HomeMy WebLinkAbout0046 SANTUIT-NEWTOWN ROAD - Health "MARSTONS -
__ A = 031 = 005 002
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Uf F T0NVN OF BARNSTABLE
LOCATION y6we&,�Apwn }"�' SEWAGE #odd/
VILLAGE A140 i�li��3 ASSESSOR'S M.4P & LOTO)1`&DrSOD'
INSTALLER'S NAME&PHONE NO.441K' Carl 7�iy��✓ %��-$9.r6
SEPTIC TANK CAPACITY 4000 6-W L �.
LEACHING FACILITY: (type) AV /*41 �� (size) /0'X 30',e�
NO. OF BEDROOMS ,
BUILDER OR R //C
PERMITDATE: _ Z —`�l 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 of leaching facility) Feet
Furnished by 6CJT
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TOWN OF BARNSTABLE
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' LOCATION'76��Ga%fIJGrJ�( Y' SEWAGE #o�OD/ ;:</Gr,G r,
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VILLAGE &2100 A, ASSESSOR'S MAP Sc LOTO)/''�A5rvz '
INSTALLER'S NAME&PHONE NO'. l 7�.r�r ✓✓ '''' �ii -891�'` �t
SEPTIC TANK CAPACITY IiD�� GaC -
LEACHING FACILITY: (type) SvlC�,.`/ �y) (size) /DUX 3o"xi
N O. OF B EDROOMS d•.
BUMDER OR R �C
PERMITDATE:` .v-t- COMPLIANCE DATE
r
Separation Distance Between the; i
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and�Leaching Facility'. (If any.'wells east on site or within 200 feet ofaeaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
wttlun 3.00 feet of leaclun facih Feet
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No. �`� G '""� 7�� Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS f
01pprication for Digpool 6pgtem Construction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System ltl ndividual Components
Location Address or Lot No. Owner's Name,Add ess an Tel.No. v
6 . 11�lr�lil /'' . �
Assessor's Map/Parcel ,41'�61�c
Installer's N e,Address,and Tel.No. Designer's Name,Address and Tel.No.
7 7/'P.40�
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder("to
Other Type of Building Gi No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow ��� gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank AW09 40� AV-5,16- y Type of S.A.S. G4
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) e znz,G
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued b is o f alth.
Signed Date
Application Approved b Date
Application Disapproved for the following reasons
Permit No. Date Issued
•� 03/- Dos;po �-
No. Y�G '� 'l" Fee "
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
As
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS f
0(pprtcation for Mgoml 6pgtem Congtructfon Perron
Application for a Permit to Construct( )Repair( )Upgrade(V)Abandon( ) O Complete System C7"Individual Components
Location Address or Lot No. fJ Owner's Name,Add ess and Tel.No.
Assessor's Map/Parcel ' r 7PO /
Installer's N e,Address,and Tel.No. Designer's?Name,Address and Tel.No:-
-7 7/- 3�ffe
Type of Building:
Dwelling No.of Bedrooms i 1 �a t Lot Size sq.ft. Garbage Grinder(to
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow 3�� gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank /Deo 91f7' .e5lrlsll:�0' Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued b t i oarAVof ealth. /
Signed Date
Application Approved b Date
Application Disapproved for the following reasons
Permit No. /-- Date Issued""
THE COMMONWEALTH OF MASSACHUSETTS ��—�os , 00 Z
BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CER ,that the On-site S wage Disposal System Constructed( )Repaired( )Upgraded
Abandoned( )by 4/` �%�S
at /l/P CU tzO Lllel has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit IV/Adated
Installer Designer
The issuance of this permikqs ll not be construed as a guarantee that the syste 11 fu n esigne .
Date /) 0/ Inspector
�,%/ -------------- ���o��D�� Fee----- _
No. ����
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Df 6 pool 6potem (Congt✓coon Permit
Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( )
System located at �(� �Pdti��� �
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction must be-completed,within three years of the date of this permit.
Date: Approved by
NOTICE: This Farm Is To.Be-U' sed I+or the Repair Of Faiied
Septic Systems.Only.
