Loading...
HomeMy WebLinkAbout0025 PLEASANT HILL LANE a � ��asar�"�'�" �1 i � � �� ry- --- - _ -- _-____- . ----- I . ; 0 TA 1- IN _ 5 INSULATION der El N -.A DEASs t:;5 SPRAY FOAM '3T15 DED T BATTs uuiiexs iNSU/ATMN °CIItIN05= 1-8OG-696-6611 "Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date_ Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner . O�Property Address aVillage hi�Nt 1�14�VZ 'r oG S 1"1'eaA���- ti-l�� {SOU- � T��VfN�tl► S �2fMn(k--kk 6 1-C) ITS 3 Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ) (�) (00 ) Slopes ( ) ( ) ( ) ( ) ( ) aFloors Walls ( ) ( ) ( ) ) ) Sincerely He y E Cr , President Ca e Codn, Inc.- TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map_ Parcel �"`3 dOZ 15 plication # Health Division ` Date Issued Conservation Division Application Fee Planning Dept. Permit Fee 1 Date Definitive Plan Approved by Planning Board Historic,- OKH Preservation/ Hyannis Project Street Address "/-Zi Village ry�Uto/� JOwner d-2o�,:�c es �,g /� - Address ./ Telephone cf—77,f' ® Z 3'4 Permit Request ,T� —/�—ZlJ ��7T��� �'���/i 5��✓.�� i, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 14 1f00, 6 Construction Type /G.! Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Ll"' Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes QlNo On Old Kings,Highway ]Yes'-_-' LJ-No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other ; Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) ' Number of Baths: Full: existing new Half: existing new c Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing _New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ® new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION w (BUILDER OR HOMEOWNER) Namet'r� Telephone Number Address /� ,�G�/`�✓O,�i �� License # /�D �;4rli U Home Improvement Contractor# Worker's Compensation #h_1d ,6 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 4 o v SIGNATURE DATES//� FOR OFFICIAL USE ONLY t APPLICATION# { DATE ISSUED MAP/PARCEL NO. F S ADDRESS VILLAGE OWNER ' DATE OF INSPECTION: s FOUNDATIONS ' FRAME INSULATION FIREPLACE E ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL F GAS:- :< ROUGH FINAL F , INAL BUILDING 1 r DATE-CLOSED OUT- . a ` ASSOCIATION PLAN NO: f 4C E 1 lc � S 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration ^-wa'; Registration: 153567 c Type: Private Corporation r h 1 Expiration: 12/15/2012 Tr1P 206433 CAPE COD INSULATION, INC z' t HENRY CASSIDY t ; 455 YARMOUTH RD. HYANNIS, MA 02601 3'' '_ '--.Up date Address and return card.Mark reason for change. r Address Renewal Employment ❑ Lost Card DPS-CA1 io 50M-04/04-G101216 of ice o-�``��umerAtTairs us ne Re ulption License or registration valid for i❑divide! ase en.!y HOMR � lt� before the expiration date. If found return to: _ Registration: 153567 Type: Office of Consumer Affairs and Business Regulation Expiration: 12/.15/2012 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 - OD INSULATI_-ON 1,NC_-_ HENRY CASSIDY 455 YARMOUTH x_..2, HYANNIS,MA 02601 Undersecretary AtKalid ith t si tune F MASS11chusetts-Department of"Public Safet% Board of 1364din�g Regulations and Standrds a '' �. Construction Supervisor License License: CS 100988 , HENRY CASSIDY 8 SHED ROW WE%T.YARMOUTH, MA 02673 'r`' , itl�9 Expiration: 11/11/2013 ('umm11,14ncr Tr#: 7620 r f [UiL I M No, 1605 P. I Client#:4597 CCINSUL ACORD,,, CERTIFICATE OF L SILITY INSURANCE DATE(MMIODMYYY) 07102/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION CANLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT APFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONS]I d U-rE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder ie an ADDITIONAL INSURco_file policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subJoct to the terms and condltlons of the policy,certain)policies may reyUhU Lill endorsemenl.A statement on this certificate does not confer rights to Ole certificate holder in lieu of such endorsemenl(s). PRODUCER NAME: Mat' aret Young Rogers&Gray his.