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HomeMy WebLinkAbout0512 SOUTH MAIN STREET - Health (2) LUTH-MAIN`ST.;CENTEC z , 5. b Al UPC 17534 No.2153COR k ASTINGiS,MN I CERTIFICATE OF ANALYSIS Page. f.' Barnstable County Health Laboratory Report Prepared For: Report Dated: 03/15/1999 Ford,James M. Order Number: G9901573 James M.Ford 512 So.Main St. Centerville MA 02632 Laboratory ID#: 9901573-01 Description: Water-Drinking Water Sample#: 01573-01 Sampling Location: 512 So.Main St.,Cville Collected: 03/08/1999 ollected by: D.Miorandi Received: 03/08/1999 Test Parameters ITEM RESULT UNITS MCL Method# Tested LAB:IC Lab Nitrates 2.8 mg/L 10 EPA 300.0 03/08/1999 Note: Water sample meets the recommended limits for drinking water of all above tested parameters. Approved By: (Lab Director) Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 r TOWN OF BARNSTABLE LOCATION SEWAGE # ��� VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHON� NO._� SEPTIC TANK CAPACITY LEACHING FACILITY:(type) `. G )�6 (size) NO. OF BEDROOMS� PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 1 — VARIANCE GRANTED: Yes No rrev k d TOWN OF BARNSTABLE LOC'i,TION S ra& Aim,,i Sr SEWAGE VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONf NO. „�,,,�;, SEPTIC TANK CAPACITY J 6 a LEACHING FACILITY:(type) C Y6 (size) t 4 NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 1 - VARIANCE GRANTED: Yes V No f �; f�,y ® nTOWN OF BARNSTABLE LOCATION c�l //�� '/� �% _ SEWAGE #C'�-F ' ASSESSOR'S MAP & LOT ITISTALLER'S NAME�& PHONE NO.;:ijZt A/ SEPTIC TANK CAPACITY 0166 t O&rl/ sriST Y LEACHING FACILITY:(type) f ff i (size) 0.0 Cam/ NC. OF BEDROOMS . PRIVATE WELL OR PUBLIC WATER&liv� E BUILDER OR OWNER v DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED_! VARIANCE GRANTED: Yes No���' 11 ,2 30 f� Fmm THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...........................................OF......................................................................................... Appliration for Uispoii al Works Toustrurtion Prrutit Application is hereb made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................ ! z7:t -�--�-__- --®r4._ ---------------------------------------------------------------------------------------------- L tion-Address or Lot No. ......................................... ............-----...-----.•...----••----•---.............-•----......................._.._._---- Owner Address ...............4/1� �,k.....&/ A/--------------------------- .................................................................................................. Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms...............3 _Expansion Attic ( ) Garbage Grinder (i?*) aOther—Type of Building ............................ No. of persons............................ Showers ( ) Cafeteria ( ) Q' Other fixtures ..................... W Design Flow...............//_Q....................gallons per person per, day. Total daily flow..................................... 1ppS. WSeptic Tank—Liquid capacity/oa.a.gallons Length... _-►_.. Width_�..:. ... Diameter________________ Depth.--_.. ........ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........../------_. Diameter.......�j..... Depth below inlet.................... Total leaching area.; _6_.4/..sq. ft. Z Other Distribution box ( ) Dosing tank ) , ~' Percolation Test Results Performed by........... 7e..l^f_ dq<- ,e -_._ �'✓ °d?a Vie_",1 ate...... ___________________________. Test Pit No. I_...2.......minutes per inch Depth of Test Pit....../_a....... Depth to ground water________________________ Test Pit No. 2.....,A ......minutes per inch Depth of Test Pit.-_./;2.......... Depth to ground water........................ a -----------------------------------•---...........---------.........------------•--•-------..._.............................................................. 0 Description of Soil...........,O<......e'14_.- x V ---------------•-------•----------------•-•------•-.....-------•----------•----------•----.....-•---------------------•----•------•---------------------------------•------------•-•--•----•---••--•---- W VNature of Repairs or Alterations—Answer when applicable.