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io" CATION SEWAGE PERMIT NO.
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INSTALLER'S NAME A A0DRES5
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DATE PERM"IT ISSUED
DATE COMPLIANCE ISSUED
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INSTA LLER'S NAME & ADDRESS
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B U I*L D E R OR OWNER
DA T E. P E R M I T ISSU ED j-ZI/Z7
.'DATE COMPLIANCE ISSUED
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ASSESSORS MAP NO:
"ARCEL. NO.: -
No6S10. !F.2-7 FE$..-...
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
l O.mO.................OF...��XLM.O.!c!D.Q----....-----------------.....------...-••----------•-•--
ApplirFa#ilan for Uispm al Workii Tonotrurtiun unit
Application is hereby made for a Permit to Construct ( ) or Repair (�,) an Individual Sewage Disposal
System at:
................... ......•---•--------------•••-•--•--•---•----•-•--•---.........•-••••--------•.._..••--••-....•-•--
tion•Address v
N
. ............................................. I$... /
. .......................................
a A Q Owner Address
�-f---------••-• . 60 ll�lii c1.-e p t
Installer Address
Type of Building Size Lot----------------------------Sq. feet
U Dwelling—No. of Bedrooms...............................7........Expansion Attic ( } Garbage Grinder ( )
Other—Type of Building No. of persons ..................... Showers
a g ------------•-----•--------- P ( ) — Cafeteria ( )
dOther 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 ( )
a Percolation Test Results Performed by ----•---------••-•-----------••----------
Date
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water--.---------.--_-----..
fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_____________________
04 .---------•----•.•....------.•.--••---•-----------•••-•••....................••-------•---------•----.....••••---------•--•----•-•-----._.........----------
0 Description of Soil....................................................................................................................................................
x
U ------
w
x _ -
V Nature of Repairs or Alterations—Answer when applicable.-- 1 - ---- -----_� _��L?ll�i- lc1 X�.•.
c�s� rsd-----------•••--•-••-••--•--•--------------•--•-•--.......------------•---...-•-------------------•-•--•---•------•---------•-••-•-•••-•--------------•-------...----•-
AgreementJ:
The undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance with
the provisions of iI-q. 5 of the State Sanitary Code—The undersigned further agrees not-to place the system in
operation until a Certificate of Compliance has been is ed by the board of health.
- G �• / f-IindS -- 5a'6
---
� =Application Approved BY �� ---
Date
Application Disapproved for the following reasons:................................................................................................................
----------------------------------------
•----------------------
.--------
•----------
--------------------
.------------------•-------------------------------------------------------------••-------
Date
Permit No.---... ... ...._._... Issued_
Date
No.....: FEs....e t3:..'
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
1.L?.t.ari...................OF..tr,r '
- App iration for DiaposFal Works Ton.6trnrtiun "permit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at• f
.... 'ri 4 -Rrt - k')/firwon /)i!'f ..............
Location-Address
sorl k"( p!C. r.'...vn /..ri `...........................
ti
'�r Owner Address
w � � � �... C „C� �uf� 171ct+,, f.r�.�� t�-���� u�C,t:-,,-:•E,4
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms...............................Z--------Expansion Attic ( ) Garbage Grinder ( )
pa, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
P4 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........................................
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----------_.............
�+ ----------------------------------------•-••--•--•-----•---•------....................•--•--•------•.........................................................
0 Description of Soil........................................................................................................................................................................
x
U -•------••••••-••••----•--•--------•--••-•---••---•-----•-••-•••-••--•-•-•-----•-•-------•----•-•-•-••------•-•-•-•-------•----•...-----••---••---•-••---••-------•----•--------•---•----••--•-.........
w
U Nature of'Re airs or Alterations—Answer when applicable_
P
= '(
------- ------------•---•--•---------------•-•••--•-•••-•••-------•-•-•--•......-•--•-•--••---.....•----•-••--•••••-•-••••---•--••-•---------•--•-------------•----•---•-••......----.....----•-
i+,
Agreement: -
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T- E i 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 off health.
Signed.... ` _S-f_:_'fi --'. `S' 1 .............
...
...-.
' ," � .Date
Application Approved B - ........................................
_ /.. -��
PP PP y--------•----• ,_-..:.. ......... /.A — Date
Application Disapproved for the following reasons:....................................•-------------------------•-------------------•-••-•--------•••--...........
............•--•-----•-----•----•----••-•••----••----••---•...................•-------•-•-.....----•-•._.._......_..-------------•---••••----••-•-•-••----------•--------•------•----•-••--•------.._..._
Date
PermitNo.......... -==r"--------------------------_ Issued.......................................................
