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44 TOWN OF BARNSTABLE - 1
LOCATION Lr> I �j� (.�I,.� �.,.-� �� �,�/a SEWAGE # 9 6- tbz7
VILLAGE- A VtV. - 27 Z
ASSESSORS MAP & LOT o n<
INSTALLER'S NAME PHONE NO. . ?, Zt-5cak\ 77 1 - 3 (o�
SEPTIC TANK CAPACITY �` ®
LEACHING FACILITYAtype) k c c- ,. Q 1 (size) (0 0 16 y (�0 hS
NO. OF BEDROOMS PRIVATE WELL O I A
C'e BUILDER OR OWNER G -ev\iiOtl .« 04-vt , c9 .
DATE PERMIT ISSUED: 4B G
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No �--
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!' ASSESSORS MAP NO:
�y PARCEL NO.:
No. ---1-0 i / Fxs........Y.`�...
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HE
A T
-f..L.-.......OF......... ...., . ..- ,r
ApplirFation for Uhnpoii al Works Cfayustrurtivat thrutit
Application is hereby made for a Permit to Constr t ( or Repair ( ) an Individual Sewage Disposal
System at /-
- ----------------
/� Location-'.Addre. /-'� or Lot No.
r1.. , �.�?k' .._ .�? -' ----- -------- Alm e-----
----------
. .
�— Owner Address
.. .........................
Installer Address� �^
Type of Building 13 Size Lot.e ��--•Sq. feet
U Dwelling—No. of Bedrooms.............................. .. .Expansion Attic Garbage Grinder �11&
Other—T e of Building ............................ No. of ersons................_....__...__ Showers —
yp g p ( ) Cafeteria ( )
Otherfixtures ---------------•-----•-• ---•--------•-•-•-•••---•-••---•--•••-•----•-----•••----•-.......-••--••-- ---- ................................
W Design Flow......... ...................gallons per person per day. Total daily flow---- ..............gallons.
Ix Septic Tank—Liquid capacitif 0 .0-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. it.
z Other Distribution box ( ) Dosing tank (,-)� _q
Percolation Test Results Performed b � -__.__. .�eYr. __ y
a y - �'_. 1 �/� ate..L�--,_. ��. -- -------••--
Test Pit No. ------minutes per inch th of Test Pik-_p_ -_ Depth-1/6Depth' ground water-.---
(s, Test Pit No.�a,�Aminutes per inch Depth of Test Pit./._ ......_.. Depth to ground wate.........................
O o
----------
Description of Soil � -----------
U ................................................ ------.cka. ---- -----------------------------------•------•----------
-------------------------------------------------------------------------------------••-•--------------------------------------------------------•---------------------------.......................
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 A.-I
p of the State Sanitary Code— The undersigned further agrees not to place thZs
tem in
operation until a Certificate of Compliance has been issued by the boa f health.
ned.- -- --- �li
Application Approved BY--.----••-•.-------••-•-- �. .. .. ....... . . .....-•-------- -1 .....
�i Application Disapproved for the following reasons______________________________
............•......................................
----------------------------------------------•-----•--------------------•--•----------------......--------..............---•--......••-----•-•-•......-••-•-......•---...............................
Datc
PermitNo..........................................................Z
Date
o "1No:,X ..1......._ Fss.............:'............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Applira#ion for Dtspuoal Works Toutitru.rtion Vrrutit
Application is hereby made for a Permit to Constrict or Repair ( ) an Individual Sewage Disposal
System at:
......... .............Ax�f e:!!0W
f ,f
Location-Addr
•� or Lot No
........... ..... -rujilk
Owner Address
............ - --------- ------------------------....
Installer Address
Type of Building Size Lot . �! ___.Sq. feet
., Dwelling—No. of Bedrooms........ ..............................Expansion Attic A? c) Garbage Grinder41(P )
aOther—Type
of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
� Other ixtjes .............................. . .
w Design Flow....... _.........................gallons per person per day. Total daily flow...........a-C........._............gallons.
