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HomeMy WebLinkAbout0024 ALDER BROOK LANE - Health 24 ALDER BROOK LANE ` W. BARNSTABLE x A = 133052 a l III No. 4210 1/3 BLU UK, (2)mr J-1 SK 10'0 b o i �2v03-oN� Fee- ' 1 No.WL---_---------- -~-------- ----- BOARD OF HEALTH i-C TOWN OF BARNSTABLE —= Applicat ion for Vell Con5truct ion Permit Application is hereby made for a permit to Construct (�(), Alter ( ), or Repair ( )an individual Well at: _Z _ALpE K B&CO K L AOIE Vi• — �- Location — Address Assessors Map and Parcel FAUL P0'TAs —^ Po oX ',�23 _W-3AR►�t°f6_-L � oz(68 Owner Address �v� -R-- b -°-�LKAQs�MA 02.663 Installer — Driller Address Type of Building Dwelling .I N G^LrE Woos Other - Type of Building--- ______ No. of Persons---------------___ Type of Well porlk%Le A c�� p-- Capacity- CTPt—A Purpose of Well- 0'4SUm9-r10 — — Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until Certif'c .of Compliance has been issued by the Board of Health. Signed -— ���G�---- — mat 3 Application Approved By ------- !y -- ate Application Disapproved for the following reasons: -------- - ----- ------- date Permit No. "" — Issued--- -�',�-- ---------- dat BOARD OF HEALTH TOWN OF BARNSTABLE (t ertif irate ®f (Compliance THIS IS TO CERTIFY, That the Individual Well Constructed 00, Altered ( ), or Repaired ( ) Installer at—7-L� A LDE K i R,OO V, `L A OIE , WEST— I. ARV S-OA D LE -------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private We Pro ction Regulation as described in the application for Well Construction Permit No. 20&-bg57 Dated-9 Z- P3- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE Inspector-------------_--- —____ No.1► Q�—Q�— Fee--~5----- ----- BOARD.OF HEALTH TOWN OF BARNSTABLE licat ion,for Vell Construct ion errnit Application is hereby made for a permit ito Construct QA), Alter ( ), or Repaii( )an individual Well at: . ,_'Z-4_ �DE& t�RPOK L.AV3V _ - �33- oSZ — — 9 Location — Address Assessors Map and Parcel FAUL P OTAS fA PO I _W_3aRr IAWi E r i"-'A 0��6g Owner— — Address t �jFrrn6�© y�1F��bR.�u.-�tJ_C��1�1L 5 P•���1ER_R� _ 023 Installer — Driller Address Type of Building Dwelling Other - Type of Building—=_ '_____ y' No. of Persons— -----------_ Type of Well 1'o r�3�E �F�CE/jll Capacity— Purpose of Well—So SumPT►o►J Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until j Certificate. of Compliance has been issued by the Board of Health. Signed — dIt Application Approved By ------- 2 3 ate Application Disapproved for the following reasons: ----------- ---- — date 'd � I Permit No. "`� Issued — Q-3- --------_ , dat .r, ,, .,. BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ()O, Altered ( ), or Repaired ( ) Installer at_7y A Q& 3PO() LAnA_ , hlEST—bAPQS_?A_ L —__-- ----- H has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private We Pro ction Regulation as described in the application for Well Construction Permit No ? 3-- -Dated z j 0 ----- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-- - Inspector-_-_------------------------------- — BOARD OF HEALTH TOWN OF BARNSTABLE )Pell Conoructionpermit (A)2CO3-C4,5- 5 No. — ----- ----- Fee rv- Permission is hereby granted wK__Tm0Q[) WELL U�LLI NCT to Construct (X ), Alter ( ), or Repair ( ) an Individual Well at: No. At-D1`R 39j:10K. L(AQE WEST a(a2,M A F - - - street as shown on the application for a Well Construction Permit J No. W Zoo3—CX{$` _ Dated-- �t_`Z d ---------------------------- _— _ • Jam. DAT 2 G 63 Board of Health E — s Y 'T.,•,: y M, f } J .l t t 7 i' a+ .� _ r ..t _ 1 "d.'�...