HomeMy WebLinkAbout0087 BISHOPS TERRACE - Health x L
hops Terrace
1 203
s ,M tle oir�o�
TOWN STABLE r-olt1a salt aPnlh„ 7,
�7v,K3t to H�13715
LOCATION r, SEWAGE #
VILLAG ASSESSOR'S MAP & LOT '
INSTALLER'S NAME& HONE NO.
SEPTIC TANK CAPACITY
-LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the 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
b'nchryr�s
�T
O C
MAY-01-2003 THU 09:07 AM CAPIZZI-HOME-IMPROUMENT FAX NO. 5084281547 P. 03
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liaCommor>wlrmth or Mass cmwm
Exe'01*,* 4ffloe of EnWonmentol ANcirs
lEnvironmental•Partment of
Protoction
MumVA~ F.vwto
tw w CsNrsel Tft+=
Dow
wwM
tVRBtALFAt�mpAp�D1dP0�►1, lRC'ZION lQliidf
PART A
CZWMCATION
`Z7-7 r '/Wdttae vto+mset
Naas of luspeetoec (u ttia'it�at)
�P�7�Iame�Addras asd Telephone,N meer.
a� u s
I eertiO rZa.t I acts pee.oe.11y iaspwcw the m"*V diepoaal a vkl at chi,•ddm.■
sod mtapiet@ ae or the time er twp[eti0n. The inep and that the iorbrtaatlses itpartsa 4)ov is true.at�ew,ata
t.evmGo of o».sits rw retioa wee perrortt►ed haeed oo
ii`�Paal.7*�emt. The.ystamc MY trabdss and at:periaam i+s tln proper lit mian and
� ptrete
CondkiamUy pS&W
— itissdr Fwthnr E•ahatian D.the Ioo.l Apprwbg Autbwhy
rail.
2--roe itssatum
rum$Yom Idmm aisau t•.ep,aJ tkl. import to the
pep• u 4atam be rat w is abarad 4mam at bw a io.of 10,Oo� �A:<that:q��Ntitb AO)dqa of ao®pbtils thin
etpote to tb epptopr�k rtdotmW ul ofSa of the AP'd as paater,the iaspe�aad the irsum ttsaar gW mAuk the
TL at"at"adould Dsparwwat of Z n vaeomW pt�ametioa.
a7atam owwr AM mpiee seas to the bqw.it appbabla aM the appmWsq eAbmrip.
1DWJpMON smANARY.
CbS4 A.s,C,w
A) OTM= IPAUU-
7 V w tteK IundMu k A hiht wnifthmad as,i bbdicate.that the 9e4m.kgmt"ay of the hihm�w defined in 310 CIO 1b.303.
A41 hihyt etltaria sat wahsatad ast�W alwv.
Rl wwwrm CONl1ITiOXMLY pmeEs,
bqpo*bwOtp ep melt Wtsm emapseWU mmd to be mpbmd or mpabsd. The gatsta,Vm"apinm at the ttplaeetasat or rpw,peat..
Meat+ym-so,or no determi W(Y.N.err ND). Describe be.ir of deter an in all iaets"N' It am dwmudar
T►r oeptic tank it emtal,eraebad.agnxs�tmt =4 ohm aabstantial hfileeatim wpwb err e+dDRtstioe►. lath vaw a aat ie
is the 8oa,d -W peen lion if tb*ammu�septic taak it i'aybae wiih a mptie%w*at apPte+»d
t�avlse0 11/93m) I
one 1 bmr s"" a ration,w...atweene aloe . fA)t(t♦in a+laP . T.LOQos.(r1>7 9a•iroo
•w�s.c*a..ram, .