Date
@4t� il THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
1 ,t.3r7.....................OF.�rr rrt.�, fir�ic2
.....................................................
Trrtif irate of Tomplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (, ) or Repaired ( }
:.t- t
Installer
_._
4
has been installed in accordance with the provisions of T i T i E j of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No............ : • ~-I.. dated-_-__ __._.__/- .' _..I
--------- . ------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A G ARANTEE THAT YHE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE------------------------- - -- -- ........................ Inspector......................--- ......_.. ... ..................................
i
9�
THE COMMONWEALTH OF MASSACHUSETTS 1
BOARD OFI tHEALTH
t rl..r I. 0F�J:,rF1�•la•iJl ,E r
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No.................. ..... y-F E....A.L............
Disposal Workii Tuonotrnrtinn Permit
Permission is hereby granted............... @J
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
Street —
( i
as shown on the application for Disposal Works Construction Permit No.................
.............:).._ Dated...... �...__....._`...................
Board of Health
DATE. �'"•••--- I 1
J
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
No.......: - T _ FElm.....a :......
T
THE COMMONWEALTH OF MASSACHUSETTS
BOARQLQF HEALTH
................... ..�.-----....OF............ AAW...tii l ....4---6.................
)AV Apptiration for Uhip vial Works Tnnitrurtinn ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
. ................__% .�..�. .1 .....PATA...4:�'►dil .�k....--...----. .....................................................................
L a'on-Address — or o.
MAY
ner _ r.Address
a .... = ..................
�. ' ..... �1.5 1.......l.aw1c 1,
Installer Address ecll,,
d Type of Building Size Lot .......Sq. feet
U Dwelling—No. of Bedrooms ......... ...... _....Expansion Attic (W) Garbage Grinder (IV)O
pa,,, Other—Type of Building ..(_'Z.................. No. of persons_....1........__._____.. Showers Cafeteria ( )
Q' Other fixtures ----------------------------------
W Design Flow............!_/0.......................gallons per person
er. day. Total ally flow.........-357-( ..................gallons.
WSeptic Tank—Liquid ca acit r-fdV�-gallons Len th__�------ Width___--------- Diameter________________ Depth................
x Disposal Trench No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.---______-__.__---- Diameter.................... Depth below inle......_............ Total chin area..241 ...sq. ft.
G
Z Other Distribution box ( ) Dosingla ) -�� ' -
Percolation Test Results Performed b IS Date._
Y =
Test Pit No. I.....a-----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........................
G�
4.. :_:.. ..... -C
IA
p Description of Soil----------
x 1 Q<<...• O
C�
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 iITi:; 5 of the State Sanitary C —The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be i sued by the boar .
�-
n - ----- --- - -----------•.... /Dat
-
r. .2/APPlication Approved B -• •-1 -- ......................... .i��-----------•--•------- -
Date
Application Disapproved for the following reasons:................................................................................................................
---------------------•-----••--------•---••-•---------------------------------------------------------------•-•---------••-------•-••----------•--•---•--•••----•-•----••------••---•-••••••------------
Date
—Z� —?�
Permit No. Issued ----------------------------------•-•----•.......
Date
No.......` ..... ..... Fims..................l...._
THE COMMONWEALTH OF MASSACHUSETTS
. w
BOARU.,,QF HEALTH
' ( �-�{'�
r, a
OF............ ....... .....: =.. f-------------.-......bt.
i
Aliplirafion for Dhipoii al 10orkfi Tontitrnrtion Errant
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
J. {
.... r... �3`.tc�',..$_ � ... F...�!y 9__ ... ry .._.i .................................or Lit.No
..-.. L ca ion-Address
9 �✓ �� t y,
.s,. �` ...�e' t` r� ....••.- 1""1� - ..1..._ 1_g_�is1u !j
. Y
t t} yu
---0 ner address
.T.........7. .._....C. _1-_.................... '. .... .>~.; t.4 �.. __ .l.-. ..
Installer ; Address d 7 Type of Building Size Lo _._-/t..................Sq. feet
U Dwelling—No. of Bedrooms.............. .. . ..................Expansion Attic (�jO) Garbage Grinder (i'V'
Other—Type of Buildingf�' No. of persons.._..3.................. Showers — Cafeteria
dOther-fixtur J .....................................................................................................................................................
WDesign Flow........... �0...:...................gallons per person Per day. Total daily flow........... 2._0..................gallons.
WSeptic Tank—Liquid capacit 0_j� .gallons Length. . :.......... Width... .......... Diameter................ Depth................
x Disposal Trench—No..................... Width................_: Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth=below inleaf:..........._-_ Total chi ng area......----......sq. ft.
Z Other Distribution box ( ) Dosing tank ) ((�N
`"' Percolation Test Results Performed by . . .- --------------------•---•......... Date..