__............................................................................................. ----------------------------•-----------------------------------------------------------.......----•----••-•--•------------------------------•------------------•-•--•-----------•-•----•------•.------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with A.- •. the provisions of "T"TT :IL 5 of the State Sanitary Cod —The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been •ssuf�d by the board of health. Signed � ,..00000e . . �•----------------•• ................--.------------- Date Application Approved By............... ........ Date Application Disapproved for the following reasons--------------------------------------------------------------------------------•---------------------....._..._ ...........................•-----...---------------------------•••--•------••-•--...-••••--••-----......_._ Date Permit No.-------- t/...................... Issued------------------------------------------ .. �- oat Permit No.--•-••F--9-=._.b..`-------------•----- .. Issued_-.------•--- •---------------------- L�:.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r.'1�t__.........OF..................A.:..y.�-? +s: f................................ Trrtifiratr of Toutpfiattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (><) or Repaired ( ) by-----•................... y-r%°^^.��..........�eS�_1-Q ...•I.---------------------------•-•----------•---...-•-•------------....................-----------------•-- • nstaller at.....................�- $ ,�...- ---------- ' ------ !�.cr r a - t----•-------4� ==--=c- DP 0 has been installed in accordance with the provisions of TIT E 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No---------1&.2------ �_�jC._.___. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................... ----------------------------- Inspector...-----......--- --..` . i...----------------.............------•---•--•--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �y L ..........: Z'�y�r............OF................� r��t�r!`,� ��1! f...........................:..... N0....... �L.l 11.� iapo,sa17ivioual orku Tortuga tiott rrutit Permission is hereby granted. ...(/.=Q s..L----------------------••------------------------------•----------..............--•---•--- to Construct ( ) or Repair ( ) an In Sewage Disposal System atNo. --- c ,}r_. ` [".�.. 5.7-, -��•. ,� r ! j- ----•------•--•----•-----------•----•-•-•-•--•-•----•---•-- srreet �. as shown on the application for Disposal Works Construction Permit No .�_.G_�"Dated.......................................... --•----------------------•--_.____--..__ _.._r_ „.. .......................................... � ' ' C n, oard of Health DATE------------------•- ------------------•------- --------•----•--•----.._..... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS Fims....._ ..." . THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..........................................O F...........................--..._......_..........__.... Appliration for Uiipoii al Works Tnntitrnrfiun Vamit Application is here b made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .5/a2 ----------------4!2-Y-�..c. !-... ? lt.. 'l .�s; e C'n------------------.....---......--•---------------------------------------------..........---- L lion-Address .- or Lot No. .. f!!n X......................................... -----------•-••-•--•-_.....•-•---.......------•-•--- `owner Address Installer Address UType of Building Size Lot............................Sq. feet �., Dwelling—No. of Bedrooms...............3..................._.....Expansion Attic ( ) Garbage Grinder, (01D) PL4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ---------------------------------------•-. .< W Design Flow................ ._�............._...-__gallons per person e� day. Total da}lyv flow-----------_--------------------------------galls. 9 Septic Tank—Liquid capacity,l�Q.p..gallons Length___ .6-.. Width_Y.../._... Diameter................ Depth.5.^........ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No........../........ Diameter-------f'.F,�..... Depth below inlet.................... Total leaching area. ' ?AY.--sq. ft. Z Other Distribution box ( ) Dosing tank ) aPercolation Test Results Performed by....__.____ ��,�Y`_L ... �? �.`.�?Ets_J<Date...._.�d-••_____________••-•--•-_-.. Test Pit No. 1_...2-------minutes per inch Depth of Test Pit------!_'....... Depth to ground water------------------------ Test Pit No. 2.....0L......minutes per inch Depth of Test Pit.... .......... Depth to ground water........................ ODescription of Soil..........., i<......&'Z`-.----------------------------------------------------------------------•---------------...------•-----------..................... V ............................. ----•-•-•-----•••-•••••----•-••--.....••--•••--•••--•---.......-••--•-•••-•••••-•••••••••--•-•••••----•---•-••-••-•---•---•----•-•-•--•••••••......---•--••--••......--•-- W ----------•------------------•-••••-•------•----•-•-----•-----------••--••••••...------••-•••••••-••----••••---------•-----•-•-••............-•••--•---................................................ 0 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 u..:TTriT .,•, 5 of the State Sanitary Cod —The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' su@d by the board of health. Signed_._ ..... ----•••--• •••--•--•-•--•••-•-------------- � Date Application Approved By................ ----------- ---•-- .,1._ -4 Y ...... Date Application Disapproved for the following reasons:................... •••-•-•••••-•••--••••--•••-•••--•--•••-••••••-•••••••••••---•---•-••..............•...... -----.•--------------------------•------------------------------------------------------------------.-•-- ------------------ Date qq NOAO 1.1.4.. Fx$.� ............ r')PSIGNiNG FLNG NEER MUST SUPERVISE THE COMMONWEALTH OF MASSACHUSE JSTALLATION AND CERTIFY IN WRITING BOAR® OF HEALTHTHE SYSTEM WAS INSTALLED IN STRICT �^CORDANCE TO PLAN. T�LVri.... OF...........Bdznst.abl ............................... Appliratiou for Uhipati al Works Tongtrurtiott frrmff Application j*§ hereby made for a Permit to Construct ( x) or Repair ( ) an Individual Sewage Disposal System at: l Z ..LotC••South Main... e ? .: ..... ........--•-------------••.............---•-••-- Location-Address or Lot No. Nicholas D. Franco Owner Address I _ ................................ I e—J Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms...........3................... _Expansion Attic ( ) Garbage Grinder ............... No. of ersons.__.._............_........_ Showers — Cafeteria Other—Type of Building __._......_.• p ( ) ( ) a' Other fixtures ...................................................... W Design Flow.... 110 gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity...1.0-0 gallons Length_$.�...... Width.4............ meter________________ Depth..................' " x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.........._.........sq. ft. Seepage Pit No---------1---------- Diameter........1.2....... Depth below inlet.................... Total leaching area....26.. ......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 10/1/8 5 aPercolation Test Results Performed by---E-1-dr-ed-- e---El3g-knees i-n-g............. Date........................................ Test Pit No. 1..........2_._minutes per inch Depth of Test Pit.....1.2.......... Depth to ground water---------------------._.- f� Test Pit No. 2...........2...minutes per inch Depth of Test Pit-_.--1.2.......... Depth to ground water_______________________ •.............................•---••---------------..........--•---------------...........---------•........................................................ O Description of Soil------------•.T.p..-#1..-4= �oa> r & S1+bso-4 1--p-------2--'---1.2-=----Me4ium---LGe-se--•Sand v -------•--------------------------•--•-••-T-P---#2--- ----Med-ium---Sand-r-- 8 = --kda e ---------------•----------------------•------------ --------------------------------------------------------------------------------------------.......................................................................................................... U Nature of Repairs or Alterations—Answer when applicable.