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SUBSURFACE SEWAOL DIAIi0v0AL fYl1'IT,Y Dapsmom PORK
PART A
CElMIFICA970N(aasaaleuadl
PwprW Add�
01rp�r. '
Daso of lsapaeges
sl YlBTM CONDITIONALLY PA=Zq(=02taus4)
i
""V baahvp or W-ba ut w b4 at *-Ow 1na1 ohmrwd la tote dit"mutJd6 bate i•dw to bsW m or obatnimW pipsls)
or ON 10 a btobsn.samW or vaawa disbilmtioo beat. The paka"a pals 6WPWUAn it(wlth appte.al of ehs Board of
Idaalch):
baoksa pipa(s)a wpLosd
`_ ebre:lrctloa is
\ disatbutioa boa V bwWW W rsplsaral
�• 7bt"aam mwrw pumplos Moro thaw lour tows a p..r diia to WOW*or obowmaed
iaspaetion if iwkf;�appreval at ehs Beard of$ualth): �i+t+). Ths 4R�"�ps+s
baokse pipola)an mpk wd
obatavotism im rrm oed/
C) rURTNER EVALUATION 1$REQUIRED my A8D OF
' E\ 8SA1.THt
Cood%ioas ssiai.--�..r rWeb wquim Miltar evalua '
ehe Board of H b7 aahh is atdar to datarmias if thr aepstam by j to pror+es the
P+blie baaleb•aafary sad tb!anvitoaana+a.
1) VYSTZM WIM PAos UNUM15 so Or BRAT.HANNER' QETgIMINN TNA!=81;01Y0'!'Bb/1S NOT rvNCTIOTT1Nv IN A
WBlCH WILL PROTEC E PUBLIC RL41.*AND S4YM AD Tm iriAONmom
Caaspwl or privy W 50 fiat of a owfaw water
Caaspsol or prig it wi 60 Aat of a botdariog wdatared=1%M
a talc manh.
2) OYNTEM WILL FAIL S TSIE BOARD Op'liU"T9(AND �vATOi/UrPL11RR IF APPROPRIATE
VZTE t INFB THAT BYSTlldl 13 PUNCTIONINO IN A YANNBI f$AT MOTWT TIM PUBLIC RrALTil AND
SArElY AND THE R0N>1 L%"r
The a mptic tank and soil abaorpeion system sad R adtbin 100 ha to s mv&m water vvpb or tributary to s
sorbet tar"IV.
The hY a optic teak and sail abserptiou emu sad it te1Wa a S ma 1 of a public wtsr amb►wall,
TIW bas a septic taak and sag Wourptias ryrcrm teed is whbk i01wt of a pain wmw anppl,w11.
The nyst m has a sspue teak and roil absorption cyst m sad is Im than 100 bat bat 6o star at:w'a i%m a pri s"wour
•uppb w4U.uslaas a wall.sat analysis for oolifarm bacteria sad walattla orpals aempomde bdimtw that the wall r bps
ftm pollution bom that bd*y and tba ptaaaaa ed aamaamm RbWt sad apart altsapo is aggal to or km than S ppm.
8) OTRER
(rovised 11/03/") 9
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MIME AFACE A WAQ9 O1spos"A]f>Y»�PECTfoN>r0>
pm,r A
CMYTPICA176M("IMMOUed)
PIwta Address; g 7
ow.�R
a1 8=2=6 FA LA
t�direr»siaa4 e>tat th&sDrrm*alum air or
mere of tbs t .ditamiaatiea it ideneiied helow. '1'y Board of Heshh sbettid°mod d�tarYmlae web erspll CAM16 s09. The basis for
ham". aaeaMat!to mrtoes the
Into pcltiq or 4Kent eotapaaeat due 90 an varyoaded er ebWd La or arffpool.
Dond+al of s�ueat to the awLee ad the Ovtmd r earpos nat+te due art
me+pool
/9w offided or mad Lu or
static 1i d le"1 is tb 4kWautjon ben abw ' ' �
atttLt invest dw to an o.ersoaaed er cad RAS or aaaepool.
