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0012 ENTERPRISE ROAD - Health (2)
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S.. .x/"1 �` ,Z' t` Kr S^• f�.3 •,i 'it'•t ` •q., F, i ::a! rc� � t t"'• na< ~B-z,; t�'� �. ry ! , r � - `r, a r . C �' P � i#"h � �iA• t: i af'i* ;,z' t^,F F t`�'a1 5 �ac+, p � f ; r +. 'r � '*• Y � w. � Y... _ e t r • ,4, �,r �j .r. x i..+.9i*F �h �. s ,L f `" a :• a ;,_ .ras 14 K'Ff,lam',(� € a •^r t •if - �h* t.,1.. �. x.,.1. 4.r+�».P; Y'���.� 1 *"� 'Fi .se'� tf �',r ♦'t:'t",i^Yzlr'`Ji..,;f+ 'p�?,* rhy�$'A:�s�wv��` , �♦• +, 't r e 19 19$6 t W, • , Jun �r=% mar he;, y i.s i�. x •.Y.,.v.'f t °s `4 ry' ."yea NirA�, s ..a, �.,, 41'.. 4„ #r r'� ,r • Y7:•;, iJ. .cY � t <. a :+•,,s `- }' S- p ?.. �. Y4 �t ti. 4y °^f i' R r ' .•kr 4.f., .,.c ` hi ''t ; r 4`• ?•arX`" `'a,s 1^'ip .r3' " r:', `" ,',.w. K:; J'o s•,.Yr �� y,,;;. ?Yr'xr ''mot e i r ' � , „_ •f.,' rT .rp t ..�p,.e e'� i} p- i r r ;� � ' p.F+ r" L 2 ,a � � Xi �. a f L � i t}, `.M i . r♦ : k r .,,. � •r g. #:.i ',a p a'"-.r� � k,'. � [ ;n' ��t' i .,Si �ii, r ism r ,r• r,. 'r•, r " `t �. , .r._ , r -•.* ? vc.� �.�r 4' r.. 1 Z t. / L '6 i t t a'4 .'r.4 4 J S F a y i a�•j +5. ~ Y '.% e ,� r �' p "^' v ti,^ •.r µ„F '.. ,, '"a � }+1.. �' r �y4t '` .p��. i ,'�.,y�•, +n..y.,.f F$ � a�?�` r •.r, •s� `r ryas f r i w rn r''+...t • y $ y .mr w is ., t S Mr.-Jamea Sandersd ;` , l Mine Meats .Inc• 4r ,f !. LE-n-terprise�koad ''.f,•' dr w r ;e,:�D`i ;r i ',fiµ ..,�} f ,� x t .. .•'lM...^��,F y ?e..r,h, :.r At -r} �. .. r�' �s�.'Ir .i�3', i'F �1..'h �i .,,.� r '� t ., f"z�,�,R$o"' *. �,. L". ,�}� !✓` tt f' s .•r'1. 1 -`k .mil�,, rt .� ` ...� • tHyannis, MA- 02601.. g.j r� ,r. ,rF,t ` . + `' ,,��� • c;,r, ram~' ` ,v+" f rn' , ::, � a " s 4 �• 0 �,�t� x e` s,�?•+�"i F�t '��*f'� �J R r ..d t �`' t�'yr•.,�`dr •,�j�'�s it h �"h} �z.'a�' ��t MX.r't .I�i Yr �7� a X, y �•^x '` f, •'r r 7: J} �'.r - r� Dear Mr• Saundersi=•. +.kf''4S #'� �,f.'rh `'� a• ,{, 4�F ♦r ,« t r: to 1✓.a' t..s .r -yp a E' i'- �, 1•. �L r..y:Mp ',,p r ,?� . r;:. 3 i '.=. .:!r ., e F [' :?' ,ft 9"C r�, . }f �"tir. s f` �,i� �n ✓ ,,.x- a t P .<� •wS # .:, `, aJ w i �r e4= '; `• r, �` S +t,+, r nr�f^, a g...s,-f v.� f :7. � `�" •w � k kr, C � ;, ,��'. �rs1{ -� ^,. Your are granted a .conditional variance "from "our'a%Interim Groundwater Protection`r�,, �RegulationsTimitingdafly='sewage flowsato�-330`gailons, •per acre rin~ceitain`citicalzonesr iixi A '`'�'' of;`contribution to pubIic watery supply,.,wetls,�to'operdte a butche shop`.^atiI2+Enterprise:, w ' r•Road, Hyarinis, with.the'Pollowing conditions; 1 # •,- ` N�� 's r.r, I'r� �'i +' }�ji ^` `ti. b w�• F i"*A,a f ��.J l r # � 4R.^6 4 1 r� 'f'•f tK"4 jS�T' �`` R�'4 t SYrr�.r $h.y rkk '4 ,/ {`,• .t,tr f, `t!a � � � �.- •:'r� ,t�'. .�a r' r y..�~is Sr s>T E+.i` �•r: „-a t '�.�^ vy,^ui �,y t sj k.• Floor4 plans;showinftr�I allEequi meat bathrooms,'refiigerator's, sinks, etc:',-.and modes_' 3 r ' �•7 — •�+��a P r }� ,arc. s ♦ y: - s * ! r.a • f. -operandi; mustbe approved by:the ,Board of�Heaith{+prior tto.,issuance jof pour foots r e♦ J t .r b a k " } 5 ..,t/� Y x e> yC+ v .d. ✓ ` !."'+, �,°� • establishmentipertnit. y* v:♦+.5 �. .` +, R _ - � r -'<s t ♦„ L` Y 1 ii t `' ky Ac 9 � ''.'t +•.M it � 4 �_. ,r f, .,4• � :S . ft k� - � a �5 .. xt.�" r. r t �:+.•n Mi"' ,S ,*� �.,>�'r.ri �'� E r '�`:. f .}, r ..r "' ♦� " r,'.�<:z' ,,(2).`,'You must�mee't all:of ,the requir®ments`of 105 CMR390.000, Mini�numCSani#'ation t r p Standards for Food Service Establishments, prior tv licensuie' ti�� x •. a f' ,r r ,- R � ,r»_, x R� 4a r = (3) The grease,trap}(nust,be 'pumped4every three�(3) months and written^certific%�tion t {s ,. . .submitted to,the'Board"fraom a licensei,septage hauler.'- ' •'S r '# u jt s i�^' "' r; a ."`' G ..t}� i r:.p? ,+..�* .fh ft X r-.7 y�`^ E.;- � `.> . .. a, «.. �t ],. •.,.� •?• x r t . 9 �� ,� 1t A,. t. w -''' ), ,.E ,, n 6,..,} ,+ x :.. •4�, t a.-.