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Home My WebLink About0064 BLACKTHORN ROAD - Health f1ars�-una I f //\1 oo' -er CE L 6- r e C � 7— ,�yy f L0CATI N SEWAGE PERMIT 00. 4t 9W a �3 - 3 Z d VILLAGE .�;/lzv- I,5 / INSTA LLER'S NACIE 4 ADDRESS 0UILDER OR OWNER DATE PERMIT ISSUED ; C74 OAT E C0MPLIAMCE ISSUED � 17 � dq C q3 IS- 9 rl rJ No._83 3 Fim........ �.---•-...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................OF....., .................................... Appliration for Disposal Works Toutitrnrtiun Vanfit Application is hereby made for a Permit to Construct (\,,<or Repair ( ):an Individual Sewage Disposal System at: - �R .........'M ft...lam N�..M\\—.................................. Location-Address r Lot No. e s� z- ....__..�7. ... 1. _ ....+ _.. : ..... . ...... ........�.....!'ills...--- Owner ,/� Addrgs ............ . .... ---• .............---:.._...,€----------- Installer Address d Type of 1cIin`g Size Lot._�;3,.-1-9_ ..... feet U Dwelling—�No. of Bedrooms......... ...............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type_*4 Building ............................ No. of persons.....................--.--.. Showers ( ) — Cafeteria ( ) Q' 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--------------.........------------. a ! Test Pit No. 1.................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........................ p+' •----------------------------------------------------•--..................------------...._......---......................................................... O Description of Soil-----..... ---------------- ---------------- --- ---------------------------------------------------- ••-•-------- ---------------------------------.----- x w 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"IT1:;. y g g p y 5 of the State Sanitary Code—The undersigned further rees,not to lace the system in operation until a Certificate of Compliance has been issued by the b and of h t . Signed..C. _.. -------------- -------------------------------- ' Date Application Approved By...... ,,C ----._. X6 _.®� - ate Application Disapproved for Me following reasons----------------------------------------------------------------............................................... ---------------------•--.....--------------------------------........---------------------------------------•-•••-----•--------------...-----------------•-----•------------------•------=-•------------ Date PermitNo-------------------------------------------------------- Issued....................................................... Date No.-•.83. _22A.2_0 ' FE$.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ' w ....................O F...... .AT w..�.."TP001 t..----..._.._.._..................... Appliratiun for Dispusttl Works Tonstrurtiun prrutit Application is hereby made for a Permit to Construct (' or Repair ( ) an Individual Sewage Disposal System at C9..r 4 4 S_. 1�1cbC"C`'t 3�t+.1 b lr� e� mt, ")+dos ........- - .._......................... .................................................. .•----•••-•-•-•-••••••--•...........-•----••------••••----------•---------........._..--------•-- Loca ion Address t o - -.. .. ---... ...•-•--•........ . .... .--- •-- owner ---....... ddr .• a . "I ......::... .. +►, .. Installer Address qR a 1 QType of Building Size Lot............................Sq. feet v Dwelling—No. of Bedrooms.......... ................ .. .Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) Cafeteria ( ) a' 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........................................ ,4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (s, Test Pit No. 2................miNtes per inch Depth of Test Pit.................... Depth to ground water........................ a' ----------------:!t`.:;;,----------------------._...._..... ....... -------....... -------•--------•----••--- O Description of Soil....................................*__• - ..----..�........ 