Liquid Qept�in ow �
peel is lw t17an 6'below ia"rt or available vo
bse cbnrt UY day Bow.
"' ��A►o�Dittk.�ovt!than 1 tiao in eb lent Dear LiT�d
Nua+ber of"4@ pisnpw Olo{Sod or pipes).
�. Any portion of the soil,,
Ab!orptioa Sysesm eees7W%
privy is below the b1SA gowuh ow Useat on.
�1'portion of s spool Or P"is wltlin 10Aof a ourLa 4RNr cap*or tribe. � ray to a sat4e+e wae&r sttppbr.
1 poptift of•eaesDool or privy ie a Zone I of a public well.
Any portico of a os&epool or privy' .jtLat 6o hot of a privet&wrier supply wall.
•�. Any portiost of■aaspool or is loss the i too feet bat Poster%bee so rm iM a rim.weer supply
mWbra,bane s000ptel'if Water Y�y t ire If the well ha��baes assbaw"tm oopD at well watteer nob with no
"is c �pwbls,attac>s wabrsie for
/ rs� �Pomtds,aiaYlb\aittassa aid nierab ultrOpa.
V 1 AAGE•YsTsM FAILS: / \
L,.
7� apply to lays ysteas it addhioa to the eriteria`abow:
The
_ /.
�_ lsalt>s and attt�a acili 5ey•deb a desipt now of MAN spd of paat&r d"' yata
p IYMM)and tbs m is•SWWS eat tbrn.t so
/ �9 CM tba sts.iticamot because amor m of eba fellowizg conditions tom: pubLe
01 479140 ie-kbia 460 fnt of a surface&taking wets$rappb
"WIN is.khia 2W lift odFptm a ttibcCtarD to•wipes dtdsaLiet wmer et�pb
Is bead is a skrose s aanatrw am anger.Wellhead proesceiaa Atrsa f1" or•mapped Tme II of a pttblle
7as sonar or apwtater Of am owb syetsnt AMA leim at wean,sad bquv has to ooa.pliaoce orbit tba Ogmdesatrr twatmsat pso�an�
mesta of old Clot A-00 and 6.00. Pbeee mawth tb.leeal"&aal ogloe of the Dspartateat!br Avtllar iaformatloa_
inviae0 11/03/95> 3 .
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VlU= 8lrACR SIMAGE DlSP08AL lly8T$l 1NAPfficTION path[ •
PART H
CK=lW T
i*"eref Address:
Ommen
ffah of lasp""em
CAsrJt If tAs 100eWiap hew been done. `
—""PIMS h4715otloa.as requested of tM Owner,ooe Wt,cad Beard of Health.
New of tha seism sompmmw ba-ft been pnadped for at bun tee waks and eht a VA=has lace rwOeiddaS abrmal now raise
durtske that pow. Large volumes Of water have a00 Own introduced into the amal"as*or at Van of ebbs inspection.
--An bulk 0—pe•e ben ebFAned and examined. NOW if they ado not aeat7sbla with NIA.
--The&c'lky Or dwlliaB was inspected for ales of aevap b"k-up.
Trm system dace net ecocide aon.sani"er uUhWbial wasp flow
"W sits w tatpettad Or WSW of tnaskoue.
All amm eompoes U,mdudieS LU Boil Absorption System,have been Meow an the site.
.�The septic tw%k manhohs ware Yeearered,opeetd,Bed at b%WM0r Of%W septic tank was knomed for aandklon of cam"or
t ee,mNWW of comatntetiom,dimensions,dapeh of llquK depth of shtdp,depth of seyn.
This sift Bed Ideation of tAa Soft Absorption System on the sin has bees!4termimed Oared om misting ialbtmadon or
appreedmsted by oon•inuvalwo embeds.
The CuWta o raer(and oeratpsnte,if diirerwat tram owjar).see prvided with bdWmation on the proper matrrteaanoe of Sah-
ea:faor Disposal System.