C--R=CATION OF SlaTCH A.ND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT(tiYTI' Q T DESIGNED PLANS)
h,,e.reb.y c.rdry trot „ apolicon;or tlispesa-1 works
construction pernit sipe3'oy me dated i!Z/l�l conce=2 L�e
a o�er-L y Iocate�:at ne= zl of the
fono-r g criteria..
:'sae Loed S ym=is conne_:.ed to.a r--.-16=nII2I Ile.e are ac col nercal or bLi1. ,
J1Se5'—�aCC.2L RZ'�1f me die linz.
Ile sOL s Cl2�a�ule:25 CLASS r ^r - z o�} _ - L.V. land the ^dlc_ldrl -aim !s .° � I1F=TZ or ,ate! :fl.� Dc :nc1�/// ` .iLiZIZ...�
r�_ne _are ao wVdan s .,�i n 100 fit of 1ze c_ne_es: s.-o_tic::sen
no:ri-.Y - n 7 m* = ' . v .
V _ .� � ate .�e� .rl_...n.__0 __.oI�e pro�..sed s�yric
. 1_sere s ac ii,= se in lovr=—d/or.charm_ Ln use proposed,
Y lte._ *e no ram.ances.re:usLed or a=,4
g i ne Dottom.of th2 proposed i�� � a�. Ly w_i not be ix a.�1es- s<a fivem
above the
ma dmunz adjts�,�ouad�atcr able e1�,atid� fAdj=the?round-arer.table.using zhe F=, ptor
ethod when arudcabic].
tf the S A S.will be Io.rtt rith160 fee:of any vepmic-d we:iands. ;he boaon of tine prapesed
leaching fatuity-will not be located I_s than (14) f:above,the rnz=---nurn adns,°a
mound-atcr table clevarion,
Plea-.complete the followinb
A) Top of Ground Surface=levadon(- 'ng GIS inforT.ation)
3) Q.-Vi.ucvarion 9q —th e?vfAX nt;a t. Adiu eat. /• / = l �' 7
DIFFER ENC 3 t A and 1
SIC-N 7 DATE: �A/G
(SYKrh Proposed plan of srsz..=on back].
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L O CAT~I O N c5A►,T11) l — SEWAGE PERMIT NO.
#2 Newt6wn Rd. 84-88
VILLAGE
Mar. Mills
INSTALLER'S NAME i ADDRESS
` Robert B. Our Co. Inc.
Great Western Rd. North Harwich
e U I L D E R OR OWNER
Oacey Homes
DA T E PERMIT ISSUED
DAT E COMPLIANCE ISSUED j�XY-
/_� 1 ilk �Y{
�� � 9 �
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v
THE COMMONWEALTH OF MASSACHUSETTS
` BOA R® F' H EA
/...........o F.......... :. � :.................
---------------------------
Appilration for Disposal Works Tonstrudion Purim �
Application is hereby made for a Permit to Construct ( or Repair ( ) dividual Sewage Dis
syst �at:
�",f�ocatio, A s ,...or Lo 0
ner .
,Wa .... - --•----• ••-� .......... .. .:.............. :�.---- ... �-� ....--.-•-••-
Addres
Installer
dress
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms...... .................................Expansion Attic ( ) Garbage Grinder
aOther—Type of Building .. .............. No. of persons... -------------- Showers (-►� — Cafeteria vj
Other 43SWes .....
='�=----_---•- . .......................................•--•-•--••--------......-•-••••..............-•-•••-•----
W Design Flow........2.7 ..........................gallons per person per 4ay. Total daily flow..... ...... ..............gallons
G; Septic Tank—Liquid capacit �v�'...gallons ength.. ........... Width... _ Diameter..w,�9.. Dep�ph................
0.4 Disposal Trench—No. ....14/0'/..... Width...... !...... Total Length... .....Total leaching area.~,//._�.lV./.._.sq, ft.
Seepage Pit No......./......... Diameter..... ........ Depth below inlet.............. Total leaching area....Z.. sq. ft.
z Other Distribution box ()s ) Dosing tank t j o
aPercolation Test Results Performed by.......................................................................... Date................... ---------------
-Test Pit No. ..minutes.per inch Depth of Test Pit---- ..... Depth to ground water....
