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THE FOLLOWING
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DATA
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THE COMMONWEALTH OF MASSACHUSETTS
,
110
AR® OF HEALTH
IV
R7�\ 4P � ....OF......1! '..............
Appliration for Dhipaii al Workii Tomitrurtion ramit
Application is hereby made for a Permit to Construct (A) or Repair ( } an Individual Sewage Disposal
System at:
o'ation-Add,,, <or Lot No.
.. ......._... f . _ .. . . ..... ..�
a �Install ,
Addre
••.............................
•----•"fT"t'f--OR----T-•---•---••--•---- Address /
Type of Building Size Lot.,l_�.______(90....Sq. feet
U Dwelling—No. of Bedrooms..............r3------------------------Expansion Attic ( ) Garbage Grinder ( )
'4 Other—T e of Building No. of persons........... --------- Showers — Cafeteria
Q, Other fixturgs -•-•••-••---•-----•------- -------• .
W Design Flow....................LC1................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..._..._....._.I... Total leaching area___.._� , sq- ft.
Seepage Pit No.........../------ Diameter........f_C... Depth below inlet_.....Z.......... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing to k ` �q
aPercolation Test Results Performed by Date 11..� f.�
,.� Test Pit No. 1... minutes per inch Depth of Test Pit.................... Depth to ground water........................
(i Test Pit No. 2....4........minutes per inch Depth of Test Pit____________________ Depth to ground water........................
••--•---- y --------------------------------
Description of Soil z ... � C ...7. •---I.. -------- .
x
W -----------------------------------------------------------.......................................................................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 iT:�.
p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be n&iissud.byhe b ,rd of 1 1Date
Application Approved By-•-•_ � ....... =� /-;.k- .C4
Date
Application Disapproved for the following reasons_______________________ .........._._.____........._.........__...._..._..........___....___....._........._...__
--------------------------••••---••--••....••--•-••--------••••••-•••-••--•-••••-••••---•••-••-----••------•••--•=----•---......-------••••----•--------------•-------•-------••---•-----•----•••-
Date
PermitNo--------------------------------------------------------- Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
---� BOARD, OF HEALTH
:e ......OF..... ..al..:....... .......: .: ......................
Trrtifiratr �u li ztr�
T I,,S IS TQ CERTI Y, hat the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by--------I\ . ......--- -------------------k---------------------••--•-•-•••••-•---•-•--•••-----•••---•----------••----------
ES I ler
atf ---- .....-- •-- - ..... -------t------------
has been installed in accordance with the provisions of j j of The State Sanitary Code as described in the
orks Construction Permit .__.___!.____r?__7____.___._ da.ted._. _ ___,� _�v.._.__..__.
CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT;PTHE
FACTORY. f:
................. Inspector------.----•---------------------------------------------•-----••---......--•-••---
No.........7
THE COMMONWEALTH OF MASSACHUSETTS
4
BOARD OF H . . TH
ApplirFa#ion for Di4pnaFal Workii Tonatrnrtion Frrmit
Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal
System at• Nk
,
.ql.... ...... .... ....................................... 1J_�...._..__... ..c. .. ...
ocation Addrg_ or Lot No.
" owner Addres
a14 ..-- = ..............
Installer Address
d Type of Building Size Lot. � �00 . Sq. feet
U Dwelling—No. of Bedrooms.............. .Expansion Attic ( ) 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........60--- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing to k )
a Percolation Test Results Performed b __�f- t .. �//4
Y-- - •- --�'-------- •---- �--��---- Date-- -- ------- ------
Test Pit No. 1....... ____minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
f34 Test Pit No. 2....`r`........minutes per inch Depth of Test Pit.................... Depth to ground water........................
----- ------- 4 .
l...............................•..........
_ ---.--- ----------- -------------- •--- ---
____ _-•.__ /1s ✓----
o _0.� _...�_
Descriptionoo _. - 7___________ -
v ............................. •-------------•------------------------•--••---•--------........................................................ .......................................................