___---------------------------------•.-----___-____----_---_____---_____--_--___------------__. --------------------------------•--...----------------------------------------------............--•-----••------------=------------------------------------------------------•----•••-•---..._..-------- Agreement: The undersigned agrees to install the iaforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI:i 5 of the State Sanitary Code—The undersi d further agrees not to place the system in pApplitcatl ion u it a Cert• ca e of Compliance has been issu d b the b- d f health. Signed ... �% .... A �� D to nApproved By--- -- - ---- ----- -----------------------------•----------.........................-••_. .............. -- Dat Application Disapproved for the f ollowin reasons---------------------------------------------------------------•......---------------------------------.......... .........................•-•----•--•--------------------•--•---•----- --------•--...-----•--------•------•----....-•---------•-------•-•-••----------------------------•------•--------............. Date PermitNo................. .......--------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...T.Qwn...........................OF....................Bax n s to bl.e--............................... Trr$ifiratr of Tompliattrr THIS IS TO CERTIFY, the Individu�l�wage Disposal System constructed ( x) or Repaired bys. _... ---------------------------------------------------------------------------------••-••------•-.....---- Installer - at.............Lot...#.C_.-Enuth..Main...Stree t_.....Ce..n-te ru itle-•---------------------------------------------------------------------------- has been installed in accordance with the provisions of T .TIE' 5 o The State Sanitary de s de bed in the application for Disposal Works Construction Permit No. �?..": ................. da.ted.__�'__1�' .__........__.._... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................................................................... Inspector.................................................................................... _ ��. No .. 4..........._. ,� Fps .. THE COMMONWEALTH OF MASSACHUSETTS y . BOAR® ,OF HEALTH ................... Town OF...........R?ai nstab 4 t Applir4tion for, Bi-quusttl orkii T -'astrnrtinn Vamit Application i hereby made for a Permit to Construct ( X) or Repa>r. ( ) an Individual Sewage Disposal System at: Lot #C South Main Street �®nt.� t .. ............ ...... .. --..... ....... ...... k Location-Address : _ - or Lot No. , 13loholas D. Rranco . _ ...-•-••.............. ..•--••. •-•-•- --------------------- . r Owner Address 5` �. Insfalle) Address Ex ansion>Attil „ U Type of Building }t Size Lot________________ S 'feet; Dwellin No. of Bedrooms._:_.__.___3..__.__.._.. _ q g— p . ( ) Garbage Grmder Pa; b Other—Type of Building ____:_:..,, .___._.'__.._. N"o:` of''persoris ........ Showers ( ) — Cafeteria a" Ot,herOfixtures .G. 1 .................... _....._ f__., W Design Flow............................. per person ver day Total dailyl flow............................. .......... allorts.. r Gi Septic Tank—Liquid capacity.__I,0.044ons Length _$: "6,N_ VVidtl 4 _._ Diameter________________ Depth s!*4, WW1 ."',Disposal Trench—No..................... W>,dth.................... Total'Length - Total leaching area___ sq Jft.'� h+i . Seepage Pit No.______.-g..._...... Diameter."'.._..1 .....Depth;:below.inlet . Total leaching area._ 2 6' sq. It. . Z Other Distribution box ( ) ..Dosing tank ( ). Percolation Test Results Performed by.__Eldr�g E. te�ri l0/1/ 5 ---- Date •-- Test Pit No. 1__...._...2.,minutes par.-inch Depth of Test Pit k Depth to ground water __ • , . Test Pit No. 2...........2..minutes per..inch Depth of Test"Pit Depth to ground water _::_ N a ............................................. ...................................O` Description of Soil------- 'I'P--- 1..-Q-�-- ---Loam►-- ..