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
...........
o _ /� �,....._,.
xDescription of Soil.... ` ............. .......... ?!!= ....--- ....................................................
.-.--------, - : .
UW ------------------------------------=�.-... 3... `....:..:`... �
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 TITIE� 5 of the State Sanitary Code—The and igned further agrees not to place the system in
operation until a Certificate of Compliance ed by the boa hoh ll
Signed....Y
.....�...:^............... -•---•-------
ApplicationApproved By...................................................... .
Application Disapproved for the following reason:
--...---•--... ............................................................
Permit No.....................
• THE COMMONWEALTH OF MASSACHUSETTS
. BOARD OF HEALTH
11�It
............OF...... ?..:. ..... j.. _Z _...._...
Appliration for Difivasal Works Tons#.rudion "rrmit
Application is hereby made for a Permit to Construct (,O-or Repair ( ) an Individual Sewage Disposal
System at:
.1#._ ! ;.3__t�7r�t:I •$ .t�!t_ w _ _Y,_ lv� { #; .a.r ... ... '.. r`• .....
Location Address "t or Lot No.
j f Owner ... ...._Address ....
a ................._...}.............. . .. ............................................... — ;=.........':. : ................. '.....
Installer
Address
Type of Building Size Lot__�. .. ..._.=.... 2...Sq. feet
a Dwelling—No. of Bedrooms:....:...:Y _---------------------Expansion Attic (' ) Garbage Grinder
Other—Type of Building ..........:................. No. of persons......... ................. Showers ( ) — Cafeteria. ( )
Otherfixtures ........ ==---------------•-•-------...-•--•---.-•-•.....----------...-----•-••----•-•-----•-•-•------••------•-•...........---................
W Design Flow.---......=�.. .........................gallons per person per day. Total daily flow..................l Ot.................gallons.
WSeptic Tank—Liquid capacity............gallons Length.K 't____. Width4:.;!'C>`'... Diameter................ Depth.........
x Disposal Trench—No......z'............. Width...... .. ........ Total Length....................... Total leaching area.........--........sq. ft.
IF
Seepage Pit No...._...`........... Diameter......{.4....... Depth below inlet...:`............ Total leaching area..: a` ..:..sq. ft.
Z Other Distribution box ( ) , �:? Dosing tank ( )
Percolation Test Results 4 r4 Performed by _: �?.i.►.. ....":... . {' .. .."' +..... � 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........................
._.. 4-
O Description of Soil...... .:`g.
----------,
U .... i ..3�......._... 1......... .... ..... �•-•-.....................................•e�.... ... o/n..Y.. ..................................
W �# F. s 1. / tr `� f .ILt !.'$fr�r� tf nii ai � {✓ti iP) 7 a rf •
... ......... ..........`_._____._. ._.... ...___.._ �..__.__._ _ o _.........- .__.................................................................�._--........
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 TITI.E 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. ,s
-'( Signed---•..... �:= Jf ..f_ - t .,a+ � :"/r 4!
• •--£ t f - r Datef
t .................
Application Approved BY.............-`•-•--•------------------------�t-...---- •-------....._._ .................-......................
Date
Application Disapproved for the following reasons:.............. : ...................................•---•-----.......-------------•--------------.........._
----------------------....-----•--...----•----•-----•--.....--•---............---............•. .Date
PermitNo.................................................._•-•- Issued.....................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF...................................................... .........................
Trrtifiratr of Tomplittnrr
THIS IS TO CERTIFY; That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
f r. ; ...
b < . , `..I
Installer
at.......................•-•-••-............--•••-•-••-----•-••-----••---•-----•---•••-•---------••---------------------------
has been installed in accordance with the provisions of TITLE 5 of ,The State Sanitary Code as described in the
application for Disposal Works Construction Permit No....................................... dated................................................
THE ISSr�F
NC OF THIS CERTIFICATE SHALL NOT BE CONSTRII AS A GUARANTEE THAT THE
SYSTEM WI CTION SATISFACTORY.
' O ��ll
DATE... ....� ....✓..............................••--•--....---•--•----..... Inspector.,:•-- ---- ••------------------------•-----•---------•--•-------•---••-•---------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.