`G', f--.v:;n, h_- T:'" i' vc iE �!? vl �? i _, fir:+•c. n,f#�y �'a -T r•i� 'y'y •�.J� •.,' _"_r w - . lot 00 .. .moo = a ��� �� �►'era+. �,.+f.� + -: � �t �� �w � �d/� � � ' �r,� •- -' ' .77 -: '7' ram. _ -, +• �%- .y -.F4^p "_`, :�r, +' � i H`y Y-pY � ].,v t �.�. _ _ { F �i ,� - 7rP �Y Y��: _ <. g a *t _.� ;p �,'9, •� +,y �'f's..r . S' S i 2,cl L- ; ' .�•,�� ,.��c ir�`s f... c- ,: � '-��.r.��t�:-�.! It-� J.f t������_,�'� .!� r?.r -.,�. - # -,�A n� v � i .`s" -�,�J g .-,t -,..L ,b'�.. ''•K� _y A - '�5 �bs �'T.r � k •L�` t, ` ?T� .r. f F_l 4t i�l• . '. A; tom' \\\ { - '� - �• ,• l �; r `��.1 _ i �-F' a�s. 7 mot. ,w , 4' A- �.. - 1 !.l,�. �..` 'fir Fyn., �_}�. 17, {�. t5 ♦'�.i i '... `!1 .:s. .`. <^ `' 5-� 1 �' -* _ Sari• c"'� -k . T.., at -P�.t:.r yn� 5 - ��- i � ioIft iF '�7�VS✓� !W Mew •� � r - .. �+ �4 t _ _ C 1�7 /,'jvvan��i'Yc •. fx' '� .'' �,► ti] . iK[y{ ��sl �zil" ta .+ Nlop i., f Wr Z-�Y� r WOW AST— GALLON / `` G 'q. /4�Aw� .�.�/.f3 iy �/ . S{���j � �, •fit. ��• < _ 4'kJ�17 . . .. ' .. � v Mai hi sa L ASS. R.t ►4"t + "t� ea 'flv 5 Aro. rQn ibw F.. '> i Ti. ' P►NK:,, lay °.iE . fiok 1 .! C t ".�'#r �7: •r3E o f `� �� -� PA4., AXIOM IFSO , IF 1 4 �/��� �, /1M�' �Y •� -■+ r L�� �` r �y..e��.�r�,rr����a� T}�r��� � � •+'r"i� Cl7- 7 -O o -Hr�fir•�� �� 46 .� . !�/' - - - 5 - 5 2 I, —. .. .. � -,. ... r ._.- � r v - '>i - .. ._r � .F.�[,;+�� �� �•.,'t" ,g„s. .p lt..•.._ BSI{..Y- .... .. ..Kk .- i !�"/ •j LOCATION ���Ac � SEWAGE PERMIT NO. AR C VILLAGE 6 jt , Z 4-FN ALLER'S NAME AND, ADDRESS Tom( �Y' CL1A AA `7WfC H BUILDER OR OWNER H DATE PERMIT ISSUED DATE COMPLIANCE ISSUED — k• E4, e `U r No.. ....L1._QQ A(5 Fss......Cz THE COMMONWEALTH OF FBI MASSACHUSETTS EALTH 06 �� .Lc� ....... ..._.oF. ... ��.47W.V ............................... Appliration for Uiipnaal Works Tonotrnr#inn rprMit Application is hereby made for a Permit to Construct ( ) or Repair OQ an Individual Sewage Disposal System;a � ,...`... •- --------------------------------- \S . / d............... - •---....----..•-- • ......... c ion-Addres or Lot No. ............. :. .. ..... ... ................................ ........................................................ Owner ddr ss E w ------------------ -------- 5%. . �e '. - Install Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms----9.................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria Q, Oth fixtures --------------------------------------•••--•-- W Design Flow........ ..... .......................gallons per person per day. Totaleda* flow___..._........_.......__..._.._._........_.gallons. WSeptic Tank—Liquid capacity4/4' �9gallons Length_....... Width.. .__.. Diameter................ Depth�r�.."rDisposal 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........... ............................ aTest 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................ . ... ......c, ---- ----------------------------------------------------- W •---••••--••------•-----••--•--•••--•-•••--•--------------------------------------------------------------------------------------------------------------------------•--•-•-•------- --------------- V Nat e of Repairs or Alterations,Answer when applicable._.,fZ���4- Thea ----- "............................. .�° � .. --Agreement undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITLEE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been d by the bo of health. • Signed.-•-• .•••. -•---.- -._. at Application Approved By.. .. ... ...%�' .�.=:... / ...... ... .......................... Date Application Disapproved for the following reasons---------------------------------------------------------------------------------••-••--••-•••--•------•--....._ --•--•-•------------•-.........