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I oyo��z TOWN OF BARNSTABLE
LOCATION yys eQ SEWAGE #
VILLAGE L✓r, % ASSESSOR'S MAP LOT L-041-676a�
INSTALLER'S NAME PHONE NO.
SEPTIC TANK CAPACITY /5-0 0 '
LEACHING FACILITY:(type) 2 (size) 'y;/2
NO.'OF BEDROOMS 4/ PRIVATE WELL OR PUBLIC WATER
BUILDER.OR OWNER �o�Cn �hlJ�is✓�
k .DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No +�^
14
3
36— tl q� A7
No................-....... F:ms..............................
w
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH i
-_To w 1i.............OF.....BA1*R.lS�T_R-1B1. .........................
ApplirFa#iou for Uiipugal Workii Towitrurtiou Frrutit
Application is hereby made for a Permit to Construct X) or Repair ( ) an Individual Sewage Disposal
System at
...... .1a.....� 5` o.......#�.. ............... ...................�-- -------� -------
---
p� L n-Address. `.1 I /
old... -� ...- f....0 e — 4 �._r L! y Lot No./ d!4/ ..._/���!'
ram. Own`r Address
a -------------- .._l e :1 --................----------------•---- ------j;qq.J .qv ...5t..---- �s � .......!''i�
Installer Address p�
Type of Building Size Lot.....6 6... .c.
�-, Dwelling—No. of Bedrooms___--- ...............................Expansion Attic ( ) Garbage Grinder
aa Other—T e of Buildin
yp g ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
P4Other fixtures ---------------------------------------•------------------•---------•-•------•--•---------.....--- •-•--• •-----------••--------...------•--
W Design Flow.....-.....5__J�........................gallons per person per day. Total daily low_____--4+b..._.__ ....._.._... to s.
.
WSeptic Tank—Liquid capacity15.0.0gallons LengthLO.e.6... Width_"_1..-._ Diameter................ Depth __."_�..
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area------------ ._....sq. ft.
Seepage Pit No......�.......... Diameter.....�..��__�_.._..... Depth below inlet.3.,. '7_.. Total 1�.,ching area9..�.8.__._sq. ft.
z Other Distribution box ( ) Dosing tank ( ) cSO+K a Annice,
a Percolation Test Results Performe( ... .... ,� ..-/�
-' � �Date. ...-- ---.
•---
14 Test Pit No. 1........��--___minutes per inch Depth of Test it...flcs------- Depth to ground water-/._
44 Test Pit No. 2................minutes per inch Depth of TestP'�t . .. .De_ th tg�-round
Ep{�w1KatCg�erl,J...._@_
¢P a ..7 VO
Description of Soil a �,11= ...!d X .d / !�,? �j -------------------- �a�_ ..... Wit'
x .T.P�..
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U , d ? ..3e t-� �• � s�dl� -''S�._ ltt yx. -@
x ' — 6n�. ---------------•------------•---------------------------.................
...........CIV1
U Nature of Repairs or Alterations—Answer when applicable-----------------------------------------------------
a
-------------..................................................................... =.-----•-•-•----•--••--- ------------------------••-.....................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System ' ccord n "wits 9 /
the provisions of'iTl:% 5 of the State Sanitary Code—The undersigned furtl:e grees not to cc the sys,em m ��. eta
operation until a Certificate of Com li as been issue he b and bf ealt .
Sign --,.• • - -----•-- . --- ............... �( . .......
----------------•---•-
Date
ApplicationApproved By..................................... �.. •c•-•-----------------.----------.---.--- ----•--- -`---- :_._:......
Dat
Application Disapproved for the following rea ns:-•-•---•--•---....•------------•-----•--=•-------•----•-----...Z..--•--•------•-------------•- ---.------------
.............-...........................................................................................---•-------------••-----•---•-•--------•-;.....................................................
Date
Permit No......$_.fr..:--- t
- -----•-----•-••-•------..._.. Issued..----- ..................-..........................
Date
D }
�_7 S o
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.lJ! .ice!.............OF......BA-IRI%4..i..R13t. ........
Appliration for Disposal Works Tonstrurtann ramit
Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal ry
System at
>J-------------- i
----
.. �L n.Addre� G.�Lam-i� � � �Ii lc3Ki e/� t In:)6 1'C'o J N. Q �
.................. A A P -•----.......................... ........-•_._.,..•.'......................... ......` •... ..... .