�, : ,�; � '7 ,� E 2i r r.',. -e i�(4) R Nod other food' establishments of any type WAIF be approved by the:Board' in this z � • �, 9` n}y+ colllpiex. i`t r. 1r r { C r t • `A# S)' 'sr F rp ry i 4' '� E *.y r]''js Z15'`- <rk ss �• rr yA.: +a .+ .�•r^ t4 rf „ •"ES t ,. i'r;. b ° fin. #,.` f +a< ... X, 3 a. ��. +' r ti"s,ti ri 7 I t` :r• : ry"�,. "'` .s � ,• .,raj ;x 1s., 4;'� t'`f rc t �v.�i < iot. Ei < i 'F:�eh- .7:Ypj. ., a .�'� -a � '� a'',",r s''�!, r'�t`pJ�'.� �+ ��.i " ...t�,.�^,j s fa..a :et?4.x•1 r!'s Y - ,� , This';`variance:is granted"'because ithe,prop sed;butcher.yshop will'use less.watery than,they. �'` previous�husiness ,the Cape,.Coci Smoke House;_-owever;J the applicant is.warned that prioi e x � r tr =r"f to renting,space, forsaY'loodktype,.©peratiori thatshe'siiust abtain�autho ization�from:thee' : Board of Heialth.;The`Board would •prefer.a vacant unit tin the compieg-of a; ©wer"vrater x F� user because ofkthe ©verloadingof contaminants,in this xone`of contribution. ,� �`a a •,: ` , a.s4 .• ram.. r E ..,`f E '"f r 'c': ,} -.r'Vr s..� ;tb/j tsF�i`�•r ...';♦♦� et C +•. . �}lr lac•^ ��, � 'r+.�. ;�p'�p •°i'�r �y.�' srT� �����4 �:q� k ••s '+�.' s� rr..� fF r' .h ., Very trul .'yours, ,. R x.-,� E s �' ry�•� %">c .,{ �' •�. . .F '. ;; {` �r ''yr �r S ri rF.• x r.s , 4 • ♦s } r t j ,• a:s _ E }-* 'n • v { " r FX1 ` ll `if+ • 4 ,r. f ..,1 : �'y r:y i3:1 V'Sa jt•_,; !' ` ; r...4 ,y#d F y y ja x"} h,. ''."tr$t x" �.; ,-a+.•a•t r.W"an�'r h ...; , -cr`r g1i '`nY' t �,} x� s �, �� },._ r wF r r 9`,F«�,� •Ar t �r.'„ r ,�_ > rk.!` frts fir° � �. � t ♦X. r .4 a'� r zr,. r '1 r•- a ,�' -}� a, t „ c p 1 i +�h v. ..r �� Ft RChilds rF ;' ,• r ,7 J { ,�;`,{ :t r�• }� .T•, • ° } r 8 ,t r� h f j x:Chaiiinany, �' f r, j , ?_ + «k �� �, 1.r: t ..; a ' ` p„ +`� L _ S `r•,.7,. d >"` i. .r - } j , 1. j - r ! "1• �'" f' "!: i -.:i"f 1'irs'k. K 'L, 'rt 3S xrr � e'X.•k ,gam i ►' 'BOARD OF'HEALTH . ^� . ' , ,� • '.� f kF ,. �, �r r• TOWN OF BARNSTABLE =r�j. t ,. - ,r C ',r�s S `x .s a•f,y ! ,t t;':. G/ Y � yr ti rl Y y ,.`F ? °':.. r y`, i'7' +, ,r•,�, d' t 1 .. s a. r r• .,! " ,; "' •. &'a t, `" ro ,� r^r; S x - ¢ SY_'. ter, ,r •,`% h.: JMK/i lm 1^xr , • .Dv h F`,1 +� F.Ya i p ^� si: t 3 Y� 1E R L 7 r r r r. cc 'Mark Levfs7 }, Max•Brennen Trustees E i. 1 `` n �: WW 'r _Si McMar'.Realtylrust Pleasant,Street - x'xJ:�Brootcline :'bA.ti,02146 a t{_w.$ t tr. ''v s •,.�. a/ L' ,A+. ..r 't -.r!' r { e •♦c.:i ' ' i t �• ; r♦r - ' ', ' • ' ► r f, 1pt•" sA. *N� a , h y .♦ s - '" r r�, s��.• rF�;*r r s 7 ,It ♦ '. 3 r }+i.v r _ �c t• ;• ,t! ♦s t'. 14.,I 44 �''fp ,` �r'*Ru '`s + •`. t z •+ r t, - r 1 aR. F r., } ssF a. !y`i'"•'wr .i4. �,y j -♦. .� _ si 4'.♦ .. _ . • . W X rY `s ti: �t �..a. fa t '4 r , Lo- _s . . .y ;. p. r r try . .. .a • . - 1 .,-� .. .,. . •+� r, r� rtr:r.. .. ,�E_ o� • Fee TOWN OF BARNSTABLE cif n OFFICE OF e DlH75 KAA& : BOARD OF 'HEALTH 1639 / 639'%� 367 MAIN STREET 0 MAY HYANNIS, MASS. 02601 4 VARIANCE REQUEST FORM All variance requests must be submitted fifteen (15) days prior to the scheduled Board of Health Meeting. NAME OF APPLICANT �}A S,L.) ) TEL. NO. `j � ADDRESS OF- APPLICANT pp,)K)F, ?\n EBTS ) 1.S C, NAME OF OWNER OF PROPERTY �/ l�1�1S,� SUBDIVISION NAME o C� � 1'1('/� /iy DATE APPROVED ASSESSORS MAP AND PARCEL NUMBER LOCATION OF REQUESTCO;E'�EJ �`j VARIANCE FROM REGULATION (List Regulation) REASON FOR VARIANCE (May attach letter if more space is needed) d 0 rz.F_cL v I PLAN — TWO COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING. VARIANCE REQUEST. VARIANCE APPROVED , NOT APPROVED *M`x REASON FOR DISAPROVAL" •+ E �}L i Z•` f - n :Robert L Childs,",Chairman Ann Jane Eshbaugh Grover C.M. Farrish, M.D. z,. BOARD OF HEALTH ":: .r TOWN OF BARNSTABLE ` Ida t e . Fee cf T►+[To TOWN OF BARNSTABLE OFFICE OF i 1�171T�.BL i , , .uL BOARD OF *HEALTH 367 MAIN STREET a dx�}' HYANNIS, MASS. 02601 ". VARIANCE REQUEST FORM All variance requests must be submitted fifteen (15) days prior to the :scheduled ,£ Board of Health Meeting... NAME OF APPLICANT S,IYI )k) nl' g. "} TEL. NO.� Z� ADDRESS OF- APPLICANT `,2-11M OF OWNER OF PROPERTY �, SUBDIVISION NAME �o p �/� !�-ci DATE APPROVED ASSESSORS MAP AND PARCEL NUMBER LOCATION OF REQUESTCOK,,�.SEJ WAY VARIANCE FROM REGULATION (List Regulation) J c REASON FOR VARIANCE (May attach letter if more space is needed) T�.F_a ll a�tv , PLAN — TWO COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING VARIANCE REQUEST. VA\IANCE APPROVED NOT APPROVED REASON FOR DISAPROVAL Robert L. Childs, Chairman Ann Jane Eshbaugh Grover C.M. Farrish, M.D. BOARD OF HEALTH TOWN OF BARNST_A?ELE 008 5rnoke AovSE- 1606 �}�( CWM!5 �' /moo qA 1 I coo Ih CAA P� cock, ! o o Coxa 5 1 o c' I C o alp s Became effective December 22,.1985, after being published in the-C3pe Cod 11mes TOWN OF BARNSTABLE _ CfTHEl0 ' e : OFFICE OF e 3sAivr9T►sr. _ BOARD OF*HEALTH � rut BOARD °o e639• �e 367 MAIN STREET �0 r HYANNIS, MASS. 02601 d� 0 LEGAL NOTICE " SYSTEMS ON MARGINAL LOTS INSTALLATION OF ON-SITE SEWAGE DISPOSAL The Board of Health, Town of Barnstable, ter Massacbus 111, of ttsp in athe r General with,Laws and under nthe Of Chapter ` the authority granted by Section 31, P Commonwealth of Massachusetts, hereby adopted the following rules and regulations_ at a meeting of the Board of Health held on December 17, 1985: PURPOSE The filling of marginal lands in close proximity to ground water in order to provide for sufficient area to make it suitable for the installation of a sewage disposal system is not considered an acceptable practice and such lands are considered as not suitable from a sanitary point of view for human habitation and for the protection of groundwater and watercourses. Watercourses are defined in Regulation 15.01, of 310 CMR 15.00, the State Environmental Code, Title 5, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage. Subsurface sewage disposal systems shall be located in an area where there is at. least a four foot depth of naturally occurring pervious soil below the entire area of the leaching facility and the designated leaching reserve area. This four foot depth of naturally occurring pervious soil must be above maximum ground water elevation. The maximum groundwater elevation shall be determined by utilizing ,the formula contained in the United States Department of Interior Geological Survey publication, "Estimating Highest Groundwater Levels for Construction and Land Use Planning - a Cape Cod, Massachusetts, Exajnple", dated September, 1983, or by observing the height of the groundwater table when it is at its maximum level or elevation. Maximum groundwater determinations shall be made during the wettest season of the year - made for high water level if the Board normally March or April. Allowances shall be of alth permits the determination to be made outside the wettest season. This r gu/lation is to tak ffect on the date of publication of this notice. I . bent LJChi , Chairma GLAAJQ_ Ann e E hbaugh Grover C.M. Farrish, M. D. BOARD OF HEALTH TOWN OF BARNSTABLE r.PF::3VED AS TO FORM- ,;-.v❑ Ccunsel b. �`2+� r F>ms...:.............. • THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH : oF...... .. s ..,.�.r .............................. Appliratinn -fur Uiipntittl 10orko Towi rnrtion Vrrniit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: zo ........... ..............................•--•- ---•-••--•--•-----•••-••----------•---.._.._..__.. .. ---- Location.Address -or Lot Noo��, f �jz"t -.. CAS P�O � i-) ✓/ IL!is.._.1/�=41�.-. v ........ ............... ............. ... ..... wner Add, ..._.... e 1 - Q.... ......._.. y Installer Address r Type of Building Size Lot............................Sq. feet DwellingNo. of Bedrooms....::..................................::..Ex Expansion Attic Showers Garbage — P ( ) g ( ) p`., Other—Type of Building No. of persons_________________ ( ) ( ) 11 a' 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 ( ) aPercolation Test Results Performed by------- ----------------------••----•---•------•••----•--•------••-------- Date-------------------------------------... Test Pit No. 1................minutes per inch Depth of Test Pit-.._-___-___--__-___ Depth to ground � . (� N ------- fs Test Pit No. 2................minutes per inch Depth of Test Pit.................... De�.