-•-----------------....--------•----•---...-•--------•----••---------•-----------•--•--••-----•--------....-----• / ----�------------------------.......... pr Date /...I' Permit No---- ---- ------- ----•-------._...... Issued.-----��---------------------•-------•----------- T Date ®.� - - --- - - - - - - --- ---- - - - ---------- -- - - -------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ------ .................OF.......................................... ,c ppliration for Disposal Works Tonstrltdion Prrutit Appli tion is hereby made for a Permit to Construct ( ) or Repair ( ) an In 'vidual Sewage Disposal Systemv�� ........... ..................... ..........:. .....& . ..--••••..... _... --• .............. ....... ..... o s o No. ......... ..... •.. .-. •. •........... .--t. ......._.......... .................... Owner Address ••-�'- a - ..... ...... ............•...... Instal Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................. ....................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers W YP g -•----------------•-----•-•• P ( ) — Cafeteria ( ) 04 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 ( ) 0.4 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --- ------------•--------- - --...--'......_.----.---••-•--------------------------.---------------- ...•.--------•---- O Description of Soil..............5h2,/�2 _ �. 1�G c., ......................•---•------------------...----------------------------------------------------------------•-. UW ----•-----------------------------------------•-•.........--------------•-----------......----....------•---------- ----------------------•---------•-- ---•-....... ............................ Nature epairs or Alterati gis—Answer w p le..... ._ ..._ ......... . -----....... , t - ------ ---•-•- . . . ...... ......... . ........ Agreement: The undersigned agrees to install the aforedescribed Individual Se ge Disposal System in accordance with the provisions of TITLE 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---..... -------- Date - - .._.... �& Application Approved By-- Date Application Disapproved for the following reasons:--------•-•---••-•-------•-•----•--•...................•---•--•-----------------•---•------...-----•--........_ --•-•-•-•................•----•------•--------...--•-•-................-•-------•------......------.......---.............----.....................-•--•--•-•-------------.......•----....-------•---•- Date - PermitNo...... ..._. ��------------------- Issued......................................................Date -- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �/..t,7 1(l.................OF...... ,-Fe ........................... (Irrtifira6- of Toutpliatirr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired _(/) by---•-------------------------•-•------------.------.---•--•---•--•--•-----•---.--••-------•------- ------..-..-------...._..... ................... - ...... ....... •i.�._ ller 08 has been installed in accordance with the pro�ionsof TITIFf he State Sanitary Code as eskT d in the application for Disposal Works Construction Permit No.._.....��..r-1 ..... ........ dated.__. J THE ISSUANCE OF THIS-CERTIFICATE SHALL NOT BE CONSTRUED AS A Gi NTEE HAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ . Inspector................................................................................... THE COMMONWEALTH OF MASSACHUSETTS �f�'nBOARD OF HEALTH 1..i K.�l.....OF....I .a� L ........... 