-So.Dennis PHONE 509 760-0602 FAll —� 434 Route 134 ac No. o Exl: we Na: 077=fl16.2'156 E-MAIL South Dennis,MA 02660-1601 508 398-7980 - INDURERID)AFFORDING COVERAGE NAIC 0 INSURERA I Peerless Insurance 18333 INSURED - INSURERS:Evanston Insuranco Company � Cape Cod Insulation Inc 455 Yarmouth Road INSURER C:Atlantic Charter Insurance - — Hyannis,MA 02601 Ul3URERD:Commerce Insurance Company _34754 INSURER E: _ INbfJRER F: COVERAGES CERTIFICATE NUMBER, _ RPVISION NUMBER; THIS IS TO CERTIFY THAT YHE POLICIES OF INSURANCE LISTED HEI-:_'YY NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDFICINOF ANY C014TRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH 111I3 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE VFOROEO BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, R EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN P.1A)' HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EI( POLICY NkImLER MMIDDNYVY MMIODIYYYY LIMITS A GENERAL LIABILITY CBP8263063 0410112012 04/01f201 pEAACCHAOECTCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY p��GMISES a occurrOcn� $1 UO Ol)0 CLAIMS-MADE OCCUR .IVIED EXP(Anyone pereon) $5600 PERSONA4&AOV INJURY $1000000 GENERALAGBKOATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PhR; - PRODUCTS.COMPIOP AEG s2,000,000 POLICY M PRO LOC $ p AUTOMOeILELIABILITY 121VIMBCKVMK 4/0112012 04101/20lj CEOMBCDSINGLELIMIT 1 UUU UUU ANY AUTO BODILY INJURY(P.,Pcron) ffi ALL OS X SCHEDULED BODILY INJURY Peracarcien( s _ AUTOS AUTOS ( } X HIRED AUTOS X NON-OWNED AUTOS - PROPERTY DAM (k $ - 9: H X UMeRELLALIAB OCCUR XONJ453512 4101/2012 04/01/201 EACH OCCURRENCE $1 O0O 000 EXcESti L.rAe CLAIMS-MADE AGGREGATE $1 OOO OOO DED X RETENTION 10000 - $ . C WORKERra COMPENSATION WCA00629JU1- 6/3O/2012 Ol'>13O/2O1 X WCSTATU• OTI* - AND EMPLOYERS'LIABILITY ANY PRgP{2IE7O{�Pq(y7NE / ECUTIVE YIN E.L.EACH ACCIgkN1' 1 OOO OOO OFFICEWMEMBER 6)(OTUo �� NIA J (M in NH) It Yee, - EL.DISEASE-EA EMPLOYEE $1 OOQ OOO lose daecADe�mda� -- DESCRIPTION OF OPERATIONS Unlow _ E.L.DISEASE,POLICY LIMIT 0,000,000 T-F . DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VE141CLES(AUaah ACORN 101,AddDlua l RBm 6k scheaulo,11 more Space le reNulred) "Workers Comp Information"* Included Officers or Proprietors Certificate Holder is InClUded.as an additional insured undOf Goneial Liability when required by written contract or agreement. CERTIFICATE HOLDER CANCELLATION Cape Cod Insulation,inc SHOULD ANY OF THEABOVE DESCRIBED POLICIES aE CANCELLED IIEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVI51ON8. AUTHORIZED REPRESENTATIVE 4 618E -2010 ACORD CORPORATION,All rights reserved. ACORD 25(2010/05) 1 Of 1 The ACORD name and logo are regislered marks of ACORD #S83849/M83848 MEY i The COmmolY 1 vi:dih of Aissachusetts ,., Department l Industrial Accidents v W Office, t l Investigations 600 VVi;:'liirigton Street Bosl,, il1A 02111 WYVII .,; :ISS.gov/dis Worker's compeusatioti Insurance Al'titl.,,it: Builders/Cofttractors/Electriciaiis/k'NuYi>tber5 pplicant lnfortuatioll Please l't'uYt Legibly Ibly N,uuC (Liusiuc;s�lOrganiz�tlioti/lndividu�ll 1)iJl�zllr/lil.): _yet�k? Phone#: 43 ." ?� — are you all employer? Check the appropriate box: Type of project(.require(l); I. UN l ant a rntployer with_ I an)a ,rnci: l onttac[or and I have 6. New construction -tea-- rutployces (full and/or part-time)." hired thy:;iih contractors listed on 7. ❑ Remodeling the attacitc,l hr:et.1: I am a sole proprietor or partnership These suU.,.,,nu:actors have 8. ❑ Dernolitioa aucl have no crnployees working for employer.,nna have workers' comp. 9. ❑ Building addition Inc.in any capacity. [No workers' insurance.-1. 10, ❑ Electrical repairs or additions comp insurance required.] 5. We rue;I(:oi pot [ion and its officers 11. Plurttbing repairs or additious I II:I�,�;.