- t®r ._____._ ! ................................................................................................................... ......3-... O Descripti of So 1------------------- . --- 46 v -------- --------------------------- .. ........................................................... - - W -------------------------------------------------------------------------------------------------------------- ----------------------- x / >r - �Z37t-�t�N-------------------------------- Alt ----------- V N�s Re <' or erations—Answer when applicable.....__ �._......, ...... .................. - 0------- -----... ------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issggd by the board of health. Signe ••_. ..... . ......................... ,. ' .. r. b Date ApplicationApproved By-------•.....................• -----------------------------•--- ---------------------....--------------- Date Application Disapproved for the following reasons:-----•-----------••----••----------------------------••-•--•--•-•-•-•---•-------•------------------------------- --------------------------•-•----•--•-----------------------...--•._.......-•-•-•---••--••-••-----•--•----------•-------•--•----._..._......._.............-----------------•------------------•------•- Date i r` PermitNo......................................................... Issued........................................................ Date d'." 4 '+ No v.-_._...-d..; Fs:.................... j THE COMMONWEALTH OF MASSACHUSETTS 3 BOARD,OF HEALTH 7�..."'_.h _...............OF.......i > —' 0'/-; / E Apliliration -fur 4%gponttl ork,i Cnnnntrnrtinn Vrrniit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: _ Location•Address or Lot No. -� .............................................-................................... _-.........••-- ....... ......................._....._..____........ , /gwner Address J W ............................................j.............. -----------•----------------------- -•---•--------------------------- --------------------•--- ............. Installer Address Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms-------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) U p`�-, Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures --------------------------------------------------------------------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow..............................:..........--.gallons. W Septic 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 ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date------------------------------------._.. Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water...--------------....... r:[� Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water--._.._.--__--___--_-. P4 --------------------------................................................................................................................................... O Description of Soil-------------- --•-...... -------- ------- --....... --- -•--•-•--•........................... ........... v _, . y _ W x =- ------- -------------------------------- U Nature_of Repair- or Alterations—Answer when applicable......./ C17.'?�-!...=. ._._._.+'�>���.c/Zg '.` �______.__.... -- - ---- Agreement: ti The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate.of Compliance has been dissued by the board of health. Signe .__ �-! 0 12, � p ------------------------ i --------•-----�--Date Application Approved BY---------------------- •--------•-•-•-!------------------- ------------------------------------ -------------- Date Application Disapproved for the following reasons:..............................................................................................................•- •.............••--•-•---......_..•••..................------------------..._•----•-•-....•-•--•-----•-•-•...........--_._.