6 No... Fn...SO..... Disposal rk To strurt' tt r it Permission is hereby grante ------------ ....-- . •. . ...............................................»..»_ to ConstruF�y� or air (� n I ivid r em ,�at No...__._4.. ...!......,o� .........., (J. r...w® .... .. !!.. . (''e Street as shown on the application for Disposal Works Constructi ermit �� ___ _. Dated . . .. ... ................. o �ltb G ......... DATE........ _/_ -•-----------------•..........._.. FORM 1255 A. M. SULKIN, INC.. BOSTON i 1 1.1V1'IXOTL:,CI.t.TABORA74RIF..S, INC. A1A Cl RT NO.:Af-.AIA 063 8I.an Sebastian Drive-Unit#.12 Sandwich A1A 02.56.3 508(888-6460) 1-800-3.39-6460 TAX(508)888-6446 CLIENT. Paul Potash LOCATION: 24 Alder Brook Lane ADDRESS: W. Barnstable, MA COLLECTED BY: Desmond Wells SAMPLE DATE 10/9/2003 SAMPLE TIME: NA WATER SAMPLE TYPE: New Well DATE RECEIVED: 10/9/2003 LAB I.D. #: 0310253 WELL SPECS.: 4V 507 8' RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Date Analyzed Limits Coliform bacteria / 100ml 0 Absent 9223 B 10/9/2003 pH pH units 6.5-8.5 5.37 4500 H+ 10/9/2003 Conductance umhos/cm .500 84 120.1 10/9/2003 Nitrate-N mg/L 10.0 0.05 300.0 10/9/2003 Nitrite-N mg/L 1.00 < 0.004 300.0 10/9/2003 Sodiu►ri' mg/L 20.0 ' 11.4 200.7 10/10/2003 Iron mg/L 0.3 < 0.1 200.7 10/10/2003 Manganese mg/L 0.05 0.440 200.7 10/10/2003 COMMENTS: Low pH indicates high corrosive characteristics. Manganese is not a health hazard, but may cause staining and/or give water an odor or taste. WATER MEETS EPA STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. <=less than Date .l v t Y`(1� >=greater than onald J. Saari TNTC=too numerous to count ' L oratory Dire or t. le tq .:s CRJUB RgF �k THE ANTIDOTE FOR CIVILIZATIOW" Massachusetts Department of Environmental Management Office of Water Resources R TYPE OR PRINT ONLY Well Completion Report 1. WELL LOCATION GPS (OPTIONAL) LATITUDE LONGITUDE _ 2y_ �} t�. . AW V— LAtiF pa�,1 Ia si. Address at Wetf,Location Property Owrier � ��. Subdivision,Name Mailing Address., . cc 3 Y City/Tiwn �(`j �rS s� e. - CiN/Town y Assessor's Map ' Assessors Lot# NOTE: Assessors Map and 'Lot# mandatory rf no street;address available~ t Board of.Healtty permit obtained Yes ... Not Regwred ❑ w Permit Number � Date;lssued u 2. WORK PERFORMED 3. PROPOSED USE 4.DRILLING METHOD [New Well ❑ Abandon 0 Domestic ❑ Irrigation . ❑ Cable ., Auger El Deepen ❑ Recondition ❑ Monitoring ❑ Municipal 0 Air Hammer �,❑ Direct Push ❑ Replace ❑ Other ❑ Industrial ❑ Other ❑ Mud'Rota -` ,❑ Other 5. WELL LOG Iz Unconsolidated Consolidated 6. SITE SKETCH (use permanent Landmarks with distances) W Permeability N T cts From (ft) To (ft) High Low U) U) 0 0 Other Rock Type "'rJ0 X x X - 50 51 x x x F-m c,« �. —5-1 —Go k xI I X YJ 11 LA 7.WELL CONSTRUCTION 8. CASING Total Depth Drilled From (ft) To (ft) Casing Type,and Material Size O:D. (in) Well Seal Type Date Drilling Complete $u '" y(o SWL4q, VC y t' ?I►Bess NAP%P, 9. SCREEN From (ft) To (ft) Slot Size Screen Type and Material Screen Diameter �6 56 ,oiZ '5TA1tir-E5S STEEL Hn 10. FILTER PACK/GROUT I ABANDONMENT MATERIAL 11..ADDITIONAL WELL INFORMATION Developed? EX Yes ❑ No From (ft) To (ft) Material Description ,` Purpose Fracture Enhancement? ❑ Yes E� No 3 t ` Method Disinfected? Ex Yes ❑ No 12.WELL TEST DATA(PRODUCTION WELLS) 13. STATIC WATER LEVEL(ALL WELLS) Yield... ,Time Pumped Drawdown to Time Recovery to Depth Below Date Method (GPM) `j(hrs'&min) (Ft. BGS) (hrs & min) (Ft. BGS) Date Measured Ground Surfac (FT) lo)FS o3 NTP�AP1 <Zo `FRS _c�2 /m►r��� —So /� 03 14:PERMANENT PUMP (IF AVAILABLE) 15.NAMEIADDRESS OF PUMP INSTALLATION COMPANY Pump Description Cloalbs.