�ercised their right of ❑ a hunleowuer doing all work exemprton jwt VIGL c. 152§(4),and 12. Roof repairs myself. [No workers' comp. we have• n„;mployees. [No workers' 13. Other / insurance required.I "I comp. in ur:rn,_e required.] iC( l t'('I ZGl 1lJ F 'Any applicant that checks box #1 must also fill out the section below shoo iu;iilcir workers'compensation policy information. I tuuiruwncis who submit this affidavit indicating they are doing all woa.,u,i dkoi hire outside contractors roust submit a new affidavit indicating such. iVoll ratios that check this box must attach an additional sheet showing the r:rn::of the sub-contractors and state whether or not those entities have employees.II flit sub-cunlraclUrs baVe c[npl,)Y65, they roust provide their workers'cony, I,:d�;y number. l tan an employer that is providing workers'compensation i)i,%m uitce for my employees.Below is the policy and job site irt(aruuttiort. Insurance.C.ompany Nante: A tl a in�LLh ( :_L 1 62AC_6> Pohc:y rl ur,Self-iris. 1..ic. #: 612CA 0 Ll 5-C�, Expiration Date: .lob Sitc Address: . City/State%Zip: Attach a copy of the workers' compensation policy declaration pago(shuwing the policy number and expiration date). l ailurc to secure coverage as required tinder Section 25A of MOL c. 1 i 2 :,in L;ad to the imposition of criminal penalties of a fine up to$1,500.00 and/or our-year iutprisunnrent,as well as civil penalties in the form of a STOP 40 ikK ORDER and a fine of up to$250.00 a day against the violator, be advised Ittat a r'upy of this statement ma e forwarded to the Office of lnvestigauk.u,of the D1A for insurance coverage verification, 1 dMherec nder the iris and penalties oj'perlr;l v that the information provided above is true and correct. Siartalurc: __-.- Date: ` official use only. Du riot write in this area, to be completed t,t�Cav Or town official City ur'l'uwn: __. Perinit/License# Issuing authority (circle one): 1. hoard of Health 2. Building Department 3.City/'fm n Clerk 4.Electrical Inspector S.Plunibitlg Inspector 6. Other Contact Person: __-- Phone#: f TENANT/PROPERTY OWNER/AGENCY WEATHERIZATION AGREEMENT 1. The Parties to this Agreement are the following: tLisp, me��u 7i (hereafter known as Tenant), (print your tenant's name)) Doi o tf'°Z o,,+j o-L (hereafter known as Property Owner) (print your name) and Housing Assistance Corporation (hereafter known as Agency). In consideration of the mutual promises hereafter stated, the Parties agree as follows: 2. The date of Agency's signature will be the effective date of this Agreement. 3. Property Owner and Tenant consent and agree that the Agency may do the following with respect to the property located at(street, town) l6 � unit# and currenby leased or,rented to the Tenant: �— a) Enter the premises for the purpose of performing a Weatherization inspection. b) Enter the premises to-perform Weatherization work which the Agency determines in its discretion is necessary and appropriate as a result of the Agency's inspection of the property and in accordance with the appropriate priority list for the type of dwelling. The Agency and the Agency's contractors may also enter the appropriate common areas of the building for the purpose of accomplishing the Weatherization work. The Agency and representatives of the Commonwealth of Massachusetts, Department of Housing & Community Development(DHCD)may further enter the property to inspect any and all work hereunder. The Agency will provide reasonable notice of the timing of the Weatherization work and inspections. The Weatherization work will be performed in accordance with the Property Owner's consent as further specified below: *** INITIAL.ONLY.ONE OF:TH,E:E.OLLOWING*' z r;. 1 consent to performance by the Agency and its contractors of any Weatherization work determined necessary.and appropriate by the Agency as a result of its inspection of the property_ I understand that the Agency will provide a detailed statement of the actual work performed and the associated value at the completion of work. I will provide a separate consent to performance by the Agency and its contractors of Weatherization work following my receipt of the Agency's inspection report and a statement of the estimated work and associated value, J This additional consent will be sent under separate cover as Attachment A. I ;» understand that the Agency will provide a detailed statement of the actual work performed and the associated value at the completion of the work. 4. The Property Owner understands and agrees that any and all work, including related repairs for which the Property may also be eligible,will be performed at the Agency's discretion. The Agency estimated completion of the Weatherization work by the end of 2012. 