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 TI`T._.
p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be n is u
PP PP Y d by the btaa�d of 1
Sir ed---. (�.
Application Approved B Hate
Date
Application Disapproved for the following reasons: ---------- ......
.........................................................................................................................................................................................................
Date
PermitNo.........................................................
Issued-.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
......OF....
..... ............ ...................................
�prtifirtt le ,af f�unt�r�iaanrr
THJ,S IS To CERTI Y, at the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by..... .. .....
,.. .�- I er
at_ -� --••--. .. -1...__.__.... z
has been installed in accordance with the provisions of `�of I� �The State Sanitary C de as described in the
application for Disposal Works Construction Permit .__.m , .= .7.......... dated.-..._2....... J
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT,BE'$QNSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector.... •••--------------------------.._........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...........................................OF...................................................
_._....._...................._....
No.-- 7 7-••--• 2-. - FEE
�i��rar,��1 k� �n � ailan prani�
Permissionis hereby granted............. .................• ---------------•----•---------------...--------......-----.........................
to Construct,(, ) or Repair ( ) an Ind* id al Sewag spos System
at No.., �c ------ -- =
Street
as shown on the application for Disposal Works Construction Per it No. ...........
_ a Q� Board of Health
DATE ----------•-----•-----o--•---------•-•..............•---•-------.........
FORA 1255 HOBBS & WARREN, INC., PUBLISHERS ',.`st• �.
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APPROVED , ..BOARD OF HE,AL'TH, z IN
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"+>DATE}`,. AGENTr.
SCALE' / 30' DATE ; ;7/4/� r� ♦
��ORED E ENGINEERING CO< 11ve) CLIENTT SN�•'7k. _ �4.
k a EGISTERE " REGISTERED I CERTIFY THAT THE `PROPOSED
;� J08 NO. _�!-?P 'BUILDING, SHOWN ON THIS .PLAN F A :FCIV.IL�: . LAND h,
ENGINEER Sy` _SURVEYO.R CONFORMS 70 THE ZONING- LAWSv fX
*^y DR. BY ' _A'� - OF BARNSTABL�E MAS
712 MAIN ST CH. '8Y l��/7/
SOS. YARMIO�TN, MASS HYANNIS M•A55. G Q_. = ;r
�. 14FA4 L» , SHEET=/ 'O F =Z ' �
DATE REG- LA r �rt,f+
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INVERT AT BUILD/N!r 97.a FT. � D/AM__�
INLET SEPTIC. T�}NK S FT ^� _ �� FT, 0/AM• _ C- SEE ToW- L1. .4TJON,
OUTLET SEPTIC TANK '- 9�FT.
r INLET D/STR1BUT/DN BOX 9 6- 0 FT. GROUNo W,47'ER TABLE ,
- .
TLETD STR/B!!T/UN dOX FT
�. /N4-,577 LEACH/NG Pi7- AFT. SEWAGE 01SROSAL SYSTEM
LEACH//VG P/T TABULATION'
DES/GN CRITERIA SCALE : %¢ /`-o'" 101MENS/ON A 3 FT.
D/HENS/oN B FT..
V 1i+9SER OF BEDROOMS 3 D/HENS/ON Ci 4 FT/�?./�✓,
GAReAGE�/SPOS.gL UNIT" - '' -SOIL LOG
TOTAL E57/M.4TED -LOH/ 3 3 D GA4.1DAY z SO7L TEST/4t! SOIL, TEST 2 s'. SD/L TEST
-�— fL 98 . , /' /UMBER OF OL,T
3/0E LEACH/iVG PER P/T SC/7 'FT. / ! RESULTS BY R,71 B U S/A.< IS
: -190TTOM 46gCH//V¢PER PIT 7 8—Sq• �T. b r/. Z f'ERCaLAT/0/V RRTE�iOE/ ASS M/N /NCfr
TOTAL LEACH/NG AREA SQ. FT. AEJtCOLAT/ON RATE fk2
RESERVE LES4CN//V6 AREA 2 6 G SQ.
