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LOCATION - !3 L,3y% SEWAGE #
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VILLAGE ASSESSOR'S MAP & LOT-M-00i.6
INSTALLER'S NAME & PHONE NO. 771-
SEPTIC TANK CAPACITY I,OJy 5�44vw3
LEACHING FACILITY:(type) `���" �' (size) l , odd g.�llwv�
NO. OF BEDROOMS PRIVATE WELL O PUBLIC WATER
BUILDER OR OWNER GAYs, . 01A Ca,
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: f,
VARIANCE GRANTED: Yes No LJ
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No..{x/-.E.�.�» Fns.......jO ......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH _
-----------------------------
Appliration for Dispaaal Works C omitrudiuu j1rrutit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at: I -
e --- ....
Location-Addre � /1 t - '� p� o t o.�yy�/ •"� -
..............._........_...... ��£ ....bull�%` ..! �........».......»..._.
.. .....
canpvfcef�
A dr s
a ......-•--•.......................J.,„�.•---- ---••-----•••--... ....-/ .....T a_K..kf5...---...........Insta AddresA
Type of Building Size Lot- 2/.3.2=Sq. feet
U Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( )
`4 Other—Type T e of Building ............... No. of ersons........._..........._.._._. Showers
a YP g •----•--...,- P ( ) — Cafeteria ( )
QOther fixtures ......................................gpt....................................................................•••......---.......................
W Design Flow...........J..1.�?.---_--_-- •--_---gallons persen r 4ay. Total daoy flow......... 2�.f�................gallPnst�
WSeptic Tank—Liquid capacity. Qgallons Length. .._(p..... Width.. .. ... Diameter................ Depth....
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No......... . Diameter....._ Depth below Total leaching area.z'(Slsq. ft.
Z Other Distribution box (N Dosing tank ( ) _
aPercolation Test Result Performed by.... ..r2....1e. :�.....__.,�................. Date.... _..g_7.......
Test Pit No. 1................minutes per inch Depth of Test PitJ... Depth to ground water..kv106.....
1.4
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
04 ... ----
------------------------
...
....
......--------•----------------------------------------- ------
V
W ------••---•---------..............................•...................................................................................................................................................
VNature of Repairs or Alterations—Answer when applicable......................................................................................0........
.................................•-----......-•-•--.•------------------•---.........................--••-------•-----------•-----------------------.---...................................•.............
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of 41TL U 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...M.4). !
�r Date
Application Approved By........ON V... ........ �
Date
Application Disapproved for the following reasons:.................................................•------•-----..---------------................._...._....._-
........ ......................•---...-•---....---•---------••---•--........-------••--•-------•-•-•...................---------•-•.............................••---...----.. . .....••••-••..
Date
PermitNo.....---- l 1 ------------------- Issued.................... .----.......•--•...............
Daatete
fy FR
•Y� t � �. r � '�` � -, �'.._.... Yip
Y-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
?),l�a„)1 �....OF............L.''-1/.�-0J,!�JT •.....
Appliratinn for Dhipoiittl Works Tontrurtion 11rrutit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage' Disposal
System at: .. I?' . -•......--
fLocation-Address I/ ///� `f,
J�/j,, 1, ��!G t I( Gt_( - /G7 ' c. ( ................G 1� r 11 � ;
--------------•-...._._.__......1._. ..... - .................... •-----_-__-
Owner / / A dre s •�•-
W tfS�!?(1 ! ..r.• !`Tf/E' rs_f,_C-lt (.�......................
............................... -.,...•-••--. ...........----....-•••
Installer Address
Type of Building Size Lot_./_7_/.3.z :..-Sq. feet
U Dwelling—No. of Bedrooms.............................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............................ No. of persons............................. Showers ( ) — Cafeteria ( )
Otherfixtures ......................................fit -.................................................... ------..._......_....__...----....-•----.....
W Design Flow............1•. .. ....................gallons per:person per Jay. Total daily flow........... f;2...............gallrons;,
WSeptic Tank—Liquid capacity.1/ llons Length.4e5_(c?._._ Width..�'..���.._ Diameter................ Depth..c_...L
x Disposal Trench—No- •................... Width:.............._.... Total Length....................
