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tc IATIOq 40 SEWACI PERMITp0•
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V I L L A G E ASSESSORS MAP NO:
PARCEL NO:
IC3STALLEU'S HAVE b ADDRESS
!3 U 1 L D E 0 OR 0 dp E R —
DATE PERG7IT ISSUED
O DAT E C0MPLIARICE ISSUED �d
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
............. ...........OF..__RA P_r X5._TRTV.-F--------------------------••--------•-----... pv —
Aliptira#iau for Uhipniial Works TOwitrurtion Famit 605
Application is hereby made for a Permit to Construct (>Q or Repair ( ) an Individual Sewage Disposal
System at: 4 9
- Location-Add res or Lot No.
owner / Address "
Installer Address
Type of Building Size Lot.7Gy_4��.�__.S eet �
U Dwelling—No. of Bedrooms............ . .....Expansion Attic ( ) Garbage Grind
Other—Type T e of Building .............. No. of ersons__-.._______--______•__-____ Showers — Cafete is
P� yP g P ( )
Q' Other fixtures _________________________________
W Design Flow.............S5�....................gallons per person per day. Total daily flow.........A .?........................�galons.
WSeptic Tank—Liquid capacityJ5 ...gallons Length-W.......... Width....4t........ Diameter................ Depth.._ ........
x Disposal Trench—No.......I............ WidthAO. ...... Total Length___.?A......... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area_4�27...._sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
'-' Percolation Test Results Performed --------
Date.....�!'!1_- ...............
a Test Pit No. I----------------minutes per inch Depth of Test Pit......13..._._... Depth to ground water._I`!.� -_ent u3t I
(i Test Pit No. 2................minutes per inch Depth of Test Pit......f ....._.. Depth to ground water.Nt3.t..ehcam*0-e re
a' ---------------------------------------------------------------------------------------•-----------..........................................................
0 Description of Soil..... ........ ..•-----------------------------•----------------
x
UW •••--••------------- --------------------------------------------------------------••--•------••------•-•---••------------------••---------•---•••-------••---------------------•...-•-•-----•---•-•-•-
Nature of Repairs or Alterations—Answer when applicable.__._..........................................................................................
..-•--•-•••••---•••••-••--•-----•--••--•---•--•-•-•-----••-•-----------------•-•----•-••••••--------•-------------------••-•----••----------•-••.......................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary, Code— he undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been s b the board ofihcalth
ee
-
n
Application Approved By•--••--• .. ..............•-------------••-•--------------------...------- .. /6: 7..............
� Date
Application Disapproved for a llowing reasons------=...........................................................................................................
----------------------------------------••-•-•--.....................----------------•------•------•-----
Date
PermitNo......................................................... Issued.......................................................
Date
s "
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................. .• ..... ................................................
Appliration for Uiipnsal Workii Tomitrurtion Frrutit
Application is hereby,made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at
.._...... \ 3 1 Y�1 i•`>1_`t _C,�. Cl s3.. ...... .1�IZI�� __�_,F��'r"�,1..�C..ti._..._Y.1.....................................
................r.... ...........
Location-Address or Lot No.
..............••------_^--....._........--•---.....•.....---------•-•---------•-------------_... ..................................................................................................
Owner Address
W
Installer Address
d Type of Building Size Lot...._.
7 ........:�...._.......Sq. feet
V Dwelling—No. of Bedrooms.............3._...........................Expansion Attic ( ) Garbage Grinder ( )
p---------------------------- No. of ersons-----------•------•--------- Showers — Cafeteria
p., Other—Type of Building ( )
0.1 Other fixtures -----•.............••-•-•-•---•. .
Design Flow............... .....................gallons per person per day. Total daily flow.......... .......................gallons.
WSeptic Tank—Liquid capacity_/'a b__.gallons Length---!2......... Width....r:....... Diameter_.............. Depth....-4.......
x Disposal Trench—No. ......f............ Width j-'.t%"�...... Total Length..•352.......... Total leaching area....................sq. ft.
Seepage Pit No-------------------_ Diameter.................... Depth below inlet.................... Total leaching area.................. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed ...... Date...... ...............