(rs.eseA 11/03/9S) �
MAY-01-2003 THU 09:08 AM CAPIZZI-HOME-IMPROUMENT FAX NO, 5084281547 P. 07
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$ UAFACS i$iVAQF D1BP 81'82'EN INSPWnoN FORK
MTM T "RMAMN
Pwpwty Addrwa; $"`7
Owesr.
bet*of lntpeadeo:
Fww CONnt ONO
Of g1ft"
owbW osodw(m
Iamb"
aor,Lc.
b oDetea, W aa)
irenU um(}so or m);.gaew
ow aowo'r FmAinp.if a aug, Act:)
Lars d■ta of
Type of mabhohment:
Dade flow., a.IL...u.Y
at asp ow or m)
bbmWiai Waste Hddu*Ta"p umm:Wo or no)`
water asstar �aete to tLs T8L 6 m (>'m or t►o)�
�i++p.�araWhle:
La data d eeenP,�W;_s
07mia (Dwaft)
Last data of oaxpaaey:1�
GENUAL ZNMRMAIION
PUKKNG PZCOX"f ad.Dotes ofitkfwmatdon'
/'�/a��-cam G-Ica--Yr
�Wm pompsd as p� 4f k opRioa: (vw or no)—,aJ(z)
If Yu,wh m.pompad:
1Vsaea for pvftpiDg:
TM or Bywrm
%Ptfg a mmo4amptinftm%on-pool
,paean
o.w6m etwpool
p
show eaten Lm or ae) wTao,attach pre vlow wT wtisa s>MF,&,if NW)
otbw(stphdnl
11ATT Am of all mmparsm.data fmstallsd(if l umn)fled sate d bhrmatioa:
SWOP odw 450ctad.bra arri IK at the sits:(ju or po)
t rav/a�a 11/tII/45) d
MAY-01-2003 THU 09:08 AM CAPIZZI-HOME-IMPROVMENT FAX NO. 5084281547 P. 08
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BLWMFAce @EWAOB ply�9N,fYf1'rsJ1 uirser&C' 31DW PORK
sWT= IN " RMA290N(aaiatfewd)
owdenRT 0
Pml- Ad�oo.� g.7 6 ' _r—
(]eau as she ow
Dora below Qada:-D
Ymtarfal of we"I'Metlgor —M"—7"�,otbeKsplafo)
Db=mioa:
•imp lapel►:
D6'Maat Sam top of dudja to betemm orwtla we or baf(lmo-22—
Sams tbie m�;��
D*"O bvm top of moon to Wp of outlet tw or bath : GL, 6�Dttaam A%.be�tto�„or satin to bottom of=dot we or ha>11e: G
CMAteaau:
(rommmudatift fW pwupfag.cond$foa of ietbt and outlet or hamm,des of
euideeoe of latkap,atsa lfgwd M+�1 in t�latfea a rudest fewer,atfumtww ➢ �
ORL19E TRAP..
qmW on afte plan)
Dapab below gred•:
unto w ei ooaahuotion:`osaaate �FAp"atlur(asplaia)
Dlttemaiooc
Seer,t Ackk .—
abtaear from t"ar eaw w tap of ar saflle:
aietanoo Gam bnewm of of wtlme nets or bate:
Qema.av:
(eeoo tea for pump&".ooadition of inlet end Mist,testa or baMm.depth of liquid bwl in m a itim fewrt,atrtwomwal fntFity.
of laskap.Me.)
i tewisee 11/OS/®S� �
MAY-01-2003 THU 09:08 AM CAPIZZI-HOME-IMPROVMENT FAX NO. 5084281547 P. 09
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OU"U >rAft ONWAOa DINP08AL/177'iJt!>WOPRGTiON P�DBx
PART C
519124 3MbRMAT30K(oopilnwd)
o Addmm S'7 -�
mart e4>ao�.pa)a rnMc�
0~e.OD mist Pisa)
book Dab.