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LOCATION SEW GE PERMIT 930.
Lo✓ VILLAGE /, J
INSTA LLER'S ICE . 8 ® S
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8UIL0ER 02 OWOER e;
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0 A T E PENC2IT ISSNE0
=%`_ ° TE COMPLIANCE ISSUE®
0
s
o.._..�d._.. 1 ... F�s.��...............
THE COMMONWEALTH.OF M�AC06USETTS
(BOARD OF HEA/LTFJ
.............OF...
App iration for DispatiFal Works C onstrurtion Permit
Application is hereby made for a Permit to Construct (< or Repair ( ) an Individual Sewage Disposal
System at: 0
............. ........ 2 �( = . ..........
0
.
Loca on-Address or
. A3o.
�. . :............
a M -
• ne ss AddrE"ss
w ....... --. ..------. G ------------------------------- ---•----........------------•----•------.....-----•••----..........._........................
nsta r Address .—� /�
Type of Buildi� Size Lot.`i�.VO...._..Sq. feet
Dwelling—No. of Bedrooms......... ..............................Expansion Attic .0) Garbage Grinder
'4 Other—Type T e of Building No. of ersons._........_�-
Ga YP g --------•-•--•-•---•-------- P •------------ Showers (_24 — Cafeteria ( )
P4 Other fixtures --------------------•----------•
W Design Flow S........................... gallons per person per day. Total daily flow.................. .......................gallons.
WSeptic Tank Liquid capacit}& jOgallons Length "Width.,....- Diameter................ Depth....-_~........
x Disposal Trench—N . .................... Width.......... ._....... Total Length............. Total leaching area--__-.---�-----'t..}....sq.
ft.
Seepage Pit No....../........... Diameter../.0. . Depth below inlet---�........_. Total leaching area..C ..sq. ft.
Z Other Distribution box ( ) Dosing t* ) `
a Percolation Test Results� Performed by....... .. ....... ..._._ ___L.. _. .__.....__. Date...........,_�.A�_,__..-.
Test Pit No. 1..�_ ---_..minutes per inch Depth of Test Pit.................... Depth to ground water.........................
f=, Test Pit No. 2....�' 'n tes per inch Depth of Test Pit................... Depth to ground water........................
r !- -
._..
E 1.... �noo = =escrpto
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 TLNIS 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has en 's ued by theig
boar h ��
....F0;....
Date
Application Approved By--- -------- -- ...•... -- . .. _�.............. ....41 + .. `
Application Disapproved for the following reasons:....................
.......... ................................................ Date ......---
...
........................................................................................•---•--------•-----•--•-----------------•-------••------------ -- .....
Date'
Permit No.................-....................................... Issued_ ..�:z.:..................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD ` OF HEALTH�
..............oF....... z..................... ........
(Intifiratr of Tome aurr
T I IS O RTIFY, t tk In yidu_al ,Sewage Disposal System constructed (" ) or Repaired (" )-
' — 1� 1 i .
by-•-- ...... ......; -------------• ...._.....
at.. �7( _. �� �1�1�'! � �1 f..... ._.,4 �.1 1..1. '= .. G{L1/��1 �L)
has been installed in accordance with the provisions of TI j 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 CONSTRUED ASA GUARANTEE THAT TIME
SYSTEM WILL FUNCTION SATISFACTORY.
j 3v �o
DATE....�l -----------•--------- -----------------••---•-•------------••-•----- Inspector-----; rr ----•46,6
}
,Y -
No.................... Fim$. ...............
THE COMMONWEALTH OF MASSACI-"USETTS
• - �D OAR OF HEALT� �
c. oF... ..-..-. zA�...... ' - ..............................
Appliratiun for Uhipati al Works Tonstrur#iun Vanfit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
.?Yste
1
no
Loca o ... '�•Address 11. ........... ...
rlbo b.
jj
..... . .......... . ....... ---------••---•--•.........._ ., .. G 1 w� ,��Jn/'.�1.. 57� � ... !. .. --•. ....................... .....................................................