Test Pit No. 1.... .....
..minutes per inch Depth of Test Pit.................... Depth to ground water----- .(IRL�CC�.a"' �e
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
............................................................
--...... _.... ..•............. . ..., ....••--,..__ -•,
Description of Soil--------------•---- - y 5 - ......
-
W -------------- ---------------•---•---•-------•-------••-------•---------•-------•--•=•--•-------•----••......----------••--
UNature of Repairs or Alterations—Answer when applicable................................................................................................
.............................................-..........................................................................................................................................................
Agreement: Al
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT .l^, 5 of the State Sanitary Co —The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been'`sued by the boar(tvHmaloi.
Application Approved By...... _ D7
�16 Date
Application Disapproved for the following reasons----------------------•-------------------------------------------------------------------------••-••--•-----•••.
--------------------------------------------------•-----------------------.....--- ........ ............----------------------------------------•----�•-•--•---------•-----•---•--•----•--....--•••-
"` Date
".. �Permit No..............................................f......... Issued-.......----•-----....-----....:_...... _.._...-------
Date
t THE COMMONWEALTH OF MASSACHUSETTS
BOA OF HEA TH
(Irrtifiratr of Tompli anrr
THIS IS TO CEITT-14,v, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by-•--....... ..t ... -..----- •--------------------------------•-----------•-------------------------------------------------.---.-----•---------------
n�eer
at- 1`1- ------ .i�. Sril ...-•---- 3------------------------------------
has been installed in accordance with the provisions of F 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No _ 1_4.�.j!................ dated_-- .' ". ....................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FU IO �SISIFAqTORY.
DATE. ' Inspector
---.-----i-
THE COMMONWEALTH OF MASSACHUSETTS
B04RID OF HEA TH
��r
.7 /� ...�...`�•�'...'}=,1.�•...............0 F.....'�..�'�.�•§."+1J.`t,s":�;,;� cJl✓y:�t�:..................................
. ' il.�
No.......... ... ... FEE..-----..-...........•--
Ito oottl or onion rruti�
Permission/isereby granted---- ---•--1 - ---------------------------------------•-------....................-••.....
to Construct R r ( an InAlvidlIal Sewage Disposal System
Street
as shown on the application for Disposal Works Construction� �J No... ... _..._ 1 Dated....
�.................................
,, ..........................
_
�� Board of Healt
DATE......., ----........... -- ...........................
FORM 1255 H2OBBS & WARREN, INC., PUBLISHERS
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G�STEP
{ . L EG°END:
EXISTING SPOT ELEVATION p�A CERTIFIED PLOT PLAN !' '..,
EXISTING CONTOUR - ® _ = {�
FINISHED SPOT; ELEVATION 0� r � k
' ' Ff ,ISHED CONTOUR 0
'APPROVED =, 190ARD OF ,H'EALTH
Y r .a �A AJ�l ��.�.�
4.
DATE. ''AGENT SCALE ��'r�, ¢D /DATE, , G
f L..DRE'DGE ENGINEERING CO. IN R
-- - CLIENT Pf?KC I CERTIFY THAT
-- -- THE PROPOSED '
EGISTE`RE REGISTERED JOB NO -:0 c6 B-UIL'DING -`S_HOWN ON THIS PL AA1
CIVIL LAND
k ;,• CONFORMS 1TO THE ZONING- -L'AWS
ENGINEER .SURVEYOR DR OF BARNSTA®LE;, MASS.
'33 AIIY1`°ST w 712 .MAIN ST CH BY:: T..,T� g
YARMOUTH', MASS HYANNIS, M';4SS. SHEET OJF ��` 7 _
` T� -` DA E EG • LAND
�S`URVYEYOR .
-•. t.. 'a'r 'e . , a .'/.. .. ..• ... .. .4 .. _-
2O FT. M/IV
/V07"E /F E/TNER T/,/E sEPT/.0 T.Q1�4/� OR
,;- LEr'.4C'H/nfT AIDE MORE.--rNAN /2"BEL0_JN__ ,
. PO Crr. M/. . - �'iR•4 OE, fa :2�1°®/.�q/�9 AT.t P "CoNG 1F�T� CO liE�
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s o. oDv r e • DEPT: o . I I o' WA5NED STONER :.. :.
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lNVBRT ELt��/i�T/ONS o ` o r • / • • s • • • a c P/T DR EQU/✓. '.
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/NYERT AT.EU/L.D/NG 96:0 FT. 6 FT. PIAM.
FT. O/A1+4. C(SEE T 1BULATJON>
/NLET SEPT/C TANK 9 S,5 F T. - _
' P 404/74ET SEPT/C -rA NK `AFT.
