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No.
THE COMMONWEALTH OF MASSACHUSETTS ✓
BOARD OF HEALTH
)AI: ....��.....................OF.......��A&N...... ........... ..............................................
Appfiration for Uhipusal Warks Tonstrurtijan "amit
V
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at:
>
..
..............01.
...... .. ............ .................................................
Loc 'on,_Adj 0 Lot No.
..........I.U.k. ......... C.A.4. ----------------------------------------------------
V Owner Address
................................... ............................. -----------------------------------------------------------
Installer Address
Type of Building Size Lot../Y, I/ Sq. feet
t- ---------------
Dwelling—No. of Bedrooms....... Expansion Attic (AV) Garbage Grinder VO)
------------------------------
Other—Type of Building 300/9............. No. of persons.......-1................. Showers (2 Cafeteria VCi)
Otherfixtures ..... ...............................................................................................................................
Design Flow.........55.....................:....gallons per person per day. Total daily flow------5?_.9!_Z9........................gallons.
Septic Tank—Liquid capacity./04A.qallons Length....l�...... Width...__._.___. Diameter------le....... Depth....,9.........
Disposal Trench—No. ..PeW. ... Width.................... Total Length___................. Total.leaching area.__,,,24_X. ......sq. f t.
Seepage Pit No... Diameter.................... Depth below inlet.....__............. Total leaching area..................sq. f t.
Other Distribution box (X) Dosing to ( ) - /............
Vepth to ground ter.
Percolation Test Results Performed by- e", e..... . ......... Date...ldl�
Test Pit No. I..... .minutes per inch Depth 9 Test Pit.....1.A,I-------- wa
fi Test Pit No. 2................minutes per inch Depth of Test Pit..____._....__...... Depth to ground water-_-_-_-__-_.____--...___
a' --------------------•--•----------t--------------------------------------------------------------------------------------------------------------------------
0 Description of Soil...... --- .-- -�. d d,- .4... ............... ..........................................................................
-
..................................... ........ .......... .....#::e
U ...............................................................................
................... ..... d..... ...............................................................................................................
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 provisionsof TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operatio ni-il a Certificate of Co nee has been issued by the board of health.
Signed---., ............
A ... .........
A__I. 2a
pplication Approved B ......... _.
y................................................................................................ I ....
Da_t_e--------------
Application Disapproved for the following reasons:...............................................................................................................
........................................................................................................................................................................................................
Date
PermitNo-------------- ..... Issued.......................................................
Date
----------------------
No. . ?" ..... Fmc............................
„. THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF /HEALTH
t�.x1. ....................OF...... �4 •'e;
Appliratiou for Uiop.asal Warks Toustrnrtinn Prrutit
Application is hereby made for a Permit to Construct (VI) or Repair ( ) an Individual Sewage Disposal
System at:
,t 1
- •C4 �:... (a.i.z .............. ? 1.4 ..-..--•------ .... ..... - ...........
Location-Adres r t No.
? : � e: dress ..._.......
�J o Lo
Owner
-- ------------------------------------------------••---
Installer Address
Type of Building Size ----------Sq. feet
Dwelling—No. of Bedrooms........I--------------------------------Expansion Attic JW) Garbage Grinder Vej)
aOther—Type of Building i4Ja ?s_V:; ...... No. of persons......_._4_`-:............. Showers ) — Cafeteria V47)
Other fixtures ----4t1 �7...............................I••---
W %Design Flow.._..__5,5":.. ....gallons per person per day. Total daily flow------ :.........................gallons.
9 Septic Tank—Liquid capacity,+�1',-'. gallons Length...14....... Width---46......... Diameter � Depth... ..........
Disposal Trench—No. Width Width.................... Total Length.............:....... Total leaching area..,,,V4_,,C�..____sq. ft.
Seepage Pit No. MMCL:_.. Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ) Dosing tank ( )
Percolation Test Results Performed by; ✓6, , - - ee,�,t '. f _._...._--- Date.. -----_-----
Percolation Test Pit No. 1...G 2__.minutes per inch Depth Test PIV ��'.-.._...�bepth to ground water.. <..lke ......
4i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a ..................................---------------••-------------...----•-.......---•--•------------........................................................
O Description of Soil.....J_-- , r .S Sr rC ..•••---------•••-••••--...--•••••----•••-•---•••••-••••-••-•-----•.....................•-
x .
W ---------- -a s ° .ter r -- ......--
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 TITIj 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 ' , I �x�t
----- ..--.------ ... _..
y t j
Application Approved By... ....... .... _`! � ' --•------�� .....
Date
Application Disapproved for the following reasons: ---•----------•------------ -------------•-------------------------------------•-•--..............
---.........•••••••••--•-•---••••-•-•--•-.....--••--•••--•-••-----•-•--•--••--••-•.......-----••-•••---•-••-•-••-•---•--•--••----•-•----•••-•--••-------•-••...........................................
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
f ff
OF....... f / /Z 4..........................................
...... .
Trrtif irtt#r of Tnntpliattre
THIS IS TO CERTIFY, t the Individual Sewage Disposal System constructed (() or Repaired ( )
by----------I/---- rf r _ ------------------------------------------------------------------------------------------------------------------------•-------------------
Installer s
has been installed in accordance with the provisions of TITLE 5 of�Yl�he State Sanitary Code as describe -in he
application for Disposal Works Construction Permit No..................... ..... .._. dated-....__..._.___
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE T A THE
SYSTEM WILL UNCTION SATISFACTORY.
