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4351 FALMOUTH ROAD/RTE 28 - Health
4351 -Fafntouth Roach A = 024 - 066 - - - - _ Cbtdit j G C W OF RNSTABLE TI.00ATI� f, 1;1;60 X l SEWAGE #la ;7.- VILLAGE ASSESSOR'S MAP & LO 21 _( CG INSTALLER'S NAME PHONE NO. SEPTIC TANK CAPACITY It)OU LEACHING FACILITY:(type) '(size) /000 NO. OF BEDROOMS -3 _PRIVATE WELL OR UBLIC WATER BUILDER OR.OWNER C�P Ct�'jf (��` V, Ct DATE PERMIT ISSUED: �3 DATE- . COMPLIANCE ISSUED: y VARIANCE GRANTED: Yes No i :, 0 �3 �� b y3 a> �f � No.......... / Fes$. . THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 7"&_U/. A4.....OF...... Appliratinn for Bispoiial Workii Tonitrurtiun Famit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: e, ._RD...Cv_T/W�J. ..............462--r----.....--------------------------------------...........--•---- Location-Address or Lot No. Owner Address ................/� _/�.I?...._. �%'.ts/13121._ l ......... ............. ...Y_0:.rt?i4 ....................................... Installer Address UType of Building Size Lot-.,Zf"_.0_____Sq. feet Dwelling—No. of Bedrooms..........3..............................Expansion /Attic ( ) Garbage Grinder ( ) Other—Type T e of Building J No. of persons p-, yp g _D.�/_�L_�11__6 p (0.............. Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------------•. •............................. w Design Flow_______________�_S�.................gallons per person peyr d*y. Total dail / � flow--__._._�_-3_Q-_________--_______-gallon./ � Septic Tank—Liquid capacity_lt*-gallons Length---LB_-�____ Width--.-?--.- Diameter---------------- Depth-- --J-- Disposal Trench—No..................... Width.................... Total Length................. Total leaching area----- .............sq. ft. Seepage Pit No---------I--------- Diameter._---.--(0........ Depth below inlet........6--------- Total leaching area__4/.��_.sq. ft. z Other Distribution box („�.a Dosing tank ( ) aPercolation Test Results Performed by.._.__..---�8--A.MA,,V__ Date.___��/2!�_,�__b�_-�� Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water_ 44 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water —TER R-i ------------------•------------•--••----....___..._---------•----•••...._•------------•-------_.................................'............................ O Description of Soil..................... ........... - -----------------------•--------------- x �., 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 TT T f:% 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 b t e board of li lth. P P Y Signed- 92.tiQ--- �-z�[ _.... Application Approved B -----q PP PP Y _0.f ---_. ` � Date Application Disapproved for th_ejollowing reasons----------------•-----------•--------•-------------------------------------------------------•-------------_.._.. ............................................•---•-•------------------•-------------------------.._.....----------------•---------------------------------------•---------------------------•------------ Date 63 Permit No.....- ....................... Issued. Date i Nov........ V FE:B........................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 77 WA/.......OF.... Alipfiration for Dhipaaal Workii Tomitrurtion Prrmit Application is hereby made for a Permit to Construct (�-) or Repair an Individual Sewage Disposal System at: -.424 _T1 .....7. ............. ---r......... S-1.... 2 ......Location Address or��;............................................... - No. 4--ry....7 Jf�f ..........S.Y./74.8 ........................................ 0,,,r WICI 11 S X:7 .......... ... ........... ........... -�s ....................................... Installer Address Type of Building Size Lot..:FS_'6-rf.0------Sq. feet U Dwelling—No. of Bedrooms........3------_----------------------Expansion Attic Garbage Grinder Other—Type of Building No. of persons.........(0............... Showers Cafeteria aOther fixtures ...................................................................................................................................................... Design Flow................r_.........._......gallons per person per 1p. Total dal y ow.......33.0.......................gallon 1:4 Septic Tank—Liquid capacityl6fik.gallons Length-1A.6..... Width... .......... Diameter....._........_. Depth..-.. Disposal Trench—No..................... Width.....____...._...... Total Length.................... Total leaching area_ sq ft. Seepage Pit No........I----------- Diameter------- ...... Depth below inlet...... .......... Total leaching area2", ---sq. ft. Z Other Distribution box4-) Dosing tank Percolation Test Results Performed by-----------/V_ _0--- Date...:7t). A. j Test Pit No. 1................minutes per inch. Depth of Test Pit..........._.._._... Depth to ground water Test Pit No. 2................minutes per inch Depth of Test Pit.___._..........._.. Depth to ground waterh/ . ............................................................................................................................................................. 0 Description of Soil.....................M ..........y4_ W '4x.13................................................................................ U ........................................................................................................................................................................................................ ----------------------------------------------------........................................................................................I........................................................... 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'T"iE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in 'L__ operation until a Certificate of Compliance has been issued by the board of health. Signed, .. . . .... ... .. ..W1r1__1...... -Da p6 Application Approved By------............. .....C21-----------------------------------------*---- ..... Date Application Disapproved for the-following reasons:................................................................................................................ ......................................................................................................................................................................................................... <p C-7 _6: -q I Date PermitNo. Q)...L.'.. .......................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....T�P.. ......0 F..... ................ (9rdiftratr of Tampliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed i -) or Repaired by-------------&YE-R.-o---------- _s.................................................................................................... I at..... ......r.A. k. 4....RA.........4 nstaller...71//..........r............................................................................. has been instailed in accordance with the provisions of TITIE 5 of The State IN Sanitary Code as descri'Ved-in the To.application for Disposal Works Construction Permit -- --- ---7----- .7..... dated'__ ...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................ ....................... Inspector................... ............................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7 77:1&, ......�OF..... ................. No......................... )7 L F , EE.............. ...... Disposal Works T51anstrurtion ramit Permission, is hereby granted..... TX4/11.............................. to Construct or Repair an Individual Sewage Disposal System ....... . ...-Ca...ral..:7........................................ --------------------- at No..'Lax......g.......r as shown on the application for Disposal Works Cons & ..!....W �7 Dated........ .......... .. ............................................ ------------------------- it Board of Healt DATE............ ..?•-----------_-_------_--- N1�11'i255 HoBB & WARREN, INC PUBL FIR bta'use �,,y oaf,.�Yf f ,`ro .R C- \ 'VP LVJ GK)�i-� Lt ct t`c Cp i P k E vr�'r. ml S r, ..� :�r• t �2- V;TG t•-� A+`_.L. t...i s,,.1 E� A tit i^, t M � 0F •: � / --� r � .--�� i __-� vf...;��S'S car-+-�E�c�..�t�E "�>�E.c.:_��,��. 01 C3 j Sti sT�M A� A�� `3 E PTt C TA,J�5, C»K,T2�g t,.TT•►.a►,..y ��c , ti•t� L—C AC"%,_.1 C-n Pros J \�,� `.w. \,.(J �/ ,"] r"'•" Auk- !, �i�,. 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