]11"WW moertn,�`�
,at�eee.ce 'es'1 I�'RP�ot>!er(eyLie,)
�eoeim.:
Cepadq: e
Drip Dew:_
vary]mrtl:
C4iomeats:
(m0a�itieD of(glee tN,aeadition 0� aad Duet e�ifCbem mtC,)
aist�usvlt�oH so��,/��
(beaee oa site p]ra)
Depth at liquid Mel&W.9 mni t mwn:
(iota it level ead dietr0uden is prof.evideem od WE& a ideam of leaiye auto or out of ba:,eft.)
PUMP CeAM>s�t �
�Pt in aaeDttt aefier(rm swf
bow P i0amiset,aeoditloa of PmDe Yd appwftl -eft-)
M (f+ov(ew 11/osm)
MAY-01-2003 THU 09:08 AM CAPIZZI-HOME-IMPROUMENT FAX NO. 5084281547 P. 10
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i,
BUNURFAC6 nVA02 auPOL#Z sYs7=nMapr 0jj VOSW i
PART C .
814119M DIMRVATION(@mUauW)
3-7
Oaraor.
Do"of laapooUoa: c3 Z_ci 7
NMAWRMOW ew/r"caA>o>r L�
allmsa an'&*P" If pawls msowwn vet Fquimd,bye A.y bo appeosIUMS4 IV ooa•larraft tgLmm)
placer dowabw w be P"m tetpbia:
''
ilbddM elDwr+•a,aumbor:
bnabias traocbu,avmbar,haAtt►:__,�,
Macbi�IIdeir,oumba,dimaaaiow:
e•ar0ow
arupoal awaebr:�`
CorMau:(Waco madicioa of ooil. o o/kydmulic Vure.b a!of pen ' t�oadiciea d wpueleo`.ce.)
c�pooLB: '
Qv as ew plan)
Number said sjoo:
Dopebaop of bgaid w n,
Depth 1 ao)ida Laarr
Dept,of ovum lyer•
Dwmw of mapool:
IVar"of aamatruaiom,
bdis"Wa of gra"dvater:
b acm(eaupool aunt be pamped as part of
777
Cggaeat+: (mu amb&Am of aoiL aipm d b ylie&Ilan,hwl of pemlial d wptstion„WU3
Ooam an afu p
ldaaariala
Game
(sob eaadlsion ed eeo� o<Ip�rwlie bDea:t.h+a)eef paadia• aoaditiaa d wpalaeioo,ats.l
MAY-01-2003 THU 09:09 AM CAPIZZI-HOME-IMPROVMENT FAX NO, 5084281547 P. 11
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"SURFACE SfWACE DISPOSAL SYSTEM IN'SPICTION ipRM
PART C
SYSTEM IN FORMATION (continued)
Pro .
Peru Address.Owners 7 R
Date of Inspection; `
SKETCH OF SEWAGE DISPOSAL SYSTEM;
+nclwde ties to at least two perntanenl reference{ ly,dntirk, a benehnurkt
locate ill wells within Ipp'
i ;, I.
DEPTH TO CROUWDWATER
Depth to Rrounlwalet:- L-(Ky
method of detemination at oprosurnation:
(revised 4/35/961 '
l
MAY-01-2003 THU 09:07 AM CAPIZZI-HOME-IMPROUMENT FAX NO, 5084281547 P. 01
1645 Newtown Rd. Cotuit. MA 02635 Capizzi Home
Phone: 508-428-9518
Improvement Fax: 508-428-1547
MAP 25
PARCEL ;Ta)c
LOT
To: ��'` From: Nancy zerv%anewc,R-,. ion kssjstah�
Fax: �� — (�, �D 3 014 Pages: /
Phone:— q128- %676? Date:
ae: - 8 7 f
❑ Urgent "r Review ❑ Please comment O Please Reply ❑ Please Recycle
Xu:' "4� � s
q ;A
MAY-01-2003 THU 09:07 AM CAPIZZI-HOME-IMPROUMENT FAX NO. 5084281547 P. 02
04/28/2003 15:14 5087789403 HUBBARD OIL PAGE 01
Hubbard Oil Co., Inc.
