. ... = .........
Owner Address
Wt •-••-••-••-•••-•-•••••--•-•-•••...............................•..................................
Installe :' Address '
d Type of Building ;" g Size Lot............................Sq.- f et
U Dwelling=""No. of Bedrooms.____ _________________________Expansion Attic ( ) Garbage Grinder 1�-
p`11 Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
P I Other fixtures .............- --------------•------- - --.
W Design Flow_ __.__.. -_J............... ..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.._.__/---- ____.. iameter__._...14.._.... Depth below inlet....... ......• tal leaching area___ 4__ ..�tsq. ft. ,
T
z Other Distribution box ( Dosing k "� "
Percolation Test Resul Performed b ...__- _f' i___-•__________________________ Date__ yr_ }'", .........
a y--•-
a Test Pit No. 1. t t _._...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
O Description of Soil ' ��'' ` -. q--1. ,`.__ "'"--1�1r/-._.. s�¢�cs I' " � s
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 TITLE y g g p y
S of the State Sanitary Code—The undersi ned further agrees not to lace the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signoi j y f � e •
Application Approved B lJ � ___._______
PP PP y--•-•• i --- -k—, s r -
Date
Application Disapproved for the following reasons:................................................................................................................
.
..........................................................-.............................................................................................................................................
Date
PermitNo.......................................:..._......----... Issued_.......................................................
Date
i
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH {�
...... �40I`1_1"P7.......OF................ ... ... ...........................................
Ter ifir air of ToutpliFanrr
b'4't
J� TO ERTIFW, That the Individual Sewage Disposal System constructed ( ) or Repairedby � - ' f .............................................
•---•---•-•-...•.•......._
Y ¢NtHer
• 1L �
has been installed in accordance with the provisions of j of The State Sanitary Code as described in the
application for Disposal Works Construction Permit N ..
='.; dated ` ` . ------•---
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..........ji.-_. .'... fl_- Inspector......� .............................................................
.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEALTH
7 � 04
..... . j..........OF.... '?.'4 - '.,...... F ,
O EE... • ._ .
fIS
Distu 1 irk onotrudilan rrmit ,
Permission is ereby granted... tl- - " :_
r to Construct o Re air )�a ndivid L,Sewage sp al Sy
at No .�. -----------
'- -----•-7 /f//j(���'��•�'6- � .•.. (/f-tom �;`
Y street p - -
as shown on the application for Disposal �t�orks Construction Perrriit o ________ __ ___ D "�' ......................
r
Board of Health
DATE------------------------------•-----------•---•-•--•-----•--••-•-•-••--•-•-- `
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS - -
No.......................-- Fus.................. ........
THE COMMONWEALTH ,QF,MASSACHUSETTS
BOARD OF HEALTH
............. ................O F.........................................:.-------------------------------------------...
Appliratiun for Bispoii al Worko Tunitrurtiun amit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
...........•---........................•--•----.......•.........................••............... ....•--•••-----'---------•--•-••-•••......--•---•••-•-•-••••'-----••••-•--•--••••.............•---
Location-Address or Lot No.
Owner Address
W
Installer Address
QType of Building Size Lot............................Sq. feet
aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
04 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................ 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........................................
aTest 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---.................--..
R+' •-•--•-•-•-•----•-•••••-••-•--•••---••-••----•---•-••--•-•-------••--•--•-•••--•-•---•-•--•---------.........................................................
0 Description of Soil........................................................................................................................................................................
x
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 TITIE 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...................................................................................... ................................
Date
ApplicationApproved By-----••---•••--•--•-•--•---•-•••----•--•-•-'•-•---••-•--••••-••-•••------••-•.............•-••--- ----------------------------------------
Date
Application Disapproved for the following reasons:--....-----•--------------------------------------------------------------------------------------••••......----
•------••-----------•---------------------------•-----------------------------•--------•-•-•----------•--...-------------------------------------•------------------------------------------------------
Date
PermitNo......................................................... Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
TwWrtifiratt of Toutpliunrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by•-••-••-••.....-•-•••---.......-•--•--•-•-••-•._...•-••....................•-•••-'-•.....------------------------------------------------------------------------•-----------•------•------------
Installer
at------------------------------•----------------------------------------------------.-------------------------------------------------------------------------------------------------•---------------
has been installed in accordance with the provisions of 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 FUNCTION SATISFACTORY.