-Subsoil r-- 2-�---���----I�ed�,ilAl--I►O©�@,`�F.IA�;:. Tp--- 2 of=8' Med iun ' : :meter------------------------- W ------------ --- ------- --------• ---- ............................................... x.. s U;a :Nature of Repairs or Alterations—Answer when applicable:.___:_ ____________________________________________ „2 ............... Agreement: , : 'The undersigned agrees to install' the aforedescribed IndivldualSewage Disposal System in accordance with t'heprovisions,of iITLi� 5 of the State Sanitary Code=The undersigned_ further agrees not to place the''system;in tion u it a Certificate of Compliance has been issued by the board.of:health. Signed----..... Date A lication Approved B NJ, CZ "--� Dat Application Disapproved for the f ollowin reasons:........................ . ........---•-------------•----•-----------------•-------------•---•-----------•--••••-•-------......---•--•-- ............................................................. Date PermitNo.....................•-•............---••... :', -Issued...---------------- ` " ` Date . 7r THE COMMONWEALTH OF MASSACHUSETTS BOARD O`F HEALTH ` Town...........................OF.................... arnatabr1e.............._.............__._. Tutifiratr of Tompi anrr 4 THIS IS TO CERT IFY,,_Tliat the Individu 1 e age Disposal ,System constructed ( X) or Repaired { � Gr{ w�' C Installer ` at Lot #C South Maintreetl-- Centerville---_ .....................•-••-•-- has been installed in accordance with fr�ie provisions of T iI GG5 oi,The State Sanitary C,c�de as de`s r}bed m the application for Disposal Works Construction Permit No. �_____._( Y` _: _::______ dated__..._ _.'__��_ _2.1 =:__ THE ISSUANCE OF THIS CERTIFICATE SHALL' NOT BE CONSTRUED AS A GUARANTEE THAT THE -SYSTEM WILL FUNCTION SATISFACTORY. DATE........................... =......--•-. Inspector........................................................` -- ................. THE COMMONWEALTH OF MASSAC;HUSETTS BOARD OF HEALTH 4� FEE. ........,, ......TOWA........................OF.--��rn tabla Permission ><s hereby granted._:. ...........- .7t'.'r.�----.----�� ...... ? ---------------------- to Construct ( ) or Repair ( ) an Individual Sewage Dispos tem Street as shown on the application for Disposal Works Construction Permit No.�). : �Ir_t_..... ed.._.__G�.�_�1' - (' •............... -•--- --- -----•--------------•-•----•--• B .:._ DATE_ '`° oard of Health Ga .....`�'.......... ........................................ ._:.,.;...... •'� FORM 1255 HOBBS-&-WARREN. INC., PUBLISHERS a Log Number: 6390 Buttle # E 304 Date: July 16, 1986 Of R 14. Sqtisa BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT Z SUPERIOR COURT HOUSE M C J BARNSTABLE, MASSACHUSE17S 02630 o � SAS$ DRINKING WATER LABORATORY ANALYSIS PHONE: 362_2511 Ext. 337 Client: Nicholas Franco Collector: Nicholas Franco Mailing Address: 512B South Main St. Affiliation: Owner Centerville,MA 02632 Time & Date of Collection: 7/15/86, 8:00am Telephone: 771-6366 Type of Supply: Well Sample Location: 512A South Main St. Well Depth: 35; Centerville, MA Date of Analysis: 7/15/86, 11:15am PARAMETER SAMPLE RESULT RECOMMENDED LIMITS Total Coliform Bacteria/100 ml 0 0. H 5.3 Conductivity (micromhos/cm) 200.0 1 500.0 _ Iron (PPm) -- 0.3 _ Ni tt'ate-Nitro en ( m) 4.4 10.0 Sodium. ( m) 18.0 20.0 i I . Water sample meets the recommended limits for drinking of all above tested parameters. II . Based only on results of the parameters tested for this sample, the water is xx suitable for drinking but may present the problems checked below: A. XX Water sample has higher than average levels of Nitrate. Future monitoring is recommended (2-3 times per year) to establish any upward trends. B. The low pH of the water may shorten the useful life of the house's plumbing. C. Water may present aesthetic problems (taste, odor, staining) due to D. Water sample has high levels of sodium. Persons on low sodium diets should consult their doctor. III. Due to one or more of the reasons checked below, this water sample is unfit for human consumption: A. High Bacteria B. High Nitrates REMARKS: le Geuniyer+tol--- Depar;ment shall not endorse any statements, 1 interpretations or conclusions made by anyone else concerning these results without written consent. Barnstable Board of Health 1 /7/85 Laboratory D_recicr PINK-DEPT. FILE COPY/WHITE- FIELD COPY/YELLOW-APPLICANT COPY ° BUILDING04 TOWN OF BARNSTABLE, MASSACHUSETTS PERMIT .. - VALIDATION - A=207-001-001 DATE January 24' 19. 