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LOCATION 4d �`�"r,Y 1 _ S_8p J /� SEWAGE
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VILLAGE j jk / �'1iL f ASSESSOR'S MAP & LOT f'b2
' 477-1&/;7-
INSTALLER'S-NAME & PHONE NO.�F{�p A:( U�
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) ldGY>�4 L .�E7(size) 30 S�nYE
NO. OF BEDROOMS ;3 PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER Ttbhd Lim 9AMAl.
,
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR OF HEALTH ��"
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1.. tSl`—......oF......,.....C�....� t4kes.d�4
ApplirFation for Disposal Works C oustrurtiou Prruttt
Application is hereby made for a Permit to Construct ( V/) or Repair ( ) an Individual Sewage Disposal i
System at:
-C Location- ddress 6 Lot No.
. ,. .� . : .............................................. ----------..-_------------------------------ ..-
Owner Address
W
Installer Address
Type of Building Size Lot_.__ ®q?-_...S . feet
�--� Dwelling T No. of Bedrooms...........-3.........................Expansion Attic ( ) Garbage Grinder ( )
Other—Type T e of Building No. of ersons----------------............ Showers
� YP g -----------•----•----------- ..._.P_... ( ) — Cafeteria ( )
Otherxures .... --------------- -----•...----------------•------ ---------------••------•-------- ..........
wDesign Flow............... ...........................gallons per persol�per day. Total daily flow___75.50_._........__........_.-gallons. ;
WSeptic Tank—Liquid'capacity.).k=kallons Length._, ._.b._.. Width 4_.1_Q_.. Diameter __.___.... Depth_. .. .._..
x Disposal Trench—No..................... Width.................... Total Length........-........... Total leaching area....................sq. ft.
o Seepage Pit N ......... ........... Diameter..Ai� 3... Depth below inlet..U.0....... Total leaching area._ .J9....sq. ft.
Z Other Distribution box ( DoX
g tank
'-' Percolation Test Results Performed b �repth
_.-._- r _J.�: __. �_
.--•---•--
Test Pit No. 1....7...._._minutes per inch of Test Pit._ '..._. pt to ground water.....'_---____.
fT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
---•--- ---- ---------------------••••---------------------
•------------------
_.O Description of SOHO _��..__'.......c��L L=� --•---.... .
- n._. .= ��-��
U ...............................
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 TLiTi L� 5 of the State Sanitary Code— The undersigns urther agrees not to place the system in
operation until a Certificate of Compliance has been issued b e board eal 1
Igne ..
e
Date
ApplicationApproved By......................................----•.................................. -----•--•---•-- ----------------------------------------
Date
Application Disapproved for the following reasons:------------------------------------•-----------------------........................................•..........
.......................--....................................................................
�/ Date
Permit No....... _ ;
� �T/�I
---------------•---•---•----•--. Issued-..-------•--• ------------......--------•-------•----
Date t
1
I
s s ���
No .....� FE$��... cv
THE COMMONWEALTH OF MASSACHUSETTS
BOARQ OF HEALTH
_........1 L .........OF.....P�- '.L:.tt .' �"tfi__........
Appliration for Disposal Works Tonstrnrtiun rnmit
Application is hereby made for a Permit to Construct ( ✓) or Repair ( ) an Individual Sewage Disposal
System at• r\---",
• ` Location-Address or Lot No.
............................................ -•-•.......-•-••-••••..........................---........._..•--••--•••-......................---
Owner Address
W
Installer Address
U Type of Building � Size Lot--- Sq. feet
Dwelling—No. of Bedrooms........... on.................+........Expansion Attic ( ) Garbage Grinder ( )
'_lPL4 Other—T e of Building .... No. of persons.........�............. Showers ( ) — Cafeteria ( )
04 Other _fixtures ..-•--•------•---•------•--•.................... ........--+••
W Design Flow............ ......................gallons per person per day. Total daily flow_:. ....:___....__.......__..galloons.
WSeptic Tank—Liquid capacity s.hC/kallons Length.��.__L".. Width` .. ?_... Diameter�... . Depth�....1_:.._.
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area:__........._.......sq. ft.
LIB, -, � --.a s-.
Seepage Pit No........j._........ . Diameter..!-................ Depth below inlet.[.c?_�1-....._.. Total leaching area.✓.)''�....sq. ft.
Z Other Distribution box (� Dosing tank
'-' Percolation Test Results Performed by "�_ __..j_..4�. ........ I.E..nC! - ,:_1,�.'. t_`E. ^..:.'_ �� Date -�'`"
aTest Pit No. I....2c-------minutes per inch bepth of Test Pit...\-481-1..... �eptDl to ground water.._._.........