/NLET D/57R/19U7*/O1v BOX 94.8 FT. SECT/ON OF' GROVIVD WATER TABLE
O!/TLETD/STR/BUT/ON BOA 94 7 FT ;
/NLET �E.4CN/NG PiT 9`I .o FT, SEWAGE 0/5.400SAJ- .SYST&M 7s4oULAT/DN
LEACH//1/G P/T
SCALE % /= p~. OIMENS/ON A FT.
DES/GN CR/TER/A 10IM,-N5/0N . 8 6 /=T.
An//NBER OF BEDROOMS •3 DIMENSION C -FT. '
GA:?QAGED/SPOSAL. UN/T SO/'L. LOG
TOTAL EST/M. rEo FLo,w SO/ EST SO/L TESTS 2 SD/L TE3T
KUMBER 040",04CHlNG-P/73_ l ELEK 977 ELEY• ,DATE OF SO/L'TEST. 7 /.7 /7S
S/DE LEACH/MG PER P/T -
RESULTS h/7TNESSED BY R �' L3 v•vi �c.� S
D ' PERCO.LAT/ON Ie / Z M//V�/INCN
60TTOM L,�iCN/N�s PER P/T' '7$ S4. AT y L.pA�^1 3► - _
2(eb S�gSUiL v
TOTAL LEACN/iYG AREA' ' SQ.- FT. AERCOLAT/ON RATE2 MIN.�INGH•
z_6 6 Z`
/3E3ER6�EL;E�4C'/'//N6 AREA SQ. FT =
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'LEGEND { Z:
EXIT NO , SPOT. ELEVATION - OA-0 CERTIFIED - PLOT PLAN _` '
EXISTING CONTOUR --- O —
.�-.�,
—:;,.-.1,,,.�,P,-�1
..�,,,.1,.,:,I.,.-1,:.I,.��:..,-i..,c,_I-.,I,..,-�I,I._,1,
FIIdI3HED . SPOT ELEVATION Lo.T �{ . C3fc'/!�L'E TE471/ z `
FIPII$HED CON,TOURr 0 .11 - _ M1 157`O_t/,5'___/�/ LLS'L
o ,: I N
, 4
APPROVED BOARD, OF HEALT-H
`'4 ` A
®.AT .
II
E . AGENT -
SCALE I '/�.. ¢D DATE �' . G � I7} f'.
LDREDGE ENGINEERING Co. IN .
__ CLIENT_ G'�K— I CERTIFY THAT THE PROPOSED.
` EOISTERE _REGISRERED
{ ;.` CIVIL LAND JOB N0. - - n9& BUILDING SHOWN ON TF18 PLAN
ENGINEER SURVEYOR DR.BY :Ar . �. CONFORMS TO THE ZONING LAfrf$
- i , OF BARNSTA®LE MASS.
33 NO MAIN ST: 712 MAIN ST. CH. BY T� ;ram°$ �'
--� -� yA
SOti.YARMOUTH, MASS. ., HYANNIS, MASS. __
d
--�.
SHEET— 4F 2— DATE' REG. LAND SURVEYOR
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.WEPT/C,;7A oV OR u'
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OUTLET SEPTIC TANK 9 Y."3 Fr
INLET D/STR/8UT/ON BOX 9 4,8 FT, SECT/ON O F "`. GROUND *VA rE fr TABLE
OlITLETD/STR/B/IT/ON BOX 9 4-7 FT
INLET LEACHING �iT 9�.o FT SEd�AG� /eS/�OSAL SY.STE/'9 TigBULA'T/®N
.• L EACH//VG PIT o/r/ ivs/oN AFT.
•
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V"49ER OF®EDROOMS' 3 t
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TOTAL EST/M.47�E0 FLOH/'' 3 3 o G.4.4.1pAY 'DSO 4. TEST 16t/ ' SO/L TESTy0t2 _
AIUMBER_-OF 40ACH/NG P/TSB_ / �^ELEY. " 97. j�-ELFY 7 I /7 7 S
i1 .DATE OF.SO/L TEST /
S/OE L EACH/NG PER P/T ./ S SQ FT • ^ 1Z P /3 vti/is S
U RESULTS W/TN�SSED BY
60TTOM 4Er4CN/NG PER P/T 78 SQ. PT• PEYVC04AT/OM IC.4�7E / Z MI,0V,/INCH
266 s�gso%� -
TOTAL LEACHING AREA SO FT " K AERCOLf►T/ON RATE. MIN.�INCN
RIESERVELEACN//V6 AREA 2-6 6 Sip. F7. Z-
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BUNIKIS
'No.22162 SR n/D
CO.,ONC
7/2 M/!iN ST .f.33 NO,MA/NST
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