-----------------------•-------------------------------------•-----......... Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS 'xr BOARD OF HEALTH Z.Z)..w n......................OF..... ... . . .......'....:".......................... r Qwrtifirate of (tnmplialtrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by '' =G `l_ A / 'Installer.... " - 1 ......................... ------- -- -�`----------------�--`--- -`-- �,r%----� ---c-----��---`-------- ---4...---•-••••• ------- has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated.../_�-)__....:.....`_..7............._.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL/FUNCTION SATISFACTORY. DATE..................------------gyp-•'-------��---••---•--• Inspector- C)------------ ----- ----- ................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................ 1,4..r �� No. �.. FEE _-"�-`-� ' �i��la�ttl �rrk,� Cnnn�txnrtinn rrmit Permission is hereby granted------J-----C. � 1`;7 v_ �' '" � to Construct ( )-._or Repair ((--<an Individual--Sewage Disposal System at No---- ------ 'l �"/,2_v > 5e %z,� str eet as shown on the application for Disposal Works Construction emit ....... ........ Dated_ _ ----- .'_ .. ........ - ---------------------- DATE---� ---- - �) •----------------------------•---.----------• oard of Health -�./-��-� FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS No.- ..... Finc.... .......................... THE COMMONWEALTH OF MASSACHUSETTS BOA RDO 91F KHJ EJA�j IHI L. ....or-SO'l-L...........OF ------------- ... ........ ..... .................... Appliration for 15ispasal Warks Tiatuitrurtion Vrrmit Application is hereby made for a Permit to Construct or Re air an Individual Sewage Disposal Sys A ,tep at: Ao ------------- dl�JS.... ......... .... . . ................ ..... . ....... ............ ........ ............................ '0 r Lot o. ......... ......... ................ Y------------ .........A.... ..... ........................... t r caner Address e4 ..................... ............................................... Installer Address Type of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedroo --Expansion A is Garbage Grinder Other—Type—of- pqr Showers f�ons__--- __ e P4 4 e fete is Building Other fixtures ____________ Design Flow______. ------ gallons per person per day. To al daily flow.............41 ---- -----------gallons. S 14- --gallons Length________________ Width_.____._.__..___ Diameter________________ Depth---------------- eptic Tank1j.-Liquid capa�c�itymv Disposal Trench—No_____________________ Width______..____._ h Total leaching area.__-____ ........sq. f t. 1,el - ------ Total leaching area----- ft. Diameter. A Seepage Pit No.-5&---------- epMbe v in etA.....e... Z Other Distribution box. (A-)" Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date---------------------------------------- a Test Pit No. I................minutes per inch Depth of Test Pit..._____._._________ Depth to ground water.._._______________-_-.. 44 Test Pit No. 2................minutesper inch Depth of Test Pit____..._______..____ Depth to ground water_-________________-____ ...........4--------------I ......... l . .................................................................................. 0 Description of Soi------------- ...... ....................................................................................... U ................................................................................................................................................... --------------------------------------------------- ..................................................................................................... ----------- - -- - ----------------------- ---- -------- - ----------------- --------- .... U Nature,4 P\-epa!*W or Alterations—Answer when applicable.- ------ ------------------------------- ----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance h d bb the ,00') Sign . .. ...... ........ ...7L................................................... ................................ Date Application Approved By---- ..A-7-- ----7--2- D Application Disapproved for the following reasons:............... ------- ........... ............................................................. ........................................................................................................................................................................................................ Date PermitNo......................................................... Issued...---------------------------......................... Date --- ....... .... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEA.t,._TH li50��............0 F... ................... A ........+ ' - Applirafion for J%ip asat Marko Tomitrur#ion Prrmit Application is hereby made for a Permit to Construct ( ) or 7Reair ( ) ,an Individual Sewage Disposal Sys, at L o r Lot N s n klz C11 Address...........................•......•--•-•..•............ Address Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedroo s___________________________/� .....Expansion ?Ai s ( ) Garbage GrinderOther—Type- of Buildin&�h%*, R 4lo. of persons-___._____ _________--_ Showers ( ) Cafeteria ( ) dOther fixtures -- .•-•-•-----••-•-•-------...............................................................................................------------••...-•----......--------••••-•-•••......•-• •--------•-------•------. W Design Flow._. ._: . ,` w"t_ .gallons per-person per day. Total daily flow............. . .....---___-_--_----gallons. WSeptic Tank t-Liquid capacity'' _gallons Length................ Width: :__ Diameter___-_ -_-_,_ Depth--.-_-__---. xDisposal Trench—No.................... Width..........._.._,� al L 1 .,�; .._..._._ Total leaching area--------a,___.___-sq. ft. Seepage Pit No____ _____________ Diameter ?!` "`�rf Dept inlet................ Total leaching area------ d. . ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed bY----------------------............................-•••-•-•------••---•-•--• Date---------------------------------------- Test Pit No. 1................minutes per inch Depth of Test Pit------------........ Depth to ground water------------------------ fi, Test Pit No. 2................minutes per inch =Depth of Test Pit..................... Depth to ground water--------------------- .------------- ---••••-- O Description of Soil------ .. ----- _ .----••--•- ..... ------------- ------- ---------------------------- x U ---------------------------------------------------------------•-••-- ------------------------------------------------------- W UNature 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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance h"- eetiss-Ved y-th oa>F o heal °" Sign sx � g .•• . •................ ... .... -- ,�/i Date Application Approved BY '_.� ... - r. n ------ Application Disapproved for the following reasons:.............: -•-•-••-----•----•-•••--••---•--- --------------------------•--------------..............................----------------------------------------------------------------------------------------------- Date PermitNo.......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD �: F HEALTH ............0F..... ...:; ............... Carr ifiratr of f ompliaurr THIS IS&; CERTT1FY_� the In ivi u Sewag posal, ystem constru ted ( ) or Repairedby-•--- - �' ::� ----• • :� - -�. - •=----- - -- •----- -------------•--------------- nstal � a at � t=^ --•- i � ------•• ` -- ��' ----------------------------------------- has been installed in accordance with the provis' ns of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......... .. ................. dated.....�'�'_.._2_ ' ... `�' "'._. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GU RANTEE THAT THE SYSTEM,WILL 'F NCTI N SATISFACTORY. ' _ .. DATE �f Inspector.- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No...: ..... ..t;. .. ..A°r .. . .`OF. �� --.---.... .................. 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