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---___.-.----___----_--.
t =------------•-•-••-•-:-•--•-----•--•--• --•-•• •-•••.... ...-•-...... .............................................................
O i
Description of Soil._-.`A. ..__..l...�c ��_1. 1 9 4 (YLc G(.: fir.--f-(.............................
V ..........................1-}ii_ 1� +t, )..�_.3� <>. t.�%' i ,i '1l-•. +4t—.---•-�ytl• f-•---• .......................
= �, =
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 TITLE 5 of the State Sanitary Code—The undersigns further agrees not to place the system in
operation until a Certificate of Compliance has been issued he board f ea
iin�� ------- - ------------------ ------- ----• ......-- --------- ...... -Z
Date-- --•- -•--
APplication Approved BY---••---------------------------------------------------------
Date
Application Disapproved for the following reasons:...............................................................................................................
•.........................•------.....---...-----------------•---•-------•---------..........-----------------•-•--•-•--•---•-•-••-•--------•-•--•-------------•--•-•---••-----•------------•---•-------
Date
PermitNo......................................................... Issue....................... .................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.............OF..... .................................................
Ourr#ifiratr of Toutplianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repairedby ( )
Install"... ...............................
G� I Sri L emsI ,. ." ..
at. -•--------•----••-•-•-•••-• --- I
has been installed in accordance with the provisions of !!" a; - of a,�jhe tate Sanitary Code as d scri ed in the
application for Disposal Works Construction Permit No....... __-___L. __. ��J----r3 dated---�-------1.2- -I�- -v--------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUAR, TEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector...................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD. QE HEALTH
�►� !'>...........OF............... WS , Lam.--.............. -7
Nc ...l........... FEE. y<...�.........
Disposal Works Tnntrnrtion rrntit
Permission is hereby granted..............................................................................................................................................
to Construct ) or Repair ( ) an ,Indiyidytal Sewage I isppsal System
at No............L1=2_1 .......1.--.1.:2......... _<_.c��., ��....... .--�._...._.c {r ...........................................
Street 7T
as shown on the application for Disposal Works Construction Permit N ------ J__ Dated.1_o- .�t ....._...._.
.......................................... ...........................................
)_'i of Health
.t• -
DATE........................... = —'---fp•--------•--••........
FORM 1255 HOBBS.& WARREN, INC., PUBLISHERS
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1 [EN
a; NOT 'O SCAL E
TOP FDA(. FINISH GRADE So . U
FINISH GRADE OVER
e:..do:.►: FINISH GRADE OVER FINISH GRADE OVER
o • :° SEPTIC TANK IJ-I.`T. BOX
LEACHING PIT '%`f, 7
p.•.Q °: 12 MAX. ' /� //�
•••,�••o a• '•G 'd'..".d...d, .•O p.'O•,'..A•.•.�:•,A'•b.A.b,,.:d.'.D� ;;O.;p.::,1• 'D: 'A.'�, •.b'O� .. •� ! / — d 12
d .•y.•'b.,'w:� :n.•.' .e: .a':.•A;IF;;d:o;e' ,T ' OF 1/B' 1/2' MtgXA
O e ✓ASHED Pr_ASTONE Q'._ ;_, __ PRECAST COAIC. OR
,O .V• •• O. 6 �• pr_.
p..;ec BRICK 6 MORTAR
n .
3„ [ OUTLET PIPE LEVEL TO 12" BELOW GRI-OE
FOR 2 FT. MIN.0-0
�'�•• c::• o.•:A:'a` o.••-:...o.
'p:' G• O.'• .O. b..e'. .A..b. .O p• 'O. O•O.
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o•::: o:'p 6.: :? ��'OS' 6;.:!•° •"-4'�0' :.°'b:h•'.o.•e.o:v: .y G
C. I. OR PVC TEES , : " 46. 748 P-1
:p.flo8'o: o:f
.o" .e• d
1000 GALLON {
EL . �� o :o . a a ., ,. TION Box
p`,do h4 e INSTAL L ON LEVEL BASE 3/4" TO -1/2„ 4
o.° a".:o':0: : o •. P ECA S T CONCRETE a i P ECA.J p
:'o: o'.'o.•e:o, s WASHED I
:o.'.o•.o'.:o'.'.: H- I 0 EI FO �►ED e CRUSHED �
0' 6.