Insta '`_` Address �-'
Type of Buildi `- 4. Size Lot.A�fjl�0_..-...Sq. feet
,., Dwelling—No. of Bedrooms.........�................................Expansion E�t7t'c Garbage Grinder }--�-►'
Other—T e of Building No. of persons.............. Showers
C4 YP g P ( = Cafeteria ( )
Ot ei_figures . ----- ------ --------- -------- -
------------ - ---•-
W Design Flow... .............. gallons per person per day Total daily flow 2� •-_..._..._..gallons.
W Septic Tank Liquid capacit;.e gallons Length-_-:::: °Width._ ' � '-D� iameter== Depth.....___-
Disposal :
x Trench—N . ..................: Width........
.. . _:.._._.. Total Length............. Total leaching"area........_..._....sq. ft.
Seepage Pit No...._- .,_--_-. Diameter.. .0__�. Depth below inlet...4..l.._.. Total leaching area.. �......sq. ft.
f t Z Other Distribution'box ( ) Dosing t �,r
Percolation Test Results Performed by.__..../ � .!.__....&U��W.... f le'I'Ar Date.-----•--•----. e!
Test Pit No,ai1 ��.� minutes per inch Depth of Test Pit.................... Depth to ground water.......................
Gz, Test Pit No. 2............••--minutes per...-inch Depth of Test Pit.................... Depth to ground water........................
D Descri tion of oil. ` _.-
U ------------••••-- ' ---------------------------------•...-----------------......--------------------------------------------------------...----------------------------•--------•--------
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 TITIL- 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has eni' ued by the
boar o he.
Sin :���..� - :.... �.
Dt�
GJ ----------------
Application Approved B _ Date
Application Disapproved for the following reasons-------------------------------------------------------------------------------•-----------------------•---•---
..........................••--•-•••--•-•---•••••---••••••••-••---•-•-••••--••-••--•-•...-•-••--•-•--......••--•••--•-•-••-••--••---•---•..............................------------.. •........•...
Date
PermitNo......................................................... Issued-...........................................------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
.............OF....... .-.. d`V. /�.e ....
(ffrrfifir,Fa#r ,af 'Tuntplianre y
T 1 I 0 �IFY, t t Individual Sewage Disposal System constructed Repaired ( )
/ /
pa
at.... a/...s�..L./U
................... I >. ��� ................ -
has been installed in accordance with the provisions of Hof Thg State Sanitary Code as describ d in the '
application for Disposal Works Construction Permit No ........ ._.�.. ............ dated- ---- --- J.*..._...
THE ISSUANCE OF THIS CERTIFICATE'SHALL.NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION
.- .. _ A TISFACTORY.
DATE............. : .... '.
Inspector V�, y,:.!^:.sk. yT..C'. v:.r - 1 SF "r+.�+F�,y,.}K:ai. • '- a. '""`Yfl; f°a { ', .<s .t'.., ,., Fa'rT' }�kz'.�y^^"'¢�L s'.+1"4, ,t rV ">- .., �} ,
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THE COMMONWEALTH OF MASSACHUSETTS y , WE-
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--=----- BOAR OF HEALTH
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Permission ' hereby granted:`... �-" . ............................. ........
to Const (�/�j�/—]J]7j7rt�(�jjpair /man Indly e ,age Disp al Syst
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INLET SEPT/C T.4Aw- 9 FT _ /D FT. D/Am. - I C SEE_TABULATION.
OUTLET SEPTIC TANK 9(6,3 FT. _
INLET D15TR/B!/T/ON BOX 9 6%OFT• GROUND W,,�ITER TABLE .
SECT/ON OF,
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NUMBERrOI�;B�1��00MS - - ' - -
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NUMBER OF LEACHING: PITS-T- /^ELEK 98 .. �`-ELEY, -OATS OF SO!L,-TEST ^/ Z / b �� -
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