.............OF............. '`�f r� ,lL` :?' c:..:. ..........................
...... .,.. ..
No...... ............... FEE........................
Elispoottl Works Tons rudion "Permit
Permission is hereby granted................../��4__�c'_�t.r...-_.ra"A ----------------------------------------
to Construct (X) or Repair ( ) an Individual Sewage Disposal System
a
Stre /
as shown on the ap lication for,Disposal Works Construction P No..................... Dated..........................................
.- -- ---------------------------- --------------------------------------
Board of Health
DATE' ------------------------•-•---
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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No
951
/S r�'1, "mow
LEGEND
�W61INO SPOT _ELEVATION 0X0 �j�,o . x CERTIFIEDPLAN
EX"!STING CONTOUR --__ 0
ROBOT
-FINISHED SPOT ELEVATION ( c
FINISHED CONTOUR. 0
ELOREDG _
"`APPROVED -BOARD of-HEALTH,
P
DINE AGENT W� ,Pkmr
1rAL E'r' !`l � ¢D
Y 3 "f1q`1`
GDREDGE"bIG%NL`ERING IN
CL.11�1",f�Wrrwr. 3
CO.• Ki ' dr'i y�` C• �; � 3t Y�-�`ti a tit
I����tTIPY THAT �r��+ l�b�
EGISTEAE REOISTL'Nt? JOiN NO: - i1Jl ►DINb `sHf� NN ONi`Hi3 P `�RN , � ":
CIVIL , :LAND. ,CON�'C?�.h�8 fin tN <.ZbNIiVO,
E aiNEEO' UR DR DYE ; = �' f tip,
sM1', RiAAN l 'a G� ; imss�i .
f;t 71 M A l N s 1 B E ET DM. �v "t F x �3 �Y
A py Vq
� 7 H Y A N N 1 5 M A'S S - l �.�r{G//§yyp,.; ;
7f1 5 i r a� t
, HET "', .�» ,'. FG,
it
r f _
/MOTE` /F E/7wgeA'' 7NZr SEPTIC:TRNhr OR.
G.EACNlnlG P/T ARE MORE rNAh/ /2 ffZ4&/'V
/D PT. M/N'. .' GRAD&., A 24'O/AM ETER CONCR.F7`� COYE/�
SWALL ®E BIPOV4S. 7- TD GRADE=. 'i .EXTRA
CONCRCTE +PVC PJPP JVE,4VY CAST IRON C0P40M SI.44L.L DE 41SE-O
M/N. P/TCf+► /F/N 1:;I.P/V.—WA Y'
• • EL-f e Z.S COYERS
2�r Miw. CONC.eE'TE '
A _ i_ 4kApE CC)i/ER CLEAN .SAIV O
r
_ BACICF/L L
-- x-
2 LAYER
_ -
4"C.A$7-
1RaNODC� o
MJN,.PITCH GAG. p/"3T, ' • • • , • • e e �iO WASJIED 57VAle
SEPTIC TANK • 4 • • • • • • e e' o s d ,
13aX o • � 8 � • • . • �. � p .
•EFFECT%boE r • , 3 .Q - �2
` -Loc.a • • s • • p�PTi+� • • . 0i O o WA5HEA STONE
veto 0
37-7 G� • o
$ • ) l 3 x" (:D c t.� 3 . o v ' PRECAST SFE./'A6E
! `r �/!L fDla�/ ► a• ► • • • • • . e e D ••v P/7 DR ZVU/V. ,
E•LEYAT/GNS.. .9
lNYERT AT."OlJ/LOJNG 9`�.- "FT.
1/YLE..7F SEf�'T/C ;T.4IY/C¢., 9f1.S FT J FT OI,4j . � G(SEZT.�IBULATJON}
Dtl7GE:7�'SEP7/C;TA/1E"I4g.3 FT.' .