)o�t.1 A: /tfAh 1 0 ��� �1a��}� ��ddresW ��IehtSlk,�S�� PIA ,
•-•-------•-•--------------------------•--------•-- --•--------•---•••-•-...._...........•--••••--...--•......••...._..._..........................•••
Installer Address
d Type,of Building Size Lot............................Sq. feet
U
., Dwelling— No. of Bedrooms....................::....................Expansion Attic ( ) Garbage Grinder
aOther—Type of Building ............................ No. of'persons............................ Showers ( ) — Cafeteria ( )
Otherfixx�t ttres .---•--••••••......•------------•--••......• -------------------------------------------•. •-- ---- :--------............----
W Design Flow...........�_J ......................gallons per person per, day. Total dail low____ .....................gallons��
WSeptic Tank—=_iquid ca.pacitA.WQgallons Length+Qx. _- Width° ..... Diameter______________- Depth .. ..
x Disposal Trench—No..................... Width.................... Total Length___f..._..� Total leaching area_____-_---•IIII_....sq. ft.
Seepage Pit No..... ---------- Diameter,._-� ._-__-__- Depth below inlet.3...G._1___ Total 1 ching area9..8.8_....sq. ft.
Z Other Distribution box ( ) Dosin�tank ( ) tmj Annio/I
Percolation Test Results Performed by...._.�rJC.J? _._._.__... Date9.6.? .
��
a Test Pit No. 1.......��+---•_-_minutes per inch Depth of Test it___��e .. Depth to ground water ' .
fs, Test Pit No. 2........ __minutes per inch, Depth`of Test Pit ...... � . De�th ground water. ���. ��g_ � f,2 :
x �}' '29 o. r o __ � Q.t ..*-. ¢5 yP.lw � .� PAI, ;
� �' � � �-. � ��..FJttCh`EiFLllerZ
Descript' n of So'1- �l li h Car C C 1 ------ .:._NQ. ^ 20 sa.
x 541 7 --- j CIVIL
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UNature of Repairs or Alterations—Answer when applicable____________________________________________________ `` ®' L 'a
....•----•--•---•-••--•.....••--•--••••••---•-•••--•......--••-•--------•---... •••••. .... ...
Agreement:
greement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System ' ccor wit i
the provisions of TIT?:;.
p 5 of the State Sanitary Code—The undersigned furtl grees not to ce the sys em
operation until a Certificate C • ce has b?iiss .. the a /6
Sig •---.._....1...................•-------......------------. ....------------•-------•Da
Approved By.._.. -•---...-•---•---•------------------ ------
Application. 1 j
D e
Application Disapproved for the following re sons---------------------------------------------•---....----•••-•--•------------......------- •-•--•••-•••....._
------------------------------------------------••-•---------.....----------.._..---------•--•-----••---•-•--•----••••--•-••••-••-------------••--••••------------•-•••••-----------•-•-------••-------
Date
PermitNo......................................................... Issued-.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
v
:..:...MWDA..........OF...:.....V5M0PJSTA �. ...........
Trrfif iratr of TumpliFanrr
THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed (x) or Repaired ( )
by........... w A- ....--A �..-----------------------------------------------------------------------------------------------------------------
Instal
---------------------------------••••......-•---
has been installed in accordance with the provisions of T TIE 5 of Tle State Sanitary Cod as escribed in the
application for Disposal Works Construction Permit No 6_'..�_.110.............. dated-.__.._Li_.IA
_,�.. __�j-cs......_.__.....
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA EE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE... ............... Inspector-.c CT J __.....
^^- L 01 r
THE COMMONWEALTH OF MASSACHUSETTS
4
�- BOARD /OF HEALTH
.......OF...........'-?Mtn�1,��A.4X�........................ o%
.. ..
FEE. .................
Disposal Works TonstrndUan "permit y
Permission is hereby granted = --------------------------•--.-------------..-----•---
O �
to Construct ( or Repair ( ) an Individual Sewa spi yste
atNo.........fin..I_......fig ......... kb......... 6. . .............................................................
--------•• ._...••••••...-•-----•--••......--•-• ---------------
Street
as shown on the application for Disposal Works Construction Permit .... Dated..1111.-•--t6--------------
of Health
DATE................................................................................
BE.
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
:. - __.
