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27 RENOIR DRIVE
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No.----.... J/A F�$..... .�................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
jot
OF.................... ...................
�61 AvOration for Dispasal Works C ongtrurfivit Vanat
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at: L6
- SZ
7 ..... ��- � D0 S................_............................... .. �� ..... ---....•----.----�. . - .._--
.-- L tion-Ad ess Co or Lot No.
�Y---- - ------- --------
ner � �� -i'fddress
W
--->-----...-_--• -- - •................ -
nstaller Address �/
Type of Building Size Lot...1__df__7.�.0..Sq. feet
U Dwelling—No. of Bedrooms_____________ _ __________.________Expansion Attic (AY-0 Garbage Grinder (C_o
P., Other—Type of Building ____________________________ No. of persons.................._.......... Showers ( ) — Cafeteria ( )
P4 Other fixtures .------••--•-----•--•---•------• -
W Design Flow______________________�57_�-------gallons per person per day. Total daily flow_____________.__�,,r•__3...d.............gallons.
WSeptic Tank—Liquid capacity, 6.0.0gallons Length--------_------ Width................ Diameter................ Depth................
Width___.._____._._______ Total Length_.______...._____.__ Total leaching area____.__._._.__.__._.sq. ft.Disposal Trench—No_ ______________
Seepage Pit No--------------------- Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ,y�
Percolation Test Results Performed by.. L-• -_ Date...........�/A Y-------
a Test Pit No. 1...& {;.minutes per inch Depth of Test Pit___________ _ ___ Depth to ground water----- !'/_
�..7
Test Pit No. 2____` minutes per inch Depth of Test Pit......... __Depth to ground water_______________________
� ---------------------------------------------------------------•--...---•-------•------...........-•.........................................................
0 Description of Soil.......................................................................••-----------------------------•-------------•-----------------------------------.....•---••-•-•-
x
U
W ----- ---------- -----------------------------------------------------
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 TL I 1�LE 5 of the State Sanitary Code—The undersigned further agre s of to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Si ed---•.............. = -------•---• --• OF
Si
Application Approved By........ -•----,�/-- - .................................... 1�
------- - - --- -----
aD t' e
Application Disapproved for the following reasons----- ----------•----------------------------------------------------------------•-----------------------•-----
...............••••••--••.....•••---------•----------•-••-•.....-••••----------•••••-•--------......---•-
Date
PermitNo......................................................... Issued_.......................................................
Date
M
No.......... _5. Fizz.....�"�A v.........._
THE COMMONWEALTH OF MASSACHUSETTS
-•�` BOARD OF HEALTH
.. .--.-----...OF................... y`�.- �'.�_....... ...
�I J
Annlira#ion for Diinosal Works Tonstrnrtion runfit
Application is hereby made for a Permit to Construct kr)'or Repair ( ) an Individual Sewage Disposal
System at: f - .,.. `_ -� •---
........................ ............................................ ........................6.. .........DA........o_14
--••.•--•••. L ation-Address -.. Lot No. 7�
�+
- - "C .�f^ :.../ /sue ^JQ .........
l.f �wner 1 �m ► , ddress�
W .......$�� r�r.�'f............:�yt ......-...._.............-•---••--17 �" :as:---------------------------------
nstaller �. J Add'ress- �.-
Type of Building Size Lot._ _ t:70.-�j,....Sq. feet
Dwelling—No. of Bedrooms...........
- ---------------------------Expansion Attic ( }"(, Ga age Grinderz
A4 Other—Type of Building No. of persons............................ Showers
QI YP g --••-----•-----•---._._..... p ( ) — Cafeteria ( )
a' Other fixtures ......................................................
gallons per person per day. Total daily flow................ 3 ...........gallons.
Design Flow....................... . ... . . g P P P Y• Y �-- -
WSeptic Tank—Liquid capacity/l6.:�r,A.gallons Length_�.f ......... Width................ Diameter................ Depth................
x Disposal Trench—No..............1_...... 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 b ......... ..... /
J _..?' __._ ' Date.......... ll : -Y_--
a Test Pit No. 1__ _( _minutes per inch Depth of'Test Pit-----_._ Depth to ground water•__:;-�'�:� :L
Gz, Test Pit No. 2__-_-__r��..-'_..minutes per inch Depth of Test Pit........L:.__.... Depth to ground water.....................
ODescription of Soil....................................••__•--•........
---------------------------- ...............................................................
U -......--•-----•--•---•-••--•---•---•.....-•-•--•--- ---•------•----•-•---•...••-•- --••--------•---------------- --• ;
W
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 TITLE 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 board of health.
Signed..................
.......... .................
( r' Date F
Application Approved By . 7�
--------- : „ ', ,
Application Disapproved for the following reasons:.,�'.�--------------------•--•---••------------------•-----------------------•------------------.....-•-------
••-•......................................•-•---......--••----------------...---------.......--------------------------------------•-----•-•••-••-•---------------•-------------••-----•-------••-------
Date
PermitNo......................................................... Issued.-------•--•----•--•••----•....._..___ ^-----•-- --•-•---
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
,
nr::�t .........OF.. ',' ��e
Trrfifirab of.Tomplitanrr
THIS IS TO CERTIFY, That the Individual Sewage, osal System constructed) -or Repaired ( )
by � ---------•..................••.....-
I*11er
L C� c.�.." G......