Total leaching area.-_......_.... ...sq. ft.
See a Pit No......._ .- .
pag �..... ..... Diameter Depth below inlet.._�a C__`:?_____ Total leaching area.2-�_�...sq. ft.Z Other Distribution box (�;) Dosing tank ( )
1.4 Percolation Test Resins, Performed by._..._..1.._.1r�:.....�a. _r Date..... !- /0,
(/ .... ..................•-•--
,� Test Pit No. I................minutes per inch Depth of Test Pit..,�.- � ..._. Depth to ground water. )l?�J ...-.
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
---�--••--......-•-•-----••-•--•-•--•-----•-•--••-•---•-----•••-•---•=-----•--••---•------•-----••-•-----•---•--••---...--•--...------•••.
ODescription of Soil.........:...........•--- - ..��_.__..........................................------------•----------•------------------------•-----------..._.........•••-••••...
W ..............................................................................................................................=.........................................................................
VNature 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 TITL- 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.
(70
Signed......-- 4b4d ---_--•--- -•------ •••-•-••••._. ....
Date
Application Approved By........ = ' _. ..�' -
Date
Application Disapproved for the following reasons:............................................................................................................_..
..................•-••---••••-••----•-----•----••....••••-•-------•-•-••••---•----•-------•---•--•------•......--•-------•--•••• ...•--•-••--••-•-----•-•-----•----•------•••-----•-..............••----
�� Date
Permit No..........7 1 Issued.......................
- .......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
?.......OF.......... .....................................
Trrtifiratr of Tomplittnrr
THIS ISTO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
y ( )
� �/ Installe
at............Z" r".. JJt --- t r ..c---------•------------------------------------------------------------
has been installed in accordance with the provisi'oa�'s of TIT ti 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No._- . ,�V-. _�4/....... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUN/CTION SATISFACTORY.
DATE.......................... __ ~ �"
-.._....._ ..........• Inspector , ).....................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD( OF HEALTH
C / L /... `?/� ec........OF..:...+i 3:Pa. n !!.......................................... F ]� 2
. EE.._...f
. :
Disposal Yorks Tonotrudion Vrrmit
Permissionis hereby granted_. ... �f�k_.................................................................................................
to Construct `(yC) or Repair ( )man Individual Sewage Disposal System
at No.........
/,:./�7.....� ............ %z�'1.....� t/n _..
L/ Street f
as shown on the application for Disposal Works Construction Permit No.�ra.��.__ Dated...... 1-�:...��......
•--... ..................................................
.....--•---.....••••••---••------•._...--•......._
.
DATE................. �'�� �--••---...•_--.----- Board of Health•------
-
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SCALE: 1 30
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SAL. Ew.44LIZEAS
..3. TONAI WA TER 01,V Sr TE 1
4. SOL HORIZONS TO BE PERFORMED DIST, BOX
CONCRETE X4PME
TO BE JN
A T THE TIME OF. ,EXCA VA TION
STALL60 OAt A �
*to
FORE-.rAlS TA L LAI TTom AND, BE LEVEL,,'SrABLE BASE,
SEP TrC TANK,
TRENCH L ENS TH
TO BE ZUSULLED ON A
LEVEL STABLE BASE
0 VER, SYSrEM 'ABOVE OBSERVED
-EQUIPMENT
NOTE: DO : NO T RUIV HEA V Y
OROUAV, JOA TER
-SEC TION,
L EA CHING ' TRENCH,
TO ,SCALE, �SOIL ,AND PERCOLATIOA�,--DATA"" ' '�:',','�,,�.- ,
FOR FINISH GRADE
SEE S YS TEM PROFIL E
'E
PERC, RA 7
-BY
2"MIN. TA KE AAMr
WITNESSED BY firmdAm
AMU
DA TE
L
MIN.2 118"-.112"
'.J:qM*,D Arne
PPE
4 mDiA rEsr ZLEV,
IYA SHEU STONE
NA TURA L SOIL-
'MAX.EFFEC T1 VE ON
r
-,DEPl7H_.