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 TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b issued by the bo •d of . Signed----- -----•------•--•-•---••--••-•--•-•-------•••.....---•---------•--------- ....... ,..._...._ Application Approved By.......... ............ Date Application Disapproved for the following reasons:.. .................•.._._.__._......._.--•______-_-____-_____.__--__--_______..._......._................_..._ _.....-•--•--•-------------•-----•----........--•--•------......----------•----------.................---••-•--•-•. v..-•----•--------••-•----••--•------••---•-•-••••------•---------•---•-••••.-•--- <ti Date PermitNo.......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.................................................................................... Trrtifirab of Guutplittnrr THIS IS TO CERTIFY That e nglvi 1 Sewage Disposal System constructed ( ) or Repaired ( ) by.................... ../.C.-. ......---......................................................-- Installejr y �j at. -----••---... - � .?--------- ---------• {' �= ��< has been i shin accordance with the provisions of TITLE �-r of Tj tate Sanitary Code as described in the application for Disposal Works Construction Permit No.-_-_--_._._��''_,3•�C� dated................................................ THE ISSUANCk OF THIS CERTIFICATE SHALL NOT BE CONSTRUEJO AS A GUARANTEE THAT THE SYSTEM WIL F U/CTION SATISFACTORY. DATE......rl c ............................ Inspector..... --- 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH w_ No._._. '. ! ...............................ig ............OF.............'........ -� ................ FEE...-•-••-LlQ----- iuu�urptrttrtiun rrutit Permissi t ereb granted ......................................................... to Constru ) 4 r pair ( ,� wagp4osal 0,0r9 atNo...................................................................-•--------.......-----....-----------------------------._......_...---...-----------•------------------•--....._.....•..... Street as shown on the a plica ' n for Disposal Works Construction P ' No....___.. LD ed----------------•-:---.-------.•-- -•--.....----•-------. ........ .............•... ... Board of Health FORM 1255 HOBBS & WARREN. rNC.. PUBLISHERS z..rLw Sol * -SS vU � ' / G 3. � o•� . LoT 4.43 9 0 r �" - DtST. 9OK O IZ.5104AL. C40C,Serne— ®Tesr P rs V TIANK lot 4tt5 o o.K O �o'VK I �. P��pos�a a U:SE l iS\ e► _10 0 1' 0 gex5 94xa �1�9>f '�usty. x °� * + , '� 4 .i �;� • ,1 �` i f - I r < - ji SAC'� Y, �, �,,...c:,� * L; . "• � � ♦ � ` ♦ «' y r +�r. '� �.'r4 ,.r{ .fir -s.. i, ✓s1.,..�� t,;RR y i� 'r'ti• 1 ! .o. A t x, .�_ � 'L tr d '„1� d! 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'•� :l sa y' • t .".f rt' av- •. r �,:�•✓ k R '� sL,• k �JOur Cf:4"f ..'{ uGE � 3: r " " "` ,` , / ^ y^��jJ �/��(/y�r,_.�y� ,p.�t/ 'O'• ' • S ' t '4'\ .�s � ''�'�.. • t` s tt 1�t'' � rr , {',!/`+✓, /.�f/"'NI'!��•'T•��1/'Z/• i' Nj A � 'l i a f�v � •rl �i�{, �' t .« ti.,7• R� �a c.t•+, tyr ..r a. r I /7Ffr .n0'1+4.,5. , v3,.,• ''">�•y�M1t'r.1 `/�'�'� ., c,'r/� �a s y}Fi{dy«-, L` {yy„ ;{.F ITer rrs •}. •>; : J ., ``� "� �x_ 77!.'t i , j,.t` 'v$ 'r, _i+'t,k _ ,�; �. :rr- - •A t t7 e• ..r � 33 - V7 t 4ar '/ya LA CAT ION yy��` SEWAGE PERMIT NO. s, .r 1314 L/f /4Odh /?046 _ '!TILLAGE I N S T A LLER'S NAME A ADDRESS _ /-$V w4117 Gl/, /9.*.0-7 J1# B U I L D//E R OROWN ER _ - 411,o J/,—v s /y/,%/s DATE PERMIT ISSUED ��al;c�� OAT C 0 M P L I A N C E ISSUED/� �� 1 r,4 o� Irz, 1 1 yL` 17y` i -%• OWN OF ARNSTABLE LI CA'T'ION /) SEWAGE # ` v `li ,LAGE ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILrrY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet f leachin aci '6 Feet Furnished by era, o R �� , � � � � •'•"S ��. �, � � ,, ,,�� -6 �� t-- � ---` No-9 Fmc-�^..'....... THE commomvvsxcrx OF mAssxo*uSsrrs � U�� U��U� ��" "" ~�� " HEALTH .�� " " " ��----�c»r �^��--'----''-_ x�� ppliratww*x ��spa � l Works Tonstrurtoon Pumit ication is hereby made for a Permit to Construct or Repair ) Individual Sewage Disposal or Lot No �� ------------- `r -=��==-==��'�°�"=�==.