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as describled in the
application for Disposal Works Construction.Permit No...... jp a�.�_____________ dated----------......................................
-
THE ISSUANCE OF THIS CERTIFICATE SHALL-NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WI F CTION SATISFACTORY.
///l//
DATE._ .� . .:d l.. =•-••-•-•------•---•--------- Inspector........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�. 1.. �✓f/t�. '...O F.................. ...y l..' ..
No... ... `", FEE........................
Disposal Works Tontrnrtion frrnt'
Permission is herebyranted.. __. �'' _: !tom}:
g -- =` --- ---•-.......---•...........................•-
to Construct ( ') or Repair ( ) an Individual Sewage Disposal System
atNo................................... 'i=- ..... --�_ _..........." , d E f - . .............. :� '� ...--: .
Street
as shown on the application for Disposal Works Construction Permit No____________ _______ Dated.......................................
'7,� Board of Health
DATE................................................................................
FORM 1255 A. M. SULKIN, INC., BOSTON ;�
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ORSE No.10851�vQ ,$„lr}Papm Y 2 v c,o Fr EP �4J b/' J U=• N 1>/ F706%S ooFss/ONAt � ' oa � X
GEND
EXISTING SPOT ELEVATION Ox0 ZN'vr:nas� CERTIFIED PLOT PLAN
EXISTING, CONTOUR ----- 0. T 52 ENvcn- it el-
FINISHED SPOT ELEVATION <�,� ROSERT D� TCr, I/�L.L.E
FINISHED ..00NTOUR - 0 `h BRUCE .
ELDREn ti I N-- --
APPROVED , BOARD OF HEALTH ST
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DATE AGENT _ SCALES
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1 �'� 4o`' DATE 6' 6
�;�., C R�ryAt6i?ta;e
s 'ELOREDGE ENGINEERING GQ l'.'�r'
EGISTERE REGISTEREp zzcr(, I CERTIFY THAT THE PROPOSED
CIVIL LAND ` JOB;AO ,� BUILDING SHOWN ON THIS PLAN
ENGINEER SURVEYO W BY; ._ CONFORM$ TO THE ZONING LAWS
u. , OF BARNSTABLE , MASS.
712 BY,M Al N STREET 5 CHk
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H Y A N N I S M ati
'Sig e ,
SHEE�T..,L'OF '� E
REG. LAND SURVEYOR :.
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NO /f At W&M 7We SEPT/C TAN�c OR
/a PT ASP/N LLsAG1,r�ivG i•/T ARL'' /YORE Ti5►�1�`J /d BELO it/
1RAORr�4 1Q•,V/AM ETER �ONCRRTE CpvE,r
4`PYC' P/PB S.VALL ®E a•?OuGNT TO GRAOR `.-►.v EXTR.�t CO/VCRL'T'R M/N. P/TGI+I Af 4 vY CA S T/RO/!N C O YC*R Sh+.�4 L L 3E U
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LI�L!/D LEYEL •. . . �- - . . c3AGX)=/L L .
_ z/ `LAYER Kitt. . .._.t.�s— _
P 1rT. S�Pr/ �iR/Y�C D/S7 e • • I • •. • • • . • • e WA SPIED SM)VC
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e EFTFGT/YC ti • • 3�4 - �2 i
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7
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INYC�'�.e�L�Y�T/cW� p�� c.+Ps�-�tTy s4g �s��w�y . • ►. • • • . . . . . • .•'e air oR Equw �
I,VVAM7 AT aiv/tD%Me� a<fT. Dv�y.
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oar SEP LE' ' rri .t
III '''" r; �� ��1 j• � ,.� � ^ i
/JVi(EPO/37R/8�f/Tt�II Qt ' z' 'rx `kGROVIVOWAYZA TAMAT /►+mac sew Z6 qet-
OtJTLET�ISTRl�aU�ryOIV Si�CTlO _ K y C&c eew Cs/tqt.eilfrer.
WA Ol.4P 'YST'
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wt/tIaER ofa"aWs`_ s p//►IEJVS�ON' C 5,S
GARBiCGFO/SPOSAL 1/IK/T. Ara ME ; y
sots .o�
TOTAL EST/MriTEO FLGrV 33 C•,4t./sty S.O/L TEST A!/ " SOIL 7&'s71,02
i1lUNIBE.P QF L,E•tGNlNG P/r3 C'LEY. 3 z..o /(, f "j
S/OE[rACNIAOU PER P41 $- .l PT. ��Y DATF OA-SOIL TEST S-/ /
a0r7.0M LFa,cA.r A(p PER P/T 7 gp, /e;- 0-7 RBSt/LTS i'vlT/SIESSEO
TOTAL LEACNIirG AREA ESQ. Jr L'= A �� ` PE�ICOLA770" R.4TE,at/ LC-ss
)RENCOLAr/oN ?A�"�s t 2 Tr-/�t-/✓
R,ESERYE�.EAGV/N6ARE.N. SQ. FT. s Z O MJN`lJVCq r
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