5. If the Property Owner is required to make repairs to the property prior to the commencement of Weatherization work by the Agency, the Property Owner will be notified by the Agency and will be required to make the repairs as soon as possible. Exoept where the Property Owner receives a written extension from the Agency, time is of the essence in the performance of repairs by the Property Owner. r 11. For breach of this Agreement by the Property Owner, the Property Owner shall reimburse the Agency in an amount equal to the cost, as certified by the Agency, of the Weatherization materials installed and labor performed on the premises, as well as attorney's fee and court costs. The Property Owner may also be liable for damages to the Tenant in accordance with applicable law; in such instance, the Property Owner shall reimburse the Tenant for attorney's fees and court costs. Without limiting the foregoing, the Agency may at its option terminate this Agreement, by providing written notice to the Property Owner and Tenant, in the event of breach by the Property Owner or Tenant. 12. Performance of the Weatherization work hereunder by the Agency is contingent upon the availability of funds to the Agency from the commonwealth of Massachusetts and the federal government, as well as-the eligibility of the Tenant under WAP program requirements. The Agency may terminate this Agreement, by providing written notice to the Property Owner and Tenant, if the Agency determines that the unavailability of funds or ineligibility of the Tenant warrants termination. 13. The Parties acknowledge that this Agreement is under seal. It is intended by the Parties that the Tenant or any successor Tenant is the intended beneficiary of the Agreement and shall have a sight of enforcement. QM91-0=1- ill t Address: 20 `A,4, Tenant Signature Date Agency Approved Weatherization Company JJ All Cape Energy Caliber Building & Remodeling Cpeod Insulation Cape Save Frontier Energy Solutions Lohr& Sons Resolution Energy Agency Signature Date/ _C z— •.��}. 1 n .,� �' "` � 1 C' �. .: ;}.. ik f;"'+. '- �--�'_.'K. °:*C .r'r�a: '°'k r T�•�+��. ✓; 97' { ' YY`� yyF:.`Yw�' X #�...-.y...�'. ,-,lrr"`r.j} �,,.<.i:^nFu? rr •�(�" y�• .. �! �iS• �� T'1�+' c.. ^'ti'0-r' � Assessor's office (1st floor): �YNET 0 0♦ Assessor's map and lot number ............. . .... ....�"�..'.��...��.. Board of Health (3rd floor): .4 fO Sewage Permit number ................�.... ..T.. �--'. ,.":1 i BABISTAXLE -Engineering Department (3rd floor): 'oo "6& House._number ....................................... 0 ppY 0r' APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE -/h�a-­�(-BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...........Move dwelling......S,i,.ngle family............................................... TYPE OF CONSTRUCTION Frame / ................................................................................................................. 1`*1 !.......................... April---4'-...._19........ 1. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: � Pleasant Hill Lane Hyannis, Mass Location Y Privaee dwelling ProposedUse ............................................................................................................................................................................. 't ZoningDistrict ...........R$........................................................Fire District .......... uair.4.g..................................................... Name of Owner Lisa DaLuz.......................................Address sL Nameof Builder ............Li...a........Da...uz L....uz...................................... ......................................................:.:........................... Nameof Architect .......................................... .......................Address .................................................................................... (. ...........Number of Rooms ......4................ Foundation .......Concrete..................................................... Exlerior ...........