CONCRETE a: r
STONE
b;Q;o;.poaa,b:°•oe'o;ope.ao 4'po,eo;Q;.'so:d.00,oapopo. C
H-- 0
•d �b, i � 0. :C p
-SEPTIC TA NK !
INSTALL ON LEVEL BASE A0TE.' EXCA VA TE TO ELEV.,35',0 FOR a � a•. ' .:
A OPER TO RE
M'OVE ALL IMPERVIOUS — - —MATERIAL BEAlEA TH THE LEACHING AREA � .� '-0 " 3 '-0 "
REPLA CE EXCA VA TED MA TERIAL WI TH �f 6'-0 ►•
CL EAN. r:LA Y FREE SAND 12 '-0 "
EFFECTI VE DIAMETER '
C�NE L r NOTES LEACHING T
ASSUMED INS TALL ON L EVE L BASE --- --- ------ __. �
1. AL L EL EVA TIOs��S SHOWN ARE BASED ON No
2. A L L PIPES IN Ti�'9''E `3 TE1 HUS T BE CA S T IRO"., �_ a
-� OBSE '" . 'O
OR SCHEDULEloOPVC. � � �� _
', \ 3. THE BOARD OF HEAL TH MUST BE NOTIFIED
WHEN CONSTRUCTION IS COMPLETE PRIOR P-7470
r . :
TO BA CKFIL L I���G PERCOLATION RA TE:
4. ANY CHANGES IN `THIS PLAN MUST BE APPROVED 2 MIN./IN.
BY THE BOARD OF HEFAL TH AND CAPE C ISLANDS 1^�ITl�JESSED BY.•
SURVEYING CO.,,INC. E BARRY s'
— 5. MA TERIAL S AND INS TA LA TION SHe L L BE IN
/" 2 - - ao - `'o \ `� ,•r P COMPL IANCE WI TH THE STA TE SA NI TARY BARNS. BRO. OF HEAL THDESIGN
CODE - TITLE V - AND LOCAL APPLICABLE DATE• _Dec_6_1989 "
�� RULES AND REGULATIONS o r�' �-o•G o T� y z 4z NUMBER OF BEDROOMS 3
PRECAST CONCRETE / / o Rp, 6. NORTH ARROW IS FROM RECORD PLANS AND
LEACHING PIT ._..___ — r\ ,C� � � Tewae, � Tc .re!/ NO
/ o IS NOT TO BE USED FOR SOLAR PURPOSES GARBAGE DISPOSAL
f '�,° \ 7. FL OOD HAZARD ZONE C DAILY FL Off/ GAL .
s„asol .rubsv, i
o Za.R / �� N "` , B. WA TER SUPPL Y_ OWN A R _ SEPTIC T NfC RELJ 'D. 100 GAL .
s000 GALLON SEPTIC TANK PROVIDED 1��� G,4L . r
PRECAST CONCRETE — ,Q „- 3z, I 1 LEA CHING REOUIRED — GPD.
SEPTIC TANK v u Ma.a/ins Meek,✓r++
p
�01 sated sAya SIDEPIALL AREA 226S. F. s
565 �,� 226S. F.X 2. 5G/S. F. G, D
\l? l -- z•/% wnfm_ ��� BOTTOM AREA 113S. F.
LEGEND 1 11 S.F. X 1. a /S F. i �11336PD
�' a 1 LEACHING PROVIDED GPD It
f ` �� 0 � �u �jrne,/w7`r Na Gj!'n�w�♦.
LoT \ �<f 7 I .� PROPOSED ELEVATION /'/�/" 3�s,G AV4' 3 0 �, ,O g
.SO—— FXIS TING CONTOUR
SINGLE FAMILY RESIDENCE G
,. .
Ca'BSER VA TION PIT
na M ❑ DISTRIBUTION BOX
/v e7 o GO' a w v PROPOSED SEAJA GE DI SPOS�L `5'YS TEII t
l �%o FIB"'•��t�� G�
�0 Q LEACHING PIT 29394 I, PREPA FLED FOR
^IrT���p
o SEPTIC TANK �� ��,� ° s.JOHN L IVEHAN
LOT 147 LAKESIDE DRIVE
S T L — MARS TON L
• t R P, RESERVE BARN A B E MI L S — MASS41
' C!11r5
PIPE INVERT ELEVATION
DA TE.' L),,,-- 13, /9�9
CAPE AND ISLANDS SURVEYING CO., INC.
PLOT PLAN SCALE AS NOTED
:21 /G B'`a SCALE,' 1 "� 3 O iG /� � �`V? r.;"',;:, 131 SPRING BARS ROAD
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