DATE..... -3..4.....-•-------------------------
Inspector....•• . ---••-•• ---e> Gtp- ..........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF.... J
No...... 'Ar- FEE........................
Disposrat arks Tomitru_ ..ion unfit
Permission is hereby granted...i.,L- j...... � ./ t. �?":: . __........................
to Construct ) or,Repair ( ) an Individual ewage Disposal System
•------ --•----- -str --------- ---------•----••--•--------------
j" Street ��
as shown on the application for Dispos Works Construction Permit No...... ..�� Dated........... ... '!....................
Board of Health
DATE...................................5......
FORM 1255 A. M. SULKIN, INC.. BOSTON
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� + r` LEGEND ROER t 7 \1
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r3 El ilITINO.''=SPOT ELEVATION „0,�0 ;fo ELDRED
EXIBTINA CONTOUR - p - ; � j CERTIFIED PLOT PLAN
FINISNED SPOT ELEVATION , � r',(: : . R
' SA
l�wjuzD CONTOUR 0 /
,NOTE The location of .azy existing und.erg ' sewerage,
Swells, .or. other:.utilities shown on this plan is approx IN - 7�,oIT
q>, te only as determined from records and/or verbal �1+ � ,\� •� .\ 1 �.1
i ion. Th
'n e contractor is responsible for the •i i�1 L ,,�A7 �
,.
v,erifcaton of the existing locations. in the field. SCALE, �=4� DATE /Z
' KEDGE ENGINEERING .COI IN �.'isrvE
CLIENT. I CERTIFY THAT THE PROPOSED
EGISTEIiE REGISTEREp JOB NO. g4� ��3 BUILDING SHOWN ON THIS PLAN
y;y'SN S' CIVI-1 LAND CONFORMS TO THE ZONING LAWS
E�OINFER RV OF BARNSTABLE , MAS
712 MAIN STREET CN. BYE
HYANNI S, MASS. gNEET,' OF A E REG. LAND SURVEYOR
�O FT.: M/N• /YOTF : /F E/TNeR THE SEPTIC TAN/C OR
L��1C/•//ivG P/T ARE /YORE THAN /2"&&J.OJV
/O Fr. M/N; '. ' brrRAOE� A 24'O/AMETEK CONCRET.S COi�ER
q'PYC O/PE. SHALL BE BROL/QiNT TO GRADE.64/V',iV' ,QA
CONCRETE /IEAVY CAST/RO/Y Co{/�R SHALL 13E USED
/F//V L;pR/V EyV.4 Y
C'OYERS �6 PFiQ FT
- _ 2 MIN. CO/VCRETE
CO✓ER CLEAN .SANG
9M LEVEL DrA. ,
$C71EDf1Li40 a 4AYER
c o (i4[. o. •v oofliv.
TA v K . A SHFO S7i�NE
4.
s• p I • •EFFECT/✓t' • * 314'-
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O S ONE
1t,S'•a o 1 1 • • - • • • I • o 0
7� io . 7v i a. • r• s • • • •• • p �p PRECASTSEEfD4GE
INY,�R7" t'LEI/AT/ONS P�7 c i'•q c -y S¢J' G�4y:fj °f t •o • • r •. • • • • • a o O/7 OR EQU/V.
/NY,ERT AT 4U/LD/NCr 9 9 a p�' D/AM:
/AILET .SimprIC` Ti4/VK'. 4 g-g FT, -Ly FT. AP/AM. C(SEE TABULATION
Otf?LET SEPTlC TA/VI�: 4-�3.6 FT. r . '� _
INLET DISTR/D!/TION'SOX `48`/ FI GROUND AVA7, lE TAQLE
4 a,z sEC IO/v o/C
Ot/TLETD/S7)TAPI 7rYON 00W FT
INLET LFACN/NIT.P/T.: ; 47,8 FT S�hVAGE O/.Sf�IOrSA l .SY.STEr/K Ti1BllLAT/AN
LEACH/MG- PIT OJMEMSlON /l 3 ArT.
-dtALE : /•i
DES/GN CR/TER/A. 6
_ ol�.�lrslow � Orr.
NV/NBER OF BEVRoolvs 3 DtM�JYS/ON C 4 FT./"�,'r
Gr4RQ,4GE D/SPOSAL UNIT'/Vy nlE SD/L LOG .
o ffs T.
3 3 0 ,
/L T
TOTAL ETT/IwCTED FL,Oi�t/ GAL.�LL4i� DSO/L TEST AE/ SOIL TEST#2 f,
A/IIMBER Qf 4EACN1N1. p/T3 / fgI, . -�9>a BL�Y. DATE OF 80/L TEST l� '` -3��4
S/OEA.&ACH!/VG PER R/T / Sa PT.' /..,. JDD G/
Q 2 RESULTS IVITNESSED dY
BOTTOM LFs4CN/Nrr PER P/T 7 $Q FT. o-- LO-A 1"I AE/4COLAT/ON RATE• / LDS !y//1�/INCN
TOTAL LZ4E'H11V4G AROA 2--b 6 SQ'•PT. ' � S�� �� �� PAMC0[AT/ONRA7',W J&2 �M!A/�/NCN
RESERYELLACN1N&AREA-SQ. FT Z i_ Gf ,. Z. o :
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