WSeptic Tank—Liquid*capac*0 €9_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 (,,,,,,),, ,, 'f 0
Percolation Test Results Performed b3a ` " ¢`,' ir .....!2 Date. � ?�,f .......
Test Pit No r�) __-minutes per inch pth of Test I ------- Dept o ground water----
-. ........ ..
. _..
N(s, Test Pit o� faef-_--minutes per inch Depth of Test Pi _......._... Depth to ground water.._
D Description of Soil r c.... - t
x -
c, ----••----•----•---------- . ------- .�-•-•--�-Ac - --- eggRAX � --- -...........................................................
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 T_T LE ; of the State Sanitary Code—The undersigned further agrees not to place the s stem in
operation until a Certificate of Compliance has been2
issued by the board of health.
_____-Signed..Z.:ZV11,
-
ApplicationApproved B � 1 PP PP y---••.... ........................ -------•-........._......-------------•--- ------. ------------4--=='---r"
Application Disapproved for the following reasons:.................................................................
........................ Date---...........
ry Date
Permit No..----- ... r l _ Issued
Date
THE COMMONWEALTH OF MASSACHUSETTS
t
BOARD OF HETH
'C ............... ............... .. .. .. ..
Trrtifiratr of Toutplianrr
TI-1,S IS TO C TIFY, That the Individual Sewage Disposal System constructed v4x or Repaired ( }
------ -
d t/ , Installer sr
has been instailed in accordance with the provisions of i IZ r. f The State Sanitary C de as de•cribed in the
application for Disposal Works Construction Permit No.__�..�`�..._ _h?_`�1--_•. dated--_.._��_��.��-�.
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT YHE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE......................7_`_. ....... �_ -------•-------•------------- Inspector..............------------ ----- .............................................
THE COMMONWEALTH OF MASSACHUSETTS
005
BOARD OF HE LTH..
.....................0F._ ..... r Zk. �•
................. FEE.....
io �rl or , ,ono#rion �erutit
Permission is hereby granted------ �.�'" ' .. `----
. ..--..L C -----•----------------------------------------------------•.•-•--
to Construct Ll
, ep r ( ) an Wdividual Serfage Disposal System
as shown on the application for Disposal Works Construction Permit reet � �9
���` I =----------- d------------ -
----------t•-. ........
.............. *_"-(!/_._.....__ _ ............................
Board Board of Health
DATE_.............................. =
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
1 15 F'RC�WT"P ile 1�s5UN I� Lo'T.
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.� CIVIL = •<<y Q 311' 39t /
No.3111 '
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S�oraAL. ':b o 15,000 5. F. s In
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LEGEND
� PAPA UL A.
EXISTING SPOT ELEVATION () 0 o LEVY
x � No. IG617 1
EX.IS TIN G. CO eTCJ3z -- - 0 --- r\� � l CERTIFIED P' OT PLAN
FINISHED SPOT ELEVATION! R-
.l r-I N I S I•I ED C O R`3'O; R ® 4071. _.—,.�.
N7I'G: The location of any existing un r round sewerage,,
wells,. or other utilities shown. on this plan is approx- IN
imate nly as determined from records .and/or v.erbal r4RN5T $LE �Nyi4NN/S� MA . 1
information. The contractor is responsible for the
verification of the existing locations in the field. SCALEi I`� = y0' DATE 9�23�96 �.
t
LEVY & ELDREDCE ASSOCIATES, INC. CL.IE-NT 1 CERTIFY THAT THE PROPOSED �.
ENGINEERS-LANDSCAPE ARCHITECTS JOB NO. -- . BUILDING SHOWN ON THIS PL AW
PLANNERS- LAND SURVEYORS CONFORMS ,TO THE ZONING LAW$. s.
DR.BY t —A M,
OF 84r►,tS�gB M A SS
A .
88g !J, 1W,41A/sTr,5'C i CH. BY
C�nlTc�evi�L M,S�s-s.
I .
SHEET OF ATE R LAND SURVEYOR
. ..... .......