86 PERMIT NO. APPLICANT 0L%m_er ADDRESS 009439 (NO.) (STREET) (CONTR'S LICENSE) PERMIT TO ��3IlGdr3J_ dcar_11?.n (-- 2) sTORY Single i�mily dwe111P_4 DWELLING UNITS NUMBER OF 1 (TYPE OF.IMPROVEMENT) NO. (PROPOSED USE) ZNING E AT (LOCATION) > 2C South Main Street, Centerville DIOSTR CT RD 1 (NO.) (STREET) - BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION i TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) �: i REMARKS: ..T. �c�, .;� -� AREA OR VOLUME c n ESTIMATED COST ^ Q PERMIT n ^ (CUBIC/SO UAR FEET) ���lob FEE $ In 'Jn OWNER A-Cl)n- Rn; l n- :n, (n T1, BUILDING DEPT. ADDRESS 7�S T,„ ,�} i1C^G� -7, ;� - ,� iF� O�b�1 BY 1 �/ r . l j (I Z9,3 L0C,AT10-'4--4-- a SLWAQF PElMI7 N0. VILLAGE. INSTALL A R Ea5 t) ATE PFRMMIT ISSUED AT E ' C0M.PLIAH E ISSUED i i I y y-7 1 f -7 Z9, VILLAGE,. I H S T A o ,'�..- ' /v � � � ��- ' ' .� j �3 �' �� �� 3�' . t5' � =3 7 ��' ,r "'� ����� / t1 t-1 � THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .................OF.......X.5 ...................................................... Appliratiun for Dhgpvii al World Tamitrurtiun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal J System at: ........................................I...................................................... ..0 ..................................................................................... h i Location-Address or Lot lei o. 4 o., l/�� ® 3 .....................—.... .... .......................................... ........-------------•----......----•-•-•--------.....--••-------•---•---------------•••-•-------- W Owner Address Installer Address Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms___......�...........................Ex Expansion Attic � g— p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No..of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures `----•---------------------------------------------------------------------------------------------------- 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 ( ). aPercolation Test Results Performed by..........................----------------------------------------------- Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-__---__________---_-__. fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------.................. M ----------------------------------------------------------•...----------•---------------........•---......................................................... 0 Description of Soil------------------------------------------------------------------------------------------------------------------•-----------------------------------...------..----- 1 U ------------------------------------------•-------------------•--------------------------------------------------------------------------------------------------------------------------------------- W U Nature of Repairs or Alterations—Answer when applicable___&_D.d________�__:...._6_Xrf___-/�iT___3.....r�;n.-1F R •---•---------------------------•-••••----------....._..-----------•------------•-----..........---------------------------------------------------------...-----------------------------------.....---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 1 T I IE 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 of 1 -alth. d Signe % `•'--------- .2�Y Application Approved B Date Date Application Disapproved for the following reasons:-----•---------------------------------------------------------------------------------------------------------- --------------------•---------------------------------------•---••-------------------••••--•-----------•---------------......------------------------------------------. ............................... Date Permit No.......... .......6-tv---------•--•-•-••---- Issued........................ Dste No. .�?�... Fxs....c �r .......... t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �a Applirtttion for Di-ollooFal Works Tontrurtion rrranit Application is hereby made for a Permit to Construct ( ) or Repair ( <an Individual Sewage Disposal } System at: tJ ...._._.. 