Test Pit No. 1................minutes per inch Depth of Test Pit------t':.a......... Depth to ground water--Ns?.-:�_.v 1,r�ltlntrr4
ri, Test Pit No. 2................minutes per inch Depth of Test Pit.......t 3�_____~'Depth to ground water.-fVt+r..P.WjtWJat er-1`.
a -----------------------------------------------------------•••--••------•--------------•--------•••....-•------............--••........••••-•-•-•---------•-
O Description of Soil...... 1._ f-, 0/s /) 15W _-'r1 ;,• , ca u ,f: i '_?r;:%?�e"
x -•• •• --•••--------- ---------••• •- • •-•-
U --•--------------------------------•-----•------------------------------------------.....----•.......................................................
•-•-•-......-•--...-----••-----•---•----•-•••-••-•--•-•-•--•--------•------•-`--•-••-•----•------•---••--•-•-•-•-•••---•---••••-••---••-••---••----
U Nature of Repairs or'Alterations—Answer when applicable.........................•.._......._.___...........__.............................__.......__.
t '
A greement: + �
The undersigned- agrees, toy install the. aforedescribed Individual Sewage Disposal System in accordance with
the provisions of i 11 15-of'the State Sanitary Code— he undersigned further agrees not to place the system in
operation until a Certificate'of Compliance has be s he bp - ofil
e f - --------
�Da
Application Approved By---•••••. ......f..........................................------- ---. ............
Date
Application Disapproved for a llowing reasons:.............................................................................................................
_
.....................................................-----••-------------•-----..•...------------...-----••-•--•---•-----•--•-••----•-••--••-••-•----------••••-••••••---•-•---•---••--••••----•-------
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
1 BOARD OF HEALTH
..........................................O F.....................................................................:.............
..
- �rr�ifirtt#r laf f�u�t�rliaaatrr -
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (,-<or Repaired ( )
by ..................... '................... ?�/ Installer
:. (((
has been installed in accordance with the provisions of TITIF; j of The State Sanitary C/dasrd'escribed in the
application for Disposal Works Construction Permit No.. ;..�_. ��'.............. dated_:.��._ //. ?�._..._._....___........
THE ISSUAN E Of. THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL TION SATISFACTORY. Inspector
DATE.........� -------------------------------------
THE
COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF.....................................................................................
No.1�-�.... -....•--•-• FEE...'/.. ..........
�i��la gal -• rk�� �aa���rai��t rrnti� ,
' � --
Permission is `eby granted..,,.— ----------------------------------------•-----...---------..-.._-----...._._..
to Construct ( ) ors RepaivV ) an Indi dual ewage Disposal System
at No..v ..." '`..............(� ,,f f� -•----------.------------------...........--------•- -----•---- - - .............
...... 0...-•----. ---- ....
Street
as shown on/applition r Disposal Works Construction Permit No................... at ���_..��...._..............
/�j Boa f HealthDATE----•---• ...
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
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SEPT•fC TAN - D\ 'IG - - LEACH
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ar a•( ;( _+ x„i= lM$L): , , - r.12:1 OF t/8TO.42•• -
•JJ,Y. s r- »� ,,,:. : s• WASHED STONE a ,
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(• ( i-�4. - ram' » � � �. .:..._ . .--___�,__ {./t'IN-
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IN-
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�•R• f . .r r. - �T� '� IN• Ot,,,.j '."'. k.15^(�w'+MC.
SEPTIC - r� Z 5
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.,` TANK �
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tir LE - Ev. �r .. E •. •
'ELEV. ELEV. Et u' Euc_V, a, C / k.
C• - - WASHED STONE `` �1-""•h- J'
" TEST HOLE LOG
lE$F,:BY + Alt�4'S1i}�1t. �, Jaot3` 3»oy{-( f4 ' _ _- 40
r WITNESS `
�, TEST DATE DESIGN BEDROOM HOUSE " Y' '� -'
c
y �T N: 1 T.H. 2 ,
ELEV. N O w
, + DISPOSER r�tSPQ•SER
n -OAn-\ - PERC RATE MINAN, _ ;; i 1k: !✓ ��. f j� ( 6 0
' , Su6Sol f FLOW RATEC(GAt.f0aY .5)
' , �• !� t� a
SEPTIