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LOCATION{'-�;R �•1 y ( � SEWAGE # '
VILLAGE f'44!9 /1 i ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) -ey�.j
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED: nn
DATE . COMPLIANCE ISSUED: ( J�
VARIANCE GRANTED: Yes No '
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r ASSESSORS MAP NO- —r
'ARCEL NO.-.
No.. Fxa..IS...................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® F HE LTA
7 .............OF....... ----. -------••--••-----•-----------
ApplirFation for Bigpoii al Works Tomtrnrtion ramit
Application is hereby made for a Permit to Construct ( &-�'or Repair ( ) an Individual Sewage Disposal
Sy at 1 11
....... ...............
Location-Add r y j of I�To. �/
.......... 5..i.. .._ L+' _ ...0.................... .... _.... ... V
Owner Address
-------------------------- ..................... -........................._.............................
Installer Address
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms---- ______________________________Expansion Attic (67 5 Garbage Grinder ( 76
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a Other fixtures ------------------------------------- -
W Design Flow.........5�..... ...............gallons per person per day. Total daily flow............-.3.Q......_.......gallons.
9 Septic Tank—Liquid capacityi 42 gallons Length................ Width................ Diameter---------------- Depth................
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�av' (, )�
'-' Percolation Test Results Performed by------- ,..�f.C'. ! ...�lY�Date.................. .
aTest Pit No. 14C5.5.._.minutes per inch Depth of Est Pit....-. _. .... Deptb/to ground water..............
fi, Test Pit No.�*.,,A_minutes per inch Depth of Test Pit.................... Depth to ground water.. G___.._.._...
a -------- --------------------------------------------------------------•------------------•---------------•-............-----------------------------------
0 Description of Soil...........................................................................................0---R—'aZ------ •----- f - ...........
U ----••••-•-•--------------•------------------•---•-----•-----•----------•--------••------•---•-••-------------••-------------------------------••--•-•--•----•-....------------•-•----•-•-•------
W -------------------------- -------------------- -------- - -------------------------•-------------------------------- --------•----
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 iT y g g p y�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.
Signed•. . •------_s .a� ... .......... ------------------ .. --------------------------
D t
Application Approved By--------------------------•----- ��................................ ....... 1�' -9
Application Disapproved for the following reasons---------------------------------•--...............................................(............................
----•-.........--•--------------------••--•--•--••-••---••-----••--•-•-••----••--------------------------........--------------•------•--•--••------•----------------•-•-----------------------•••-•---•.
Q� Date
PermitNo.------.LJ. 7........................... Issued_.......................................................
Date
r ". j b
No. FEs7_S...................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® F H LT
�1...................OF....:.. ' - , .-... �
Appliration for Disvvii al Murks Tomitra ion Frrmit
Application is hereby made for a Permit to Construct (4-T or Repair ( ) an Individual Sewage Disposal
System a
,g J .ry
Location Add Lot I\o
" Owner Address -•-----••--•---••-••---••----•-••-•-•----
Installer Address
Type of Building Size Lot............................Sq. feet
., Dwelling—No. of Bedrooms____.___......................._.......Expansion Attic e(f Garbage Grinder
Other—T e of Building No. of persons............................ Showers — Cafeteria
Other fixtures __________________________________ • _._--
w Design Flow......... I'.........................gallons per person per day. Total daily flow............ ...............gallons.
04 Septic Tank—Liquid*capacit)f 9N� _gallons Length................ Width................ Diameter---------------- Depth................
W Disposal Trench—No_____________________ With....._.............. Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tt (� )
~' Percolation Test Results Performed b ...... s .............. ' " Date........................................
Test Pit No. Z5.3_____minutes per inch Depth of Test Pit....:_:............. Depth to ground water---------------------_-.
Pz Test Pit No°� ,;:F :..minutes per, inch Depth of Test Pit____________________ Depth to ground water_-___-__________________
a ---•---•-•••----------------•-•----•-•--•-•------••••...........---•-•.._..._..:__-------------•-•-'-••--••....__........_•---•-------•-•---....:-----------
0 Description of Soil........................................................................................................................................................................
x
c.,
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 ofT of the State Sanitary Code—The undersigned further agrees not to place the system in
been issued by the oard of health.operation until a Certificate of Compliance has be _-�-�'���� : if
........................... ................................
Date
Application Approved By............................... ., ------� ---1��- �-�--•------
ate
Application Disapproved for the following reasons-------------•----------------------------------------------•-•••••-•----•--•-•... ......-•----•--•---•--•--•-•-
..------...-•-------------•-----------------------------------ii--••--••---••-•---------•--....----------...---------------------------------------------------------------•---------------------------••--
Permit No.-----�� �l 5f I Issued Date
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF. HEAL H
'`?e !...................o F.. - "•.v.... -�.: .-•--------.._...........
Trrtif irate of TompliFanrr
THIS IS TO F&tRTIFY, That the Individual Sewage Disposal System constructed (4'1'or Repaired ( )
GInstaller�_ � !°� ...----•-•-•..........................................•---••--
at ------. .......................................................... r. . - ............................................................
has been installed in accordance with:the provisions of liTE - of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No. ................ dated__ 41"................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT YHE
SYSTEM WILL FU ION A ISFACTORY.
DATE...... = TV........................................ Inspector---._ l' --.....................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTIJ
7.................OF.... .......................
NO �......:7.
FEE ....... .......'--
�i���io, 1 orko��on�#rai�n rrmi�
Permission is hereby granted___ _
to Constr ct ( or ep it ( ,/ an Individual a gage Disposal System
a. I..._ .•. •. - _°. '`__ !-------- �l, .r?.fit I....................................................................................