-'!UQ'Sp5 Horsepower 1�Z— l�G� �'O �tiIZ- � -1�1 Pump Intake Depth " `; (ft). Nominal Pump Capacity y (gpm) 5 �y Q& CI.�AUS t!i u't 53 16,COMMENTS „ \` 17.WELL DRILLER'S STATEMENT This well was drilled and/or aba Boned uncle y supervision, according to applicable rules and regulations, and this re) is complete and cor ect to the best of my knowledge. �'.� Driller: P �C ` ;a'��T�`n� Supervising Driller Signature: Registration #: Firm:� S� N W >l��- . (� C t , Date: /O /o Rig Permit#: 13 NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion. BOARD OF HEALTH COPY 2 L4 , LOCATION SEWAGE PERMIT NO. VILLAGE TALL 'S NAME AND ADDRESS v c�u ,--- 133 r l5 i(C, PARCFL NQ- U Sz -� LDER�OR OWNER W U ifZW SI-1 DATE PERMIT ISSUED DATE COMPLIANCE ISSUED o�. d e�j �, 0 f''� a' �.r. l ��. �� 0 0 �� ��, _.:;; No..... Fxs.... THE COMMONWEALTH OF MASSACHUSff °Tt s BOARD OF HEALTH ...... oGc., .......... 44,e�,r—kf aenC.......................................... ApplirFatiun for DiipusFal lVorki i (famitrurtiun .ermi# Application is hereby made for a Permit to Construct ( V/ or Repair ( ) an Individual Sewage Disposal System at: - Y y.......- ............................................................ Location-Address ai. or Lot No. ?4-V/ - g ✓%4Z. % ' t �4 .............. ....-••-••-•----••.......-••-••••--.••••- .� . , .✓s^,®�J .. ! ...P! Owner ` Address c30.)s41V Fi -emsu� Instal ler Address U Type of Building Size .......Sq. feet f Dwelling—No. of Bedrooms...............3__.........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria aOther fixtures ------------------------------------------•-•- w Design Flow................;:F-'_`__...................gallons per person per day. Total daily flow............. ....................gallons. WSeptic Tank—Liquid capacity/��4._.gallons Length... .G.._.. Width.l..lD.... Diameter................ Depth... _._.. x Disposal Trench—No:.......... ........ Width...g_.0_.._._ Total Length_ $.__v._.... Total leaching area_. 9.�_._._..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___.,V4j; P___<2 m.................................. Date......5 .•Z7.."91.........._.. aTest Pit No. L.G.L....minutes per inch , Depth of Test Pit.-- Depth to ground water----lo0.1/.--.__. sr f? Test Pit No. 2..C.z....minutes per inch Depth of Test Pit---- J�... Depth to ground water.....��.......------ . a. -------•----•.................................*----••---- OA� Description of Soil-------------------Q. ............ -...... 3so. -......------------------..........-•----------------•--------............--- W 26 p- ,O _ . W ?! -�O�H......y ia" 1✓.ATE!Z.... (� uNf"ti �r ....e*> ._/5?Z UNature of Repairs or Alterations—Answer when applicable............................................................................................... -- . ---•--••• -•---•-••--••----•-••••-•••••••--•-•••••••----------•-••••--•-•-•----•--•-•••-•-••••-•--•••••-••......--•-•-•._......_.••••• � `�gr�'/ -Th—e undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of AITL LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has e is ed by e oard ofg ealth.. Signed. ....: ....... ..... .. .---- .................. .....�> ` J D If Application Approved By......... t' '__ _ 1,l L -- - •- -•.......................... ----•-• f �Date ............ Application Disapproved for the following reasons:...............................................................................................................- --•--•-•-•----•-------------••--------------------•-----------•--•------....