DATE............................................ ........ --------•------------- Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........................................_OF.....................................................................................
No......................... FEE........................
Disposal Vorko TDunutrnrtiun pamit
Permissionis hereby granted............................................-------------•------------------------------------------------•--------------------..............
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
atNo....................................................................••.....-••---••---•--••-•..-•--•-----------------••••-•••-•-••-•-•---•-•-••-•------------•--•--•--••--••-•................
Street
as shown on the application for Disposal Works Construction Permit No..................... Dated..........................................
------------------••-•--••--•-•-----•---- --•-•••-••---••---•••-----•-••-•-•••••--•-----......-•-••-•.
Board of Health
DATE...............................................................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
No........................ FEs..............................
THE COMMONWEALTH,OF. MASSACHUSETTS
BOAR® OF HEALTH
OF.............................•..........................................................
Appliration for Diopos al iftrkfi Toaaotrortion amit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
••--•...................................••••--.....----...............-•--•-------............... ---••••••••----------••-.........-•••••---••---•......-----•-•---•---•-••.......................-•
Location-Address or Lot No.
......................-.......................................................................... ................•...........••........•..............I............................................
Owner Address
a ------------------------------------------------------------------------------------•-----------•• ---....-•---•----•-------.................------•-----•---........--•--...............-••-•-••----
Installer Address
QType of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms----------•--•------------------ .Expansion Attic ( ) Garbage Grinder ( )
'k Other—T e of Building No. of persons............................ Showers — Cafeteria
Q' 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........................................
14 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....._..................
R+' •••---------•---•------------------•••-••--------•----••-------••...-•----------•--------••---...............•-•-•-•........---•....-•-•-•.......-••---------
0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------
W
U --•-----•••••----•--........................................-••••••--•----•--•-•-------•--•--•--•••--•..._....•-•-•--•----•-----------------••----•••••--•---•--..................---...............•--
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 TITLE p 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...................................................................................... --------------------------------
Date
ApplicationApproved By--•••••----------••---•-----•-----•••••--.......-••-••--•-•.._..-••--•----••....................• ........................................
Date
Application Disapproved for the following reasons---------------------------------------------------------------------------------------------•---•----------•----
....•------------•••----------------------•••••-------••----------------------•---------•-•-----••-•••--•.._....•••-••••----•-•---•-•------•-•--••••-•-•--•-•------••-------..........----------..._.....
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF..................................................................................... .
Trr#ifiratr of TompliFarcrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Installer
at-----------------------------------------------------------------------••-•--------------------------------------------------------------------.----•---------------------------
has been installed in accordance with the provisions of TITL_, 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No......................................... dated_---------.....................................
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT TIME
SYSTEM WILL FUNCTION SATISFACTORY.
DATE....................................................................••••..-•--.. Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................O F.......-•------.................-----..........................:.................._..
No......................... FEE........................
Diopooaal Work.6 Tonatriulionpamit
Permissionis hereby granted..............................................................................................................................................
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
at No
Street
as shown on the application for Disposal Works Construction Permit No--------------------- Dated..........................................
•...............•--------------------•------------------------------------------------•--•----...••.--.•.
Board of Health
DATE................................................................................
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
t .:YC'r5����.!'�{"fiiv+�rY,_ df •7'., _.��+ # it '� � j'i ,. ', { 3 + •� .:�� +t j_�IJ�� t7_-x �
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P.
BUNIKI
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LEGEND
EXIS;TING SPOT ELEVATION OxO CERTIFIED, PII nT,.y-TQpi
FINISHED SPOT ELEVATION 10 0] L vT T�'/� �'``e�>'_5UN ` R t.,
FINISHED ' CONTOUR -- O P JF t 4.
,APPROVED : BOARD OF HEALTH
` DATE A.a AGENT SCAI E / �� ¢.0 DATE
ot", '!ELDREDGE ENGINEERING CO ING�,
, -- x CLIENT I CERTIFY THAT THE PROPOSED "
(FRJOB N0.