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='- a2gs
.. REVISIONS:
TEST PIT DATA DATE CF TEST/NG: q ..- q -_____ PERC. TEST DATA SEPTIC TANK DETAIL : s1ZE- .150c)�A4 DIST. BOX DETAIL � LEACHING F C/L /T Y DETAIL: NO. DATE
TEST B Y' i,?• •""^ ;.�. ,; %✓''` TO CONFORM TO TI TL E 5 REOUIREMENTS r f
T P _ _ _ DATE OF TESTING 2 -x ,_Y-' TANK TO CONFORM TO TITLE 5 REQUIREMENTS. — — f+ ('9 '•'!;G �- St
('17L 6 ( WITNESSED BYE -. �Y ',- c
TEST BY -•rtr 7Ne!w NO. OF OUTLETS: "
U1 d;c
'^ -- -- - --- WI TNESSED BYE ..•., G'. ,/✓ �..J.;r ,,. ,t �' ' ilr ,�r"'��i/: �� ��, „ /t_//�''�r �/� a�'� T/ `y// - •,._��/ V,?-�����__—— _4' �.2 REMOVEABLE COVER
II v_;+ <- /2 'MANHOLE BROUGHT TO // lVg(p R IEV ISE GA12ASe r I N1 F'Ns 10ki5
L_r� "A _ 1:'.'D'•4 I- .' 1 . .., ,: FINISH GRADE. . .. 2rrPEASTO/1E 10AM9F/LL /2trMAX --t
".. -• �. • .s - •. 6 a p :a
.'a P ". � 3 CLEAR 3 CLEAR• Ir-1- OUTLET PIPES - - � -- -- _-- REVISfc / )V� ��'� r.
`
/�� ' AS REOU/RED i = i
' t fir;. DEPTH O TEST' 6 MIN. 2"M/N. 6„MIN. °I I L
\ d:.. I
�,/ '• �- -- INLET i O/ST.-. ; RA TE r""''H�I'i•"s/ /i/+/ :% /0 M/N. 1 (,_ I BOX . . '.
__ _ _
7r INLET TEE �' � - -_ OUTLET TEE b II \ \ I rr t I n
• . e 4 C./. /000 GAL. I •
L/.!S,` %, INLET AND OUTLET 4 0" MINIMUM OUTLET TEE DEPTH- � / SEPTIC TANK - � I . '
J A' C) L/QU/D DEPTH •' /4 AT LIQUID 'DEPTH OF 4
I„ 2 61
/ ----- O PRECAST OR BLOCK :�1/l►!' F
1 TEES TO BE CAST I CONCRETE SEEPAGE P/T . I
t : -, IRON, SCHED. 40 h. f „ • .. .., r, o. . CONSTRUCTION �^ ,•_
DEPTH OF 'TEST P.V.C. OR CAST/N 24 6 p-'u. d , p e.. 10
RATE PLACE CONCRETE CONCRETE -54" „ ,/ 8' BOTTOM ON LEVEL STABLEBASE MIN
rr --- -I CONSTRUCTION I •
• 'i (WATERTIGHT/ FLL. I I
I '.1 i ___. T PROVIDED WHERE SL OPE OUNDATION I.
C_'�i'. i l �.','! •; �',:,•:::` r a, /NLE TEE w ------------ I --
. _ , • •• ,•. . ,. . '• OF INLET PIPE EXCEEDS 0.08 % OR -
":D
-- TANK TO BEABLE TO W/THSTAND I
C I,J i IN A PUMPED SYSTEM. 20 M.,°, I 1 rA.h.a-_
.•'�.9 /'1l'. •4. BOTTOM OF TANK ON LEVEL STABLE BASF H-/OLOADING UNLESS UNDER --. __._ -_ _T / n
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- LOAD/NG UNDER PAVEMENT OR I I °
. DRI VE. .I,
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NOTES . / VER T EL EVA T/ON
• PLAN V/E : ��" S' -_-__ _ _ --- --_ -'-
• :c Y - r
I. THIS PLAN IS FOR THE DESIGN AND CONSTRUCT/ON OF THE SEWAGE - "
SCALE / 30, ,
-.---Il'�
DISPOSAL FAC/L/TY ONLY. .
- lNV AT BUILDING 52 t 5 cN ( s�'``
.
�,..=. .;. ;. I /NV. AT SEPTIC TANK(/N1 -- �'.)a ,/ ` 'c �G
, 2. A L L CONSTRUCT/ON METHODS AND MA TER/AL S SHALL CONFORM TO - - __ - -- - -
NV AT SEPTIC TAN ( ) (
MASS. D.E. E. TITLE 5 AND THE .g�=:.r-.J,:,., ,r� BOARD OF _ --
HEALTH REGULATIONS. -rSAr-K.S _.._ ,�, _�� i1�:, y . z'�Qa�
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i �3 . A r t3 "�T Tt�!"1 e F P/T: ? BEDFORD, MASS LE.XINGTON, MASS
!. \ , ,_ , �'i _• HYANNIS, MASS- MANSFIELD, MASS
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