1 Location-Address/) or Lot No. ........ ••••............................ ............................................... ..•--••--••-•------------•--•----••-......-•--------•-.....-----..._.............................. Owner Address ' r ...... G. s•/ Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.........�...........................Expansion Attic ( ) Garbage Grinder ( �) per,., Other—Type of Building .----_-..-.-_-..-------- No. of persons---------------------------- Showers ( ) — Cafeteria 0.1 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........................................ ►l a Test Pit No. 1----------------minutes per inch Depth of Test Pit...............---.. Depth to ground water........................ f� Test Pit No. 2................minutes per inch Depth of Test Pit--.................. Depth to ground water...--------.------------ a ----------------- ......-••••-----------------------•-----•............................................................. ODescription of Soil........................................... ---------------•--...-.---••-------------------------------------•-------................................................. W U ..............................-.......................................................................................................................................................................... W __ U Nature of Repairs or Alterations—Answer when applicable..._ .. ...4�-------.r......-.. -�'_'_`� �/�- D T 0 -------------------------------------•---•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of ii T LE 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 ard of 4ealth. Signed.'0�4 -- `�": - ==-�- = ---•- •••----•--•------••--•••••••--- -•••--..•.................•- Date Application Approved By................. Q Date Application Disapproved for the following reasons:-----•--------------------------------------------------------•----------------•------------•-•-•-----........-- .........••-•--•••••--•-------------••••••---•-----•-------•...-••-••-•---•-----......-•-----•--••----•--•-----•-•--•-•••-----•--•••--• -•-•----••----•-•----------•-••-------•--------•-•••--.......--- Date G 1. 1 Permit No.-------- -0... ------------------------- Issued_--------------•------------------•-•------------------- o�t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................'"r..............0F..................f� ..... .. ................................................. Trrtifiratr of f�on Haanrr THIS IS TO EgTIFY That the Individual Sewage Disposal. System constructed ( ) or Repaired (� � '�✓� e f/ by....---•••---------•----`1------------•---------•---•---------•--•--..... .j..---------------•-• . ------ -----------............-----------•--------------------- r Install ' has been installed in accordance with the provisions of TITi..E 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 CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......................Cl?. -. ..>J�.' .-----------------....... Inspector........................... ..... -- --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS r.- BOARD OF HEALTH - ' ............O F....../ . a. .2... . .......................... ................. ............ ....... No.. ... .I/ Dispsal orkii Tontratrtion rrutit Permission is hereby granted------------------ --- ..Z�!...�-a--------•-----------------..................................................................... to Construct ( ) or Repair ( an I div dual Sewage Disposal System,,—, �/� at No....................... - 'z .................� ,7;"1�-.9 , •,✓ 5- � --- � •�• Tom` Z ve e ---------------------••-------------------------....._.....---•-- Street as shown on the application for Disposal Works Construction Permit Not'a ........ ..... Dated.......................................... ..................................... .+._1_...)...------....---..............._....._....... DATE....................�....... ,... Board of Health —�' g-••••-......•-•----•------_..... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS d +y .: ..••• —•"' ." •••' Y•,.:\l.:Yc.,f\�{l�l•.U,.X:u'.:.—n:l;..•-r<..Yl+.�M Au 20 FT. /` liy. NOTE /F ElTNC'h' TNT" _PT/C TANS; OR jlZ:`ACI•I//V(5 P/T ARE IJORF TNA:J /2,•:.'IFLO.& / l _rRA��� �► r24'°I�ls4 M a�TgFt C OiyC'R =T� Co pz—.17 SN.�LL OF ®RO�/GRT' To G ' CO/VCrr?erz 9,PYC P/PB RA 0 A-- . �iti,t/ F_X7.f'r•i �L• //3.0 C06�ERS - 0"IA1. P/TeN IAYEgVY CAST/ROJY CON�,� Sf�ALL 13E US�,C7 I IB PER FT /F/N OR1 VE JVA)e n9/,V. COV 7 A-- :�^ G �oB C'cSYER CLL�AN - SANlJ L/optl/D LEVEL q=. 'LAYER - ;:,; Stf�T/C TAM/t D/sT, 0. 40 0 0 0 0 rYASHEO Tt7 { BOh! e o 00 0 0 0 Deco 0 0 � J NE 4. WAS/N.ED STONE ti : • Zoo o e ® e o a p D o PRECA5 T SEEPAGE 4ZF.IIA7'•/4*',VJ PIt` c�a P��r.�/ ��O G.A����y s� �• v e a a e e s o 0 0� b,>9 P/T OR EQU/V INYEIRT AT ffu/LDIJVG l a So fy. . <. D/AM. INLET SEPT/C T.4,VK /o L C? FT. /- C(SBE 7s.0ULATJOAo,) OLMET SEPTIC TANIKasT, P _ /NNL D/srR/40uTIOIV BOX 9 /may odTtery-,�/sT,�rerrrivr�r sE _� �RO✓No TER Lf .LIVLET I.EACHMa ---17- Fr SEPVAG^E DASRO-YA 4 SYL r&/W L EACHI Yts jO/7' 7A54/1-AT10At D,ESl GNP CRI TEnIA .SCALE : %" >=o~. ®I/•1ENP��/DN A � FT. o/rbf.ElVgIOJv �`:, 4 fT• NUMBER OF BEDROO/y.S 3 DIr�EM.i/ON, C? r; /LJ//ice• G•ARBAGE•D/SPOSAL LIh'/7- '//0 SOIL LOB TOTAL E3T/M�6T.ED FLOri/ 3 U^Gr4L.�0AY SOIL TEST 0,1 SO/L• 76•S-r*2 716$7 • NUMBER 0,- `eACKIA'a P/rs— 1 SIDELCAC/•/ING PER P/T [S/ � �L�.'rY. . 3.� pr'A a! 87.0 . A re off- s011 SQ, ET. ,- ,' ,n [ ®OTTO/►/L+Er9CH/NG PEJi P/T I {•_ C� - ,`. p C — 8 R.ESC/1_TS *V1r,vE5-S-ED BY /; C n•rG o..! TOTAL LEACHING AREA G4 u. G.oA M RellCOZAT/ON AA74rAf/ LEs Nj/N�INGN MFD./urn Sq, FT• a c/,3S v/C l� ��v JLY'RCOl�47Y0N R.rt7,F2 -7 H M/N.�INCN ,eESER1�E LEACHING AFlEA Z�• SQ• f T. - •� Vic. £s/.?--_ Zr� SOIL- iJs? OF nIBERr \ /o RC ERT �s�` . C_^f_--�l T� r'V/L_1 4 A. FiO. tu95! C'' p No. �� ,,�/.�}�,� � / � Fd..C.✓R.E,��r�.�J�•�T/IV�J��/aG COS/l1/G- ;r 71c A:.q//Y S7: - �-�. C. l_�\.j} ,id`J.n . r- /d'i�Li ryri.!< '.•���r a'`Y 6d� /M�a G� �'Ocy/•nf�1.'�.,'ya�y�•;��pffa,>y �C�•oeln�r'Tr�`.'e/��/� CLIE/1•y► T- p-}NC � __ {� '� n..r 71� /, ,�✓ +y"•J% J GM 0/�JA�6./ J-%/A ,!i A .4.=.t-`V RI, Z. � - �-. 1 e �� ffr=f J • �✓'7/L • /V /J S-%(Gv -{ • p O rr -{� a I = m r; I to m m j` _ -•Y -•r C: m i £ n .--• £ ' C I < �. C: ! U7 y V1 DJ C I r••' i 1 i `1 vim^ CL0 c r n, 1r I :,, u Q re t - 1 n = rD LA - rD rs m r r- C ! ro r ro p D ro CL. Ln 1 I I I }���� D i J. .I ^ p •1 -V V+ to -1, -, -1 LO i y� .'7 i i la I 0 (U (V 0.1 -- "• 1 -- �^ w -• v = --t t -- -• ;0 = I ro 'I :7 'LL r_ r. a, a -, ro ro -a r > R ry ro ro o I -� O ci ro n, a, i 0 c c n a ro r. - r i ro O ro r+ r ` (I. o• - - r- m do cl », a -• 0 -fi n K , ro re in -r a 0 0 { O n (D (o II cn n rr+ r- r- c a v ro D r, -, -• x cr 0 i ro _ r` r• (D 7 rr 7 r 7 O O I 7 CL 0 IT1 r•+ V T Ul (D -1 0 Q. (D to 0 ; • a) —i £ O i ro CL M '1 (D (D d r• m n, X X x 'o O 7 tJ I CL > t £ .C- n £ N ro (D ]' rD < ro O o, r+ ro to r* O (D 0 cr u, O _ c (D I �- f CL C r;• i I i CL I o O. C S If • Ij I Iro1\ '', • i i �� Ir—•i i i I � �t �W .. f E/ 7 3 STmO 5.F, I C,,AG/�*�-r) Its- ' bo \ �a/N f �►S V3 00D Roo � C 1-7 00 3 /\ o tot 14, 10.1 tz O• /y� �. �� �7-,t� l(,G 20 .— .. .��� �...,. _ J �' 9 tc 08 ?ESiCa uiNG ENGINEER MUST SaPLitiVISE o E�95TA�ATION AND CERTIFY S ,,.,G r s �_ O THE SY,TEM WAS INSTALLED � 2 �xCR✓�ans t s � ACCORDANCE TO PLAN- CJ G S d5� � ��Qploj ! �5 -WNI LEGEND CERTIFIED PLOT PLAN EXISTING SPOT ELEVATION Ox0 'y EXISTING CONTOUR - - �4 FINISHED SPOT ELEVATION ] ? LoT I/ L,c,,/79So' ors sow mq,N sr.) 4 i .. At E t hT , cE Tc- FINISHED CONTOUR 0 A. -- APPROVED , BOARD OF HEALTH h1Qf''�' ��.',;;. IN APP Lam: NS T i , f'!`s' A k Fr,/-1„ �n' : DATE AGENTP/'��it2 ,;�:+� SCALE' Ir = 3� DATES !p�/�/t "REDGE ENGINEERING CO. ING� inn i✓c-v , OF i CLIENT �,-�� ' I CERTIFY THAT THE PROPOSED yr EGISTERE REGISTERED 3 3 � s' R�at_RT JOB NO. lUILDING SHOWN ON THIS PLAN i CIVIL LAND „ �, <,.t�-• ?.13r DcE ONFORMS TO THE ZONING LAWS DR.BY 'I {; P1a. 1� fi7 �..n T- ENGINEER URVEYOR ' �; e� :OF / /s ��-� MA 712 MAIN STREET CH. BY, r'- ' H Y A N N i S MASS. � A — --r ' SHEET OF 1_... E REG.-LAND SURVEYOR .•