---...................................................... ---------------------------------------••--•-••--•--••......•-•--- Date PermitNo.....................•••...........••._........--••----. Issued.......................................................- Date No...._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH w. ........ OF..............4 cat.< .......................................... ApplirFation for UhgposFal lgorkg Tomtrnrtiun Vamit Application is hereby made for a Permit to Construct (14 or Repair ( ) an Individual Sewage Disposal System at K__52'NC�4!L...�i4: ....f�::.._57A/lnJS7.C ,ff ...................................... i i#" '.........---'---......................-- 1 - ��jj Location-Address f �f j� a or Lot No. f -UL. �vT.RS/�i!......... Cf u j== 4.,a."i l:e/ar,, ; /FJgo ems_,—.......................................... ' .✓ST,A�c��. .............. - ..........'- Owner Address W Installer Address dType of Building Size Lot. -vG'..r7.'__..__..Sq. feet 47 Dwelling—No. of Bedrooms...........................................,Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures ............................ . W Design Flow............... .....-................._gallons per person per day. Total daily floes......._._.•: 3a-.-.-..--.. ........ga�lons. 0: Septic Tank—Liquid capacity/.o?°..gallons Length_. -'_.G.._.. Width../��_.. Diameter................ Depth•`f_a..._.. xDisposal Trench—No.......... ......... Width... ...... Total Length.�'�.��.`�... Total leaching area.z.Z.!�.....__sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed .................................. Date...... 8� { -- ••- ••••-•--•--.... ,aa Test Pit No. 1.. ..Z....minutes perinch Depth of Test Pit... �� ��._.. Depth to ground water.._ZQz//........ rX4 Test Pit No. 2_.�_Z.._._minutes per inch Depth of Test Pit.../ - '_..__.. ''��� /� p p .. . �� Depth to ground water........................ --------------------- ---------- ----------- ----------- ........ '--------•---.---------------- O Description of Soil....................0 ir_3G•" `��'4,w e•_5�..�sv,..... .....•.......--•--•••-•----•-•---------•--•---•••. ........................----•.......w......=..-............------ •. -- ----------......------------------------..........-------- V W ......---••---------------------------•••--•-•-�Z• .��—/��i/......._./-iil/ ... .a.p-------6✓.a- iz... t/c�� -. .zT Vic' // ••--•- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... •------------------------•------.........-----•--------------------------•---••---•---•-••-•........••--•-••...•••••••...•••••-•-•••••--••••-•••--•----••--•........................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with ITT ^ the:provsions of : : : 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...................................................................................... ................................ Date Application Approved BYE : �=',°.-.y-�� ------{ �� ------------- . J ------•-----------•----•- G Date Application Disapproved for the following reasons............//------..........................................................................--•--•.............. ..............................•-••-••--•---••-.......•----••--•--••••--••.....••-••-•--•-••-••-----•-•---._...••-••-•-••----•----•-•-------------••-•--••-•-•---•--•---••-•-••-•-••----••-••-••.....-•--- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / n/............OF.........../�.9/z �v S' �9 Q.4 ........�............. ................................................................ Trrtif irFatle of (�1ampliFana THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (-,) or Repaired ( ) by....................••--................-•--•-•-••-•---•---•--•-'•-••-•-•-...................---•• •••------•-•--•--•--••-•••--•---••--•-•'•••-••--•-•....••---------............-•-•--------•.... Installer at_- _..�:5�..../�G c�£.'� /�ne.., C Sc:!G!V�..._....�J: �AtallcJs �iC is G_�•� '�//-.4.13.... ................................................ ........ 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 ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST AS A GUARANTEE THAT THE SYSTEM WILL FU CTION SATISFACTORY. J DATE..... l -�/L�•-•----•-•----••----•--------------------- Inspector. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .f 6,--1 A...........0F.........�!9z/✓Sr14.0G FEE....Y./y/Pt' �i��r�a��a1 nrk� �nai�trnrtirrn rrmit �� Permission is hereby granted.............................................................................................................................. _.. ` to Construct (t/I or Repair ( ) an' Individual Sewage Disposal System at No.... #`' ----•/!6vr�......J6,Koa� 64,v4. �✓_,.. -c,✓sT.o rc .......... .3 5 Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... .f1 ----------, wr--------- -----------------------------•----- DATE .........................................••......... oard of Health FORM 1255 HOBBS & WARREN, INC., PUBLISHERS ,. Permi.t; Number:. Date: Completed. by HIGH-o ROUND-WATER LE.V.E;L COMPUTAT l'ON' S.cte. Location:' L OT 09 4fe c.3v­a LK• _ Lot,, Noy:.. - Addi-ess Owner: Air - Contractor:, Address.:: Notes 1 aa STEP Measure. depth to water table U' $•� to nearest 1/10 ft-: .....,. . . . . . .... . . . . .... . . . . ... . . . . . _`/lG/ .� date STEP 2 Usi'ng Water-Level Range Zone _ and Index. Well` Map locate site and determine: A) Appropriate index well . . . . . . . . . . . B) Water-level` range zone . . . . . .. . , . to STEP 3;} U n.g.;; rrionxNl y report"current Water'` Resou.r.c.es Cond:140' ns" de�e x;ne, 4u:r.-r�entl pth= to�: 9'7.G . wa.te'rAeveV fcir i ndex weal' . . ... . ..7 '81 _- _ w mo yr STEP 4 Using. Table of Water-level i Ad-justments for index well .� (STEP .2A , current d pth. to ` water level for index well (STEP 3), and water-level - — zone. (STEP 2-B) determine 1. water-level adjustment . . ... ... . . . . . . ... . . . . . . . . . . . . . . e . . . . STEP 5. Estinate depth to high water by, s.ubtract'.ing the water- leve-l: adjustment (STEP 4) f r.om' measured depth to water t•g 1 evel at s-i to (STEP 1} . . . . . . . . . . ........... . ... . ... . . . Fla - �..�w.� _ `Af .ram ����� �rr_..77'T:,•�y.� -r��• �' �` - . - po 1 { Ull Ctf1t i • Aof Aj y +43 _ ..� Ate .00 .itb7/�1G t 6S. Ql f f A-1 s f Pi _ sit 337 . - .. v/ .may '.' 'z r� C. :_.. ❑� "'c7. �M. ''f'Cf : c j Q' sW+�r�.I1i0�''J� ' � fs� - - '�,�" trI �!� - 6✓Rc;..ra.� Ge,�77►"' � _ ems.�' Wo - "� D.14 ! o L '1'acRM v C. -. Pax �a� ., Jul --� _ 5'T`ot+4 . �_ '��.� 'GiT ''�i' trt. �.0 ��f��.` . +�'.- -" r, •�r 9P•l,C�,r Irv. `o �►R�Cj a: - .. , y YJdtI' air � V r MIMI ... .. • - Frrr,�{•a. r. .k 4•.+"n1 Jl .. IA , � �, CONFORM. -ro- "THE 'MASS, AL Nu RE4 �aGD 7-1-17 ^C RONMeNTAL COPS, I=r . �"1 ." 1 1� .. '`�.pyc a r Tt? S� frTi+G.-fi��l tl;aTR1 ot 'iiC�f`! '�. �`f� JRSQ, _ / l0 Vie+^'�.k 1M6:. �T 'rO +"+ L6+r•� • CA TPA 4/r� ►rI may. ./► j�� ..... �..� '+.—. ' ,T� � rVrT ll' �� ��'.���-��\7 • �. 7 �w'�� �� -. 'r ' 7'+�i. �1.!��I ! _ [,p��/./!���� •��1�1 17 N CWVS ;. W4-zr ' �K r_ a : TA4_1je- ZAP Ael. el e6 Pl u � k a4- ENGINEERING claRs, DESIGNING BUILDING INCA Y'r �#6PLT _ A6944 ' A - DENNIS, MASS. 85