P.O. Box 10, Brooks Road
Hyannis, MA 02601
508-775-3711 • Fax 778-9403
TO: Q
FROM:
DATE-
RE: j
TOTAL NUMBER OF PAGES (INCL. THIS PAGE)
NOTES: d_ ;�„�13
No....... _ .__ Fxs............................
gg THE COMMONWEALTH OF MASSACHUSETTS
C� BOARD OF HEALTH
_}� .............._.. ... - -- -._.-----.OF.....................................
..--...
Applisaflun for Dispatial lVarks Tondrudion Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
............... ........----------.......•••......-----..
L A��ti dress or Lot No
�..................... . .. 4 .. .............................. ...............: :..... . .....�
--.-�` ........................yOwn Address
..............
� u�.......................
/Z5................ ............................................ ....._.........................---.....s....
Installer Address
UType of Building Size Lot............................Sq. feet-
�-� Dwelling—No. of Bedrooms.... .................................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—Type of Building No. of persons............................ Showers — Cafeteria
aOther fixtures ------------= -----------------------• .
W Design Flow............., .O......................gallons per person per day. Total daily flow..........3.e.O_-_._...___-____-___-gallons.
WSeptic 'Tank—Liquid capacity.`A0Pgallons Length................ Width................ Diameter................ Depth............
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No......../",C). Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by....................................................................... .
a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
rZA Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
1:4 -----------------------------------
------------------------------
------------
.------
•..............................
..-----
0 Description of Soil------------------------- -----------------------•--- --------------------------------------------------------------------
x ----•-------------------•-•----------••---•••••-•------•••-••••---••••---•••---•----�...dw....--•--• � v�_�...-'---•-•-•----•••----------------------------•---
U
W
VNature of Repairs or Alterations—Answer when applicable--------------------_-__-_-.____-____-____-_-_--_-_------_-------__-____-____-__.____--..-_--__-
Agreement:
,;;4The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the prov sions of Article XI of the State Sanitary Co The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee iss ed by� oard,toealth. p
ll � ,Signed---•• -- •...- ................................
Date -
Application Approved BY = 1� ' -------------- ------....------------------------------
Date
Application Disapproved for the following reasons-------------------------------- - ----------------------------------------------------------------------------- <
----------------------------------------------------------------••-••---•------•---•-----•-•-•----•---•........•--••-•--•--••-------------------•--------•--•-•••---------•-------•-•••......-------•---
Date
Permit No....... ................................ Issued----- � .......... .�
Date
No.................••....... FnE..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-. _.._........................... OF..................................... - ............
Appliratiou for DifiVogal Workg Tonstra ion "truid
Application is hereby.made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
..........................................Loca,....,.......,.._..__._........__................,._ ....
,,,... - ,.,.,,,_.., -,-_ .-......---._..........,.........,...,......
Location•Address or L,-ot No.,_
.................................. ........Owner.........,..................,....,........ Y f f >,t y /� 8dfess c: d F'.
� ................. ...... .........Installer %..... r .. ..... .... ._. ....................neazes5'-----.._._....-----_.._..-•--••--•--..__..
Q Type of Bi�dfing��4� Size Lot.. Sq. feet
U DwellingNo,.-,,,of B drooms.— - , ,-42 .�_.�__ ___________________Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ________________ _______ZV�o. of persons___________..-._.._____.____ Showers ( ) — Cafeteria ( )
dOther fixtures --------------................................... ---•------.._...-..•----------•----•-•-----•--•--•---•-•----••-•_._.__.._.....................