`�te.A.sbestos siding Asphalt .......Roofing ........... . ........................................... Floorsarpet......................................................Interior DY;VWall................................: Heating Electric Plumbing .........................one. bath ......................................................................................................... Fireplace None.................................................`................Approximate Cost ......$a:$, OQQ.s............................................. Definitive Plan Approved by Planning Board ________________________________19________ . Area .....88.0..sq. ft. Diagram of Lot and Building wit Dimensions Fee $39.75_ SUBJECT TO APPROVAL OF BOARD OF.HEALT .M OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .................. Construction Supervisor's License :......:.:::.............. DaLUZ, LISA A=308-263 i' 29179 MovejDweling No ................. Permit for .............. .... Single Family Dwelli................. . ......... Location ...Lot 1�1�. 25 Pleasll Lang: r ........... ........ ..................HY.annis............................................. Owner .....Lisa DaLuz ...................................................... Type of Construction ......Frame ............................................................................... Plot ............................ Lot ................................ Permit Granted .....Apirl 10, 19 86 Date of Inspection ....................................19 Date Completed ......................................19 T 141 Assessor's offieb (1st floor). 1, `$TALLE® 114,COMPLIANC FTHE TO Assessor's map and lot, number ........................ 6 �o �`♦ Board of Health Ord floor): _ "� WITH TITLE 5, o > ENVI� MENTAL CODEX r Sewage Permit number .:............ ....•... ......•••••• ••• JARISTADLE, S Engineering Department (3rd floor): i ���� ���`� vo �9• ♦� ' ;I 7 r p t6 9 House number •.................................... '°�orrara� APPLICATIONS PROCESSED,,8:30-9:30 A.M. and, 1:00-2:00 P.M. only A P P F. 0 V r D r B rnsta'ile Conservatib.1XVT OF B A R N S T A B L E ILDINGINSPECTOR &rod Date APPLICATION-FOR PERMIT'TO ...„•.... Move dwelling - Si ngle family Frame TYPE OF CONSTRUCTION .......:.............................:............................................................................................... ' ............... ......April 4, 19 86... ...... .- .�: ' _ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: LocatioAjPleasant. . . ...Hill. . . ...Lane. . .......................Hy..a.nnis. . .,...Mass. . . ... t°............. . ........ . .. . . . .... . . .... .... . . . .. . . . ............................................................................ r Private dwelling ProposedUse ............................................................................................................................................................................. ZoningDistrict ............ .........................................................Fire District ..........13yan-ni:8..................................................... Name of Owner ..........Lisa. ...DaLuz. ..................................,.,..Address ...... . ........ . .................................................................................... Name of Builder ........Lisa DaLuz..................................... .Address .........a .................................................................................... a r Nameof Architect ..................................................................Address .................................................................................... Number of Rooms .....4..........................................................Foundation .......C.Qncre.t;p...................................................... Exterior Asbestos...siding..................................Roofing .........AsRhalt............................................................ ................................ . . . j' FloorsCaret..........................'. .Interior ...........Drywall.......................................................... Heating . ....Electric a Plumbing ...........nne..bath........................................ ........................................ ..... Fireplace ..................NQA.P.........................................................Approximate Cost ......$18.,000............................................... Definitive Plan Approved by Planning Board ----------------------__________19________ . Area ..... sq, ft............... Diagram of Lot and Building with Dimensions Fee ........�.39..75.....................:. SUBJECT TO APPROVAL OF BOARD OF HEALTH a OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... .. ... . Construction Supervisor's License .. ...... ...................... Rom— Yy tiYr DaLUZ, LISA y, w '•`" o ,.2g179.4 Permit for`...MOVE1DWELLING•„• t . t , z. Si. le Famil Dwell Location .....Lot #1 j ..z ..P1 aS x>1~.. 7]J..Lane ............Hy.?Rlzv..L� ..... ' a Owner Lisa DWUiz' Type of Construction "''Frame w, .................................................... Plot, .....r ................. Lot ................................ ` t r " r Permit Gran.ed 19 86 Date'of Inspection 19 Date Completed ........... :... .... .............19. f . 4 k ' R. 2'5 Timber bane al�eret®P. We Aa=atable�.. l�oea�achutone mill.) Ph�e 428_2592 02668 OBSERVATION HOLES, LOGS 6 PERCOLATION TEST RESULTS . LOCATION: T_ION: ° DATE: 6V. ` TOE/VILLAGE: `— OWNER OP PROPERTY: INSPECTOR;! APPLICANT: BX_HOE o HOLE SIZE PERSON MAEING TEST: ` HOLE SIZE LOCATION OF TEST HOLE b PITS: Reserve Area Available Yes TEST' HOLES ® �i® Test Hole s Soil Lo NNO,.2 ve l ) in Prima and 9 Perc Test. Soil Log Reser Area ® Results o y Yes ® Noo 2 ✓ .� � T©� :SQ��• i (l Remarks : 4 I 3 / 1.' 1q i Subdivision Name: L i`J ro �h]c;�v1vT2yi2�� r 3 04 SUITABLE FOR SUS SURFACE SEWAGE _ Field SUBJECT TO APPROVAL BY �5 THE GOV-•. ' Trench ® . Chambers (� � ERNING BOARD OF HEALTH Pits Galleys. UNSUITABLE FOR SUE SURFACE SAGE: Reasons Site Plan Sketch Over ' . ' i , _ f ''»t (4_ , y•.V.. ';' �k { ',w 5,h f'i•+, S 4 r. V 0 I L L O M "fs , A 'N' ' y „ R r' r i , : ' r N 2TG SITE P L 9 ,y j+ t �' " 9 Y.,"e!! p �A,pJ is` ' .,sn. ,-;t3 y t ''fir � '•'"' >, :ram y r Vv,; i y .f t .x` ., ,,.: - ., -. ;:: „ «. -: ,,, x ., S ry r".•... Ate' l, F .d S ..- .t.g..: :::4',=f• ., ;,;,.....e d., ,i _...•. rho, wS# t-. � ,�.. '✓I r% die. i` D TOP FOUNDATION EL , ___::_ _> l a h 44 J 9 D• 10 I N E t 9 s -- IN.EL ` iN Et t 8 f t; MEN ! LWEL = t� ID!B WI6" SUMP �q W s -rx)o r. 14 M D EpT #4 q Add PERC TEST RESULTS ; o-_a. ti _.a �..�— — ,f—__._ 00 , PRECAST SEPTIC TANK WITH C HA _ � r 6 P E[� T CAST IN f ACC. I141LET AND , ; Lis ��� + WHINES ED 0L . � .,G� E uOUTLET T S' � % .__... BOARD I HEALTH ` S 17 E : I o fl o L, ''. t-� :� �---- �, I - - D AT E . P` v { t3 - - ITz- A , jJt w Rf q . y w _ y ai. •G ,Er. Y,µ r ,,. ,., yz, g i v' . 5 ,..,'�` x,;:,._ ,r`µtct:r. -: . - .•+q ..-. ,,.,_. :_ +i(,rK;J. ., sl . w. , 1 'ti'tDa-tom ; C. pPe i I L �,. OF u ' ED SEWAGE SYSTEM EE _-ram � _ _ =:_ f REG LAT €0N AND � SYSTEM DESIGN� � BY THE. T01� � _ -� r _ U S - STATE TITLE V >} DR SUBSURFACE : ";'0 0 S A L OE SEWAGE SCALE ' 1/4 - 1 Il � � 1 ` 1. ALL PIPES SMALL BE SCAK01II,.E 40 P,V.C, SEWER PIPE 2. ALL PIPES pHAL ! RL a,OE'EC 4 ER FOOT E CEE°T IOR THE f ! RS I EEC 0V Of I hE C ! B WHICH SHALT. BE LEVEL � �(, � �\ +�n• `l r� q � , .,; , i � . ' � - .. GALDAY PER BH :� GAL/DAYa� `-` Z, E J . PCS1, G�� FL 5W _._fie= _ ' CbR+.' � t _ G -i 1,, �t- `� . • SEPTIC TANK SIZE _Z �__... ' GAT., USE . ' .__ G AL. WI GARBAGE DISPUS A I ILA €ItN SYSTEM: USE - fig ' v �_ _ w' AREA : SIDE r:r s BOTTOM TOTAL F �.�.� � TOTAL RE D ` L0W ' � ' X __ _..._ --__ .. ?-- ---_ W!- ._��. GARBAGE DISPOSAL RESERUE FLOW 3qt rV L p. G L.._ ••---� +1 1 J 1/ � ( �, . _- '_.. Lam• /�': 't 4 y 91 REFERENCE PLANS «J iL t t -A al�c2_a/�`�i� h SAP O'�: Lo G- so 3, �. f .' T E, { r APPROVED B I . � BARD OF HEALTH RATE N z ' S17E /A, ;l � Ac3f- � -AN R0PERTY W ER : y`� .S �'v �` � } ' E ,fi �, ,� �' 1 � Leh �41.► !l 40 } A > n ' r r� - , c s w AA. : .,-, ,:. .�,�t ''„, .. .. ,..,. n:... ..,. ter .a1 =,• +iRr.. ' f:,,,. s a1: ;�., `.r , ., .,y . .. '�. ter, _. . .• , - . ,, ,,,. . . ,-. ,:+; k- r t " _, y« -'4.s. . a ':: ,. 41Cr' 7 p, ::X� '1�3� + :TTf,•,y !�Yy;