0 0
0
0
314
LIM.77.
SHED S TONE 24
it
HIN. '3.*
rl 2
EXCA VA TED SIOEWALL
E)�FEC Ti�E )VID TH
01
AL
r rV.
OR DEPrH ' 9LL
7-EFEC TI VE WID TH.
NUBER ,OF, 6�ENC YES
0 80
AV &q0lN*4 Tim
00,
PAacaSED (Pj
LEACHIA'S 7REACWS
4 lwrM VDEEP
28 11.OAAR
ISEE PROFILE)
SIGN" _DA TA ' ,,�
DE
zd
S. F. SIDENA L L AREA GA L SISF 89, GA L S. ,,.
NO.OF BEDROOMS
DrspOSAL -AA2-
224 S. F. BO T TOM AREA GA L 'GALS.
u
LS.
EST. TOTAL DAILY EFFLUENT-stso
NK SAL.
SEP TIC TA
480 S. F. TO TA L AREA
.........
LOT 131,
D 90XQ
70
&AL NERAL IWO T429
00 LO
SEPTrC rAW
M"COMPONENTS SHALL -:rlv
'NO TE.* ALL BE !NS fA L L ED
�S YS TE
54 1 TAR Y,
ACCORDANCE� WlTH� TITLE . OF ,,,ThFST4
EL E .71-0f!OR LOWER AS -REGUrRED
EXCA VA TE TO - v
ICABLE ,-,
DA TED :�AIVD ,ANY LOCAL PULE5� APOI
TO REO VE A L L D CLAY CONTA rNNO MARCH J995
HA TERA L BENEATH NE LEACHIA16 AREA.REPLACE, 2.: ANY CUA NGE IN THIS�PL A IV MUS T "BE,-A PPRO VED
AOPOSED x
aEDRoaq hSE pRiw.
EXCA VA 7E0,',VA TERIAL wim CLEAN.�,CLA Y.FREE 'ORA VEL T, OARD OF:HEALTH,
GAR. HE:-
6 �PRIOR :
Rk L 8SN'T NECHANrCALL Y ,COAPACTEO IN PLACE -roAt is campL TED, BA CKFIL
3. "�.'MHEN cmsmuc7 TO LING :,�:
NOTIFY, BOARD _04� HEAL 7H FOR,,INSPECTION
TED
-AlOT BE�� CHANGEb,��,WITIIOUY,
5. THESE EL E V MUS T
4., MD. EL E V.-HUS T, BE CHECKED, WHEN :COMPL
7q LOT 130 . .... L EGEND
WE BOA Rb',�OF, HEA L TH A PPRO VA L
j 6, 565-Sjr`�,:,
3.
TION, REG,"D ,'WHEN.EXCA VA TEDz�' ,lr
OAD OF�'HEATHNSPEC_
rST.-S L E
V.
EX4 ROUM E
84-
FZXTSR,SROLM EL E V.UAVERL
XNED,
.1,67. 77 SEAGE"DISPOSAL "SYSTEN
s 10'03 155 7Jv prp INVERT ELEV.
7Z 74 PREPA RED &Oj9
TEST PIT LOCATrON
�..'� �T 'S
U
OPEN, : SPACE ,,: 309 E
IRE
SEPTIC TANK THE N
P
0 A Y 't�"
rBurravax_� �:L,O-T: 130 �,:,;STALLI N
Cl DST
RNS TA E, :4 PC
X.0R,SCH 401P 0
4 PSI T.FIBER'Pi TIGHT iXINTS
OF
PROPERTY UNES
:DATE
y
SSOCIAIES
FERREIRA
CODE OrS T
'scA e AS,SHOW
NrN. A
"Tas
JVC.
R.�Nj� BARS�':ROA D'
ss'.'
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f FALMOUTH- - X
L*ED Vjl�tl
174 130
A P SEC PCL ]LOT.
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