Design Flow...............r-..........................gallons per person per day. Total daily flow.._.__._.._.___.............................gallons.
P� Septic Tank—Li ui capacity.. ,.,,gallons Length Width....... Diamete '; y___.___
W P qJ c.:>g Depth---------
Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Other Seepage Pit Distribution box- '---/ Diameter--..Dosing tank
below inlet.................... Total leaching area..................sq. ft.
z (' ) ( )
~' Percolation Test Results Performed by....................._.................................................... Date..............._........................
W
Test Pit No. 1................minutes per inch Depth of Test Pit-------------- ..... Depth to ground water____-_________..__-_--.
4.1 Test Pit No. 2................minutes per inch Depth of Test Pit---.________________ Depth to ground water------------------------
9 . . .•-•--•--•--••-•-•................•--••--•--•------•••••-•••-•••-...••••--•--•-------•-•--•------•--.........................................................
0 Description of.Soil........................................................................................................................................................................
�.
. ••-•-------------••••••-•----•--•---
x _._...._._.•----------------------------•---••---••-•...____.-__.._..__.....••--- -•-•----••--•--•-•------... ----------------------------- -••--•--------•--•-•--••-•••-••-------•-------._..._...__.
tl
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 Article hI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been iQed by the board of health.
Signed If
r"e � S/'w�` Date.
Application Approved B ...____ 1,1 f...................
-_- _ �. •
--Dat e
Application Disapproved for the following reasons:.......................... - .Js.-_______________________.__.._.____________-_____...._.._______________....
........................................ ....... -......-••-_-_._.._.....-•--•---••-----•.._.-------._._.................................................................................................
Date
F
Permit No..........- ................................. Issued.._ .L _ .f :.........
•-;'! Date
THE COMMONWEALTH OF MASSACHUSETTS
t BOARD OF HEALTH
i � -
Tatiftrate of Clutpliattre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
- ( )
by............. £_ .r � . �. r .. y �Y . ... - •••--••-••--------•-••-•----•-••--._...-----•--........-•-•-......--
•- ,✓ ,,.�+C/'f s ro;� InsEalle� .: ? o:,.,..--
at.................................................................................... •----------•- ---------------------------------------------------..............................................
has been installed in accordance with the provisions of Article N 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 CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
4,t,� ,.BOARD OF HEALTH
>. f
No......................... FEE........................
Permissionis hereby granted................................................................ .._._..._.._..._..----•-----._..........__...._..._,___._.........----.......
to Construct ( )Jior Repair ( ) an Individual Sewage Disposal System
r ::3...... Street
as shown on the application for Disposal Works Construction Permit No......:_,::r. .. Dated______________r,
......
--------•-----•--•----•--•-----•-------------•- .................................................
Board of Health
DATE_,....-.........................................................................
FORM-1255 H0885 & WARREN, INC.. PUBLISHERS
... .
Syr ..Address . .�. ...............................................
C/
Name
t
of Builder
.. .. ......... ........Address .............
....
I Name of Architect r Address ......��, ....
.. }
i. ........... f
�a l Number of Rooms 7 1 ; ... ..... .......
i .. ....Foundation
.. i
Exterior ar :•r° - ..... .. ........ ..................
.Roofing !- '�
Floor
........ . . .... ......
....... Interior �... . .... ..............
1 Heating _... t.......�L�.t ,! ' .... f ..,.. .......
l ..................... Plumbing ./....... ........
Fireplace
t
......... ..............................................................Approximate Cost .....1 ..................t� j
..... ....
Definitive Plan Approved by Planning Board --------_w_
---------1 9-------• t ( �!
Diagram of Lot and Building with Dimensions
1 SUBJECT TO APPROVAL OF BOARD OF HEALTH
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A A r {
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<..• +c� �i J xL i '
.AA r rt a
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731 /L
I t
hereby agree to conform toall the Rules and Regulations of the Town of Barnstable regarding the above
� •- construction. ove