-��'�mw�.��^��' owner -' ��---`-----------------'--- � .......................... Ins t Address � Type of Building Size Lot............................Sa feet Dwelling—No. of 8rd,00n`y-.?..................................Expansion Attic Garbage Grinder [ ) 44 Other—Type of Building ............................ No. m6 persons............................ S6ov,eco ( ) -- Cafeteria ( ) 04 Other fixtures .---.--.._---..--.----------.--------_----_-----_---.-.-------------- ~ ^� Design lrlm..-.--°'..��.~.........................gallons per person per day. Total daily flow........33,d.......................gallons. ScyticTzok--Liquid cupactyJAPAmdloua Length................ Width................ Diamotec----_- Dept6----'-- Diayovu Trench--No..................... Width.................... TotulLoogt6................L- Total leaching area....................sg. f t. > Seepage Pit B7o----_--. Diameter.................... Depth below inlet.................... Total leaching urcu--------'og. f t. Z Other Distribution box ( ) Dosing tank ( ) ~~ Percolation Teat Results Performed by........................................................................... Dut6.........------...................... Test Pit No. l................miuutesperino6 I)rpt6 of Test Pit.................... Depth to ground water-_.-.----_. Test Pit No. 2................minutes per 6zob Depth of Test Pit.--------- Depth to ground water........................ .--'_-------'_--__.-_-'----__'_-----'--'--'------'-_---------'---'___-_. 0 Description c6 Soil........................................................................................................................................................................ - ---.-..--.-._-_'---.--------------_''--_---------_-_'---_--_'-_-_--'_'---__----'----------- ......... .................. . ................................................................. ................................................................................................... U Nature of Repairs or Alterations--Answer when -------_-----_----'__...................................... -'---'---- '----------- Agcceneot: The undersigned agrees to install the aforedescribed, Individual Sewage Disposal System io accordance with the provisions o6TL I'i LE 5 of the State Sanitary Code-- The undersigned further agrees not to place the system in operationil a Certificate of Compliance has bee � Application _________ _ Approved e of health. ' .............----------------------- --. -'--r--------- Application Disapprove rBno /ouon��7 reasons:.................................................................................... __'`_-________ -------`--`-`-`---`---`--`-----'-`---------------`---'------`----------'--`-------- --- R THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /V............oF..+ ............7'f� L.. AVVftratiott for Bi,sVoottl Works Cnnn,strnr#inn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: /�+h��/ q /� LgFafjop•,Ad{�regs� J p or Lot No �s �/�—/�� G bllY../._1. .l► .`.'C......��^.l._�//�!/?!.........:... 11t.._.�'l�l?�v�!�e(!. 1.I..S� .. lx .�4<.sF�Q::w�/•-�i�e�cT '7/7,.. Owner Add ess Q.l�� .�-1 W.1S/�, g/ .......-•-•................. Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.._...................................Expansion Attic ()() Garbage Grinder ( ) a`1 Other—Type of Building No. of persons............................ Showers g --------•---••-•----------•• p (...->--- Cafeteria.(.....>. dOther fixtures ............•-- •-•--•..............•-••---........•.•••---..............--••------•-. ---.........•--•-.... W Design Flow.........11.4......................•__gallons per person per day. Total daily flow.......�,��?........................gallons. WSeptic Tank—Liquid capacity, _�Q.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........................................ ,aa Test Pit No. I................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 water........................ ODescription of Soil........................................................................................................................................................................ x U VW ................ -----------------------....................................................................................................................................... ........... Nature of Repairs or,Alterations—Answer when applicable................................................................................................ 4 ---------------------------------------------------•------------------------------•--•......--......•-•••••---••---•----•--•---------------•------•--•-••••--------••-•••----•••-••......-----••-----•-• Agreement: The undersigned agrees to install the aforedesfri4ed. Individual Sewage Disposal System in accordance with the provisions of TITILL s of the State Sanit,,yy The undersigned further agrees not to place the system in operation until a Certificate of ComplK`a cep has been issued by the and of health. >gned ...................••----------------•.....------••--- .. ......... ApplicationApproved By.... --•-------•--------•-•---------------------------••-•------------................... .... i Date Application Disapprove or a following reasons:.................................................................................... t Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH „w ..........................................OF..................................................................................... Tnrtif iratle of Tompliana S 1, _ CERTIFY, That the Individual Sewage Disposal System constructed 4--le or Repaired ( ) by-. --------------------Installer at.. ... •...........s-------- . f /---/---------------- has been installed in accordance with the provisions of T F cj of The State Sanitary od as/dVrid in the application for Disposal Works Construction Permit No.. ._..ra?.._.._...... dated._ . ............. THE ISSUANCE THIS CERTIFICATE SHALL NOT BE CONSTRUE AS A GUARANTEE THAT THE SYSTEM WILL N ION SATISFACTORY. DATE3 t�----------------------------------------------- Inspector_.... ------------.........•--•----•--•-•----...............------................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF............---........................................_............................. 0 No. .:./-. FEry....................... io�r A Tonotr inn "permit ebY gra d ......` - -'= Permission is, to Construct ( or R ( )-an I - ld yr -' p@s System atNo..................... ........ --•--•...... .. -- •. w:G-... .-- ....•.. .............................................................. Street r s as shown on the application for Disposal Works Construction Permit No..................... __... I.... .............. 9� ✓ ............................... =- = -------.-.-.-------------------------------- oar ofHealth DATE .- . FORM 1255 A. M. SULKIN, INC., BOSTON - A ! ��I►JGLC_VtAMtLY - .'� bGORr)0tvk ua 6Atz5AGC- 6QJ►-JI,EQ- \ II p!a►L�( FLOW :. IIU x 3 = 330GPp !� SEPTIC- TASK = 33ox15�`/• = �495G.P. q \ �X ST � 1000 6AL.- Strip c�15Po5nL PIT v5E S 150 BOTTOM A2EA= .. Imo 5•F, ( �� -` I� 5o S.F- x 1• 0 5o G.P�? j � � -TOTA1_ DESIGN = .42rj GPD Qrr�A i -foTAt DA►LY PE2GOLATIoN RATE . 1"IN i A N � } LC-, �U poi poi N Sc. L t' SAX ER N, .2=cas4 ��G,Goolit.vz,x ts�� • • o� Ge4�� Zd33 /O/• S TOP TE`�T 4-I Lam. .�-7• Y�3 .S -� n , - �Ga loov INV. �I M DI'PT• INS. GAt... Sv85a t �V S£PTIG X 9ls•� TANK �t•C> G LA.`� (OPO IN�l, LEAG41 ` INS(. INV. PIT Q IVfE': VIASti1GD T�ATEt 14 /�IJD � ��% /i "i. . 670Nsr s,-�i Z GE2TI�IE1� PLCP7 PLA>J PR.UFIL� LoCA-c_IoN n f �.10 SCALE SCALE Sc� �A•Ta '0 L-; p L P.T'4 R.E EIZEN GE CERTIFY -THAT THE I VSi3 51koWN ►{EREO►.l GOMPL`(S \,JITN'THc- S1D6L%WG- A►�� 56T�.GK 26QVIR.EMENT� QF -tN�' •Z. '(o W N O LOCPTED WITNI T E Gl Odp PL. lw C �" DATE��"� ��= ` {/ri )�' BAxTE2 t 1.1`(E 1Nc. R E6 I S'T�QEs�'LA►� S v V.v T11►S PL�►� 1 Novi' E3�5c_n bld AIJ vsTtc2VILLE - ass (I IlJS-i-RuM6NT 5v2v1�`( r< -r NE o1=5.5ET5 5u0ut3 pTb pET'✓W^114 L-aT LI E�j APPI ICP.►�T -- No-t• 6� u5E N