EGISTERE �REGISTEREDJ 7�0 7� BUILDING SHOWN ON THIS PLANI _
/ CIVIL LAND CONFORMS TO THE ZONING LAWS
ENGINEERSr SURVEYORS DR. By ! 1f1 �1�.-- - --- -� ' - - OF BARNSTABLE , MASS.
s` 33 NC -MAIN ST 7!2 MA!N 217 CH. BY: R' -P.i3
rt :10. YARMO' rH MASS. HYAfVN!S, o'5
SHEET-_/— OF Z .__ /fT�E EG. LAND SURVEYOR�?
4'FK..
v�.`-!'�-� 'tt"�`' 'R-� .c- �, n ,� a �f}� vS �5.,�4`a t, ..;., _•�, n, ��«; yy`T�` v v': `L f!' t::� � Rum ,=,�i�
ac
at 20 Cr ' M/N a n N0 l-L /F E/TNE�4 TfIL S�F�7-1 7-, OR
P/7-ARE MO RE:: TH�9,V /2''BEL0i'V '
CO
CONCRETE / 4 "PVC P/P� SHALL BE I�IPOUGHT To 6 A`o
y M.W. P/TCN MEAI/ :CA ST /?Oiv CO//ER 5.,1.4 L L /DE USF1J
.,
EQ FT N C7R/✓E co WA y i
177 CL E AlN ,
A .SA N p
.6 4,
_ CAP/PE I 2�La�4yEK
?' MIN. v/TCN l� .40 O U : GAG. '' ++ J o 0 01 � i/g
/4�PE/� P'T SEF'T/C TANK U/S T, A ! W/A 5 HFD S7TiNE
CS a' BOX o uti .y r •. • • o `• . . •pn q
o
,� lE t er lr: 1 0 ` ° � e pEPTl/ • .I • � y• wo
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' . - `. I a a o � � � • • • . o • • e . .� p o s v i - P/�ECc.45 T',SE.EPAG-E=-- — •,i
lNl/eKT ELEVAT/ONS 1a � ooY r . ■` • • . � .� eQ o% P/7OR EQL(�V.. j
//vVERT AT BU/LD/NG . gl�d FT 6 FT /�/faM:
/HEFT SE/�T/C TA/V/C _9`� S F7 /_D FT. LU/,q/+� C SEE T�ULATION � I
-- �.
----- - - - - - - I- OUTLE�'`SEPT/C TANK
1N.,LET G�ISTR/49UT/ON BOX 9a� 8 FT 'SECT/ON OF GROL-wo WATER ZAd. E r
! ,O.UTLET`p/STR/BJT/U/1t�BOX_9��•� FT. " tt
r G'EACN/NG OJT 9 f FT SHJVAGE �/.SPOSA L SYSTEM. _
LEACH/NG P/T TABIJLATID/V
SCALE / ¢ ,. _ /�_ O,. U/MENS/ON A ._FT
DES/GN CK/TER/�l /
D/MEIYS/ON $ -- 6.-- T.
NUMBER OF BE�RoOMS 3 D/Me'NS/ON C— _FT
aA-R6A64—o/SJoo_5A� SO/L `LOG
.TQTAG EST/M«4TEU FLDI-{/_ G'4 1,0AY SO IL TEST A4 I- SOIL TES?-*2 SO/.L._TES.T.
�iVU.iNIL4ER OF �aC4C..N(NG: J�/T_i_ t � � i � i
��E✓. �8.0 1--EL. 1! - /SATE OF .SOIL TEST : �Z�79-
5/OE LEACH/NG-:f�E.'t P/T �i8^�.,$`,7 F7; � - I
6UTTUM LF,gCN/NG F'ER P/T�:h�� 3 ' + RE•SIJLTS kV17-/VESSED •BYR•._n.
S4• FT NCH
�c o PtRCOLr4T/ON RRTE / O
TOTAL, LEACH/JYG AREA —ZLG 6 SQ. FT ',. S i'/3 S o Jt_ PE�COLA7•/ON RATE AL
RESERIiE LEACHING AREfj_ ' vSQ, FT I.. "
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