_we Street S,t f
as shown on the application for Disposal Wor-s Construction Permit No.;!____ �l.._ Dated---. -•--•-------•-----
------•---- ----•-----
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FORT:I255,I_`-Hosas & WARREN. INC., PUBLISHERS
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Q� OF a
Cµ�rr PA U L A. v,o� DAVID P.
G V g MARIANO m e LEVY `�i
-+CIVIL
� " No. IOGI7, �
�V9 lT� % LL 1A) c2 No.311115 Q co p v,
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LEGEND °
EXISTING SPOT ELEVATION OxO
EXISTING CONTOUR --- 0 --- CERTIFIED PLOT PLAN
FINISHED SPOT ELEVATION
FINISHED CONTOUR 0 .
�VO'IE: The location of any existing underground sewerage, IN
wells, or other utilities shown on t;is plan is 'approx-
imate only as determined from records and/or verbal JI \
information.. The contractor is, responsible for the �� �� -�"""�'°��, � `�d
�
verification of the existing 1.6catibns in the field. SCALEO = s/O r DATE G
LEVY & ELDREDGE ASSOCIATES, INC. CLIENT.4--819414P,1,04 i CERTIFY THAT THE PROPOSED
i
ENGINEERS-LANDSCAPE ARCHITECTS JOB NO. IcyS BUILDING SHOWN ON THIS PLAN.
PLANNERS-LAND SURVEYORS �C�ly CONFORMS TO THE ZONING LAWS
DR-BY,
OF BARNSTABLE , MA.
SSg w, VMp iIJ s�'t" CH. BY PL b
SHEET_1_ OF Z OnA E E LAN SURV YOR
20 FT. M/11/. /YOTF /F ETHER THE SEPT/C TA V/C OR
LEi4GN11VG PJT ARE MORE TH.9/'/ /2"BEL0/&t/
/D ITT. MAN. --"- SRAOE� �4 �Q"O/AMETEK C'ONfR.ET� COtiER
4'PYC PJPF SHALL pE BR0UG.VT TD GRAOE.��+N EXTR/�i
CONCRL7E All". PJTCN i`/E.4VY C/9 ST /RO/Y CO✓ER SHALL QE USE.
. e,,•, �—�— C•OIiERS �9�PL�,Q FT. !F/N !�R/VEN/A y
CiRAOE COVER CL EA/V .SA/V L7
L94/ID LEW L ( '
4.• �"CASa _ . . 2'LAY--R
IRO JV P'I PE• ICOO • v o ' a o p / •"3
MIN.P/reH GAL. 1 . . . . . . e e of /8 /8
`<t %4"p0m.-T S,EPT/C TANK Day ♦ s 1 • • t • . 1 • e •Ae WASHEDEcrIv—
S727NE
D
1 ° DEPTH • 1 ' •Al
v . WASHED STaNE
BSI X r. c� = R �rl.rj • • • • • • • • . • p p PREGAS r SEEPAGE ;
!Nl/efiT' E'LEI/�9TIONS //�X/ O I�3' O_ `a�.' • • • • • . . • • o P 7OR EQL//V,
e a
INVERT AT QU/LD/NG (c? ? FT
INLET W)OT-IC 7.4NK FT L. /Z FT, 01AM C,(5EE7ABLJLA77JOAV) .
0UT1-ET SEPT/C TANM Fr,
//VLFT O/5TIR/81I7/0N BOX 6/,9 FT. SECT/ON OF GROUNo WATEfC 7AOLE
O!/TLETD/STR/BIIT/ONBOX 6l,7 FT
INLET LEACHING Jn/T Gl,s FT .SEWAGE O/SPOSA L SK57W/l9 7AJI11-ATlD1V
LEACH//VG PIT DIMENS/ON A Z'a FT.
DR-516M CR17-ENIA -SCALE : %" _ /=o"
D/M.ENS/ON $ FT.
NilA'9BEJ? OF BE'L>ROOVS D/MENS/ON C 4—F7-
.
(7-4R4 AGE p/SPO.SAL zlNir "OrJL� SOIL. LOG P-
TOTAL —637I/►x-47•EL7 FLodV '�'�U G,aL.�DAY SOIL TEST / SOIL TEST 2 SOIL TEST
NUMBER OF LEACHING P/7rs I f^FLEK PATE aF S'O/L TEST
S/DE 4—=ACHING PER P/r �5/ SQ, FT.
FT v >'OSoiL RESULTS
B is//TNESSED dY11��1s�lyc/lei.,
OTTOM L ;ACHING PER P/T / L -eAC04AT/ON RA TO At AZI MJIV/-hYCH
TOTAL LEACH/JYG AREA SQ Fr. - laEhC0L.47'10IV RATE/k2 MJN.1/NCH
RESERt�ELEACN/NGARE/a -" Sip. .
Q
FT
4
Sco I L TEST 71-Coo l4
DAVI D P. �� SIR/O GUT
MARIANO
v CIVIL H�epd S7A L-e- )471-c? SS
,A No.31115 co
LEVY & ELDREDGE ASSOCIATES INC.
SS�0NA - /o' CL-.5?, COrrzge j;jUr,.�.r g ss.
� . ®. ND O,govn/p YY�4TEf� ENCOCJ/VTEREO G"L/ENT:�n_�v�eJe DRTE� �'�n &G
GRO UN17 LVA7 AT ELEI/ _
JOB No; 1045 SHEET�'of