20 FT. N07 /F E/TNER THE.5EPT/C TANK OR ,
/EACI•//N ? A G /T RE M TH ORE A.Al lZ"JELOK/
" /O �, M/K :�RAOE� f� 24 O/AM ETE�' GONC�ET� COIiE.P �
SVALL BE BROUGHT. TO 4MAOE.(�4N EXTRA
4"PYC P/Pd
h+E
CO/VCRCTE RVy CAST /ROlY CO/i�R SHAL L S L3E UED
COVERS M/N. PTTCN /F//V ,DR/VZ=;VAy
;_• _ /B PER Fr.
2 J. MiN. C'D/VC.eE" lie'
A ::: _ G .�oE COVER CLEAN ..SA/V O
•� . . . BACkF'/LL
Lp1//D LEVEL
r s. 2 LAYER `
MN P/�c v L---- GAL. D/ST. • • o • . . • • • e •e yyA SHFD 570NE ti
V4 4OP01i PT, SiEPT/C TA/YfC • • 6 • s • • • • • • • sea a
BaX o314
8 • r • • • .'r •
. , r .
• • • • . OgPT/� • • • • o e WAStTED STaNE
_ dic l9�gli3T�oxr�./ coT y= 377.,SGPo2 r °•oo ••• •• •• •• • ••. •• •
•113• o 1 L'eo
'• SEZRA
O• Pr•o�05C�A • • • of o P/T D.A�EQl//V.
lNieA"r PCEYAT/Oros
l r a �•_
/NYERT AT &WLD/NG %.2136 FT. 6 F7 D/AM.
INLET SEPTIC TANK 6 6d FT, 1� FT O/�11+9. C(SEE Tit8uL4TION� I
O/JTLET SEPTIC •TANK 56•¢o FT,
/NLFTDISTR/BUTTON BOX 5*.,"2-0 xr7 W,47TCR T.48LE
OtJTLETDTSTR!®t1T/ON BOX 56, oojax
SECT/ON OF
INLET LEACHING Piz' .�2rgo FT SEWAGE O/�PO�S's410 .5'l��7&M
. LE�OGT�//VG A /T 7�4�U1.ATlD/V.
DIMEN
SCALE S/ON A AM FT.
DES/C/Y CRITERIA —!4—FT.
/vU�9BER OF®EDROOMS �_ D/HENS/®N C FT.
(7i4RBA6E'D/5PO.S.91- UNIT /VONT SOIL Loci S®IL 7,657
To7'Ac E3TlAlA�eD FLOW 330 GAL./OAY SO/L TEST A/ SOIL TEST#2
Nury;,6c'R OF LF,acNrNG Pjr.�_ f`FLeV S8,8 �^-AL.EY. GATE OF so/L TEST 8�2S18 G
S/OE LCACH/NG PER P/T —SQ /sT. O'-Z' TaasotL RESULTS is//T/1/ESSED BY ToM Mc eEAN
450TTOM L_&7ACH/NG PE1R P/T-ZL3---$Q. FY- ReV COLAT/OlY CA7--F At I MJAl//NCH
7-,07,41 LEACi///YG AREA 2651 SQ. ":r /-ERCOLAT/ON RATE I 2 M/N.�lNGH
R,ESE�VELC'T,�TNGAREA 2!o`F SQ, FT. c%r-,an1
a tisE:�rr1H� .S'O!L IfS 7-
K�@ys"opt,, 5 3 0
.f• .�, Z I Il
mar DAVfD P. .LQZ o WNI7'511,rf LL- W_ _
MARIAPiOi�' f+�
cfvlf LEVY & ELDREDGE ASSOCIATES, INC.
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"O,_ ` . ► /:. EL• 4./5.8 7/2 1"A/,Y ST- , AlYq"A.11S, A-fA3S, y;
" �NOGRO ONO.; A7ZR ENCOUIV7L� . � CL/EN7�:GREENQR1Er2 DRTE � 9
Q GRd UVO 1-11ATER AT ELw .JOB NO' TOSS SHEET 2 OF 2