>NLET. ISTR/9VT�GJY BOX. 7,5' GROVNO W,47,FR WAAALE
ouTlErb� TRreVrioiv BOXY/=r sECTia/v a.0
//✓t.L=T LEACH/A/G,-o/T 96.E FT SEA ACA= VASPOJA.L SKS7W,"
7ASULATlDN
sc�tLE p ! o DIMEN.SYON A -3 7'
F
Dosi6/Y`CmITER!/4 DJ/►IENSJoN . a- FT:
-, ' "Ji/LlAlL3E�Q OF'BEDJ?OOMS ,
a�. cEo�sPos �uv/r; wank 50/L. LOG
TaTAL La3TI/ TEG.• FLAW 3 30 G.41.�DAY SOIL TEST #/ S014 7Z:'S7-**2 SD/L TW:fT
r 1
NUMMA" OF f,�-ACWJV4 O/TS J f`EtzwY. !Oe,z rA--zAF4 OATF OF SOIL TEST �l �✓� 3 /�-3
_ .SIDE ACXIKG PBR PIT l 5 r S¢ PT. /!- !� —J z�. RESULTS H/JTJVESSEG BY ,)!fE
acrmomA&Ac wcp aeR PIT L t 3 so. &7 -,,: PEIgCOLAT/DAr RATE)*1 L-t±--55 MJAIVI /CH
`` �TQT4t C �FtC /NG AREA SQ fT vi S t om �" ✓MIN.�INCHL .
i gRSERKE'LE,,4CHlJV6 A Re,A SQ. FT..
CLA y
l f3f'���s Q e -1 3 i Z-V;- Z SA-/tTv/i_ff,�F du"jt.c✓7
t Act ���{ OFA14 MCD! u '�
rti ROs4ftT �� ��,P ss9�, S-A 4,41- 1�'1s� I? �'1!�,rtr",� /Sr'I✓! �,5
A fi ERUGE o`er A
••E°wnRECrci� Q i A'
MORSE ;33 - 04OREP40Z ENWAIAWRING CL,IAIC.
No.10951 O t 7J2 MA`JN -5 - HY'ANNI, MASS.
7.9oF� G15'S6 v�� ND GROUND L�/i4TL!"R AvWC0U1VT1r.?L�O CL/FNT r f3A�+s f D.tTE
ss/ONAI F� Q GR'OIINO N/L#TER'.4T ELEL!
J0,a VOz.. �rzZz� SHEET?OF z
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02 -OOS
No...... 'S.6.__..... i Fizs........ .a 4.._.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.. .............OF..... ..... �.....................-----
Appliratinn -for Riipoiittl Worko Tnnitrnrttnn Vamit
Application is hereby'made for a Permit to Construct ( ) or epair ( an Individual Sewage Disposal
System at
4 1� .......57,0V
LocaY. 1421&
Address or
...
J7_ -7
ner re s
Installer Address
Q Type of Building Y Size Lot----------------------------Sq. feet
U Dwelling—No. of Bedrooms-------------------------------- -Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
G4 Other fixttt es ------------------------------ -
W Design Flow.............5_.. .....................gallons per pet-son 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/- 4�10 0--_--- Diameter____________________ Depth below inlet.................... Total leaching area-----------------_sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by-------------------------------------------------------------------------- Date----------------------------------------
,� Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water...--_.----_-.------_--
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_.--.---__-------__-...
9 ------------------- ----------------------------------••--------------------------------------------------------------------------•---•--•- .................
0 Description of Soil---C '�'�C - -_-----•---•------•-----------------------------------•--------------•----•---•-•---..--------------------------------•---•--
x
W ----------------------------••-------- ----•----•--••---•--- ------•-------------------------------- . ... ------
U Nature of Repairs or Alterations—Answer when a livable.-.-gyp% �_.__.. L..�' �,.y —XEa: _..
U P - 1
��/ ...�� 1�---------- ---------------------------------------------
greement:
The undersigned agrees to install the aforedescribed Individual wage Disposal System in accordance with
the provisions of Article \I of the State Sanit-ry Cod =The under g ed further agrees not to place th. system in
operation until a Certificate of Compliance ha bee e b health.
Sigd-------- - --------- -------------------------- ---- --- -------- -
4f Date
ApplicationApproved By--.....�f------ C----- --------------------------------------------------------------------- ------------- '
Date
Application Disapproved for the following reasons-------------•-•--...-•--•--•-•......--•-----•------•--...-------------•------.....------------...............
---•-...--•-----•-------••---•••--••--•--••------•---•--•--••---------------••--•--------------•----------•••----•-•----------- ----•--•----------.......----------------•-....------------------------.
-' Date
PermitNo..... �........ .................................. -. Issued...................... .................................
Date
No......45 '.......... Finc....... .D. !......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
APW-47 .60, -----------------------
Appliratiun -fur Uiipuiittl Evrkii Tong#rurtiun Vrrmit,
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage ;Disposal
System at:
Loc �o t�jddr ss.A- /I, or o.
Installer Address
Q Type of Building .+•► Size Lot____________________________Sq. feet
U Dwelling—No. of Bedrooms_________________________ __________________Expansion Attic ( ) Garbage Grinder ( )
Other—Type e of Building ______________ _____________ No. of persons Showers Cafeteria
P, YP g - P -- ( ) — ( )
Q' Other fi. es ----• -----------------------------------------------------
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 Q ':_ Diameter____________________ Depth below inlet____________________ Total leaching rea- __;.___ ______sq. ft.
z Other Distribution box ( ) Dosing tank ( )
Percolation Test.Results 4 performed bY---------------- ------ s ---------------------------------------- Date---------.. ------------------------
Test Pit No. 1-----:_^:__..___minutes per inch Depth of Test Pif____________________ Depth to ground water--__-- _:_-_---..
rXq Test Pit No. 2................minutes per inch -.Depth of Test Pit--_______.__________ Depth to ground water__-______---.._____-..
... -----•-------------•-----•-----------•-------------- -
t t
D Description. Soil-
------------------------------------------------------ �p� ----------------- ---------------- --------- ----------- -
----------------------------•-•-••----••--•••------ ------------------------------------------------------ ---------
V Nature of Repairs or.Alterations—Answer when a lira leWe
,. ""� -------------
------
Agreement:
The undersigned agrees to install the aforedescribed Individual ewage Disposal System in accordance with
the provisions of Article XI of the State Sani ry Co %The unde �'ed further agrees not to place tl sys em in
operation until a Certificate of Compliance h bee W b health.
Sig ed ------ +
Date
Application Approved By__ ----- --------- •--------•---------
Date t
Application Disapproved for the following reasons:---------------...................................................................................................
.......................•-•-----•-----•--•-•--•------------------•---•---•--------•----•-•----•------=-•-•-----••••••--------------------•---------------•-•••---=--------•--•--•---•--------- •-----
Date
Permit No............. 7 1
•---------------------- Issued........................................................
Date
'THE-COMMONWEALTH OF MASSACHUSETTS
Ir BOARD OF HEALTH
Trrfif iratr of Tomplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired )�
bY---------------------------------------------------------------------------------------------.......................................................................................................
5 >/*� i :Installer
at.................... - 'f / t--- --------- --- -----•--------------•-•--•-••-•-
��,, -- ---------------
has be V,stal�dA�r+n4 Ath the pr KT-o;&o1�£{.ticle XI of The State Sanitary Code as described in the
application for Disposal Works Con"struction Permit No.-: r�, xY. V____________________ dated.........r, �_�,.... - ---------------
t THE ISSUANCE OF THIS CERTIFICATE SHALL Nf�T E-CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATJSFACTORY.
DATE........... 776
.. = = *
----------------------- Inspector............ ...... --------------•••---•-----------------
F.gHE COMM6NVV �/�L""f�i OF MASSACH TS
-X BOARD OF k, j1= :LTH k ' '
'fy
Gc..;I� O F.... ....................................14-4 T*44 . ..........-.....No.........
` ''el ';
, j 2
urk�,�u'f1R�1Permisstoh� Greby granted-----
to
n��r�r�tun �1Crintf ...
Construct ( ) or Repair O an Individual Sewage Disposal System
�• { ,,, �• �a Street
as shown on the application for Dlspo{sal Works Construction hermit No.-_ �.�__. ._..____ Dated____ _-_f pp__ .. ________
F . ............................................ -_____.-_ . _..............
Q y rd of Health
DATE S *------------- yp� --------
t
FORM 1255. HOBBS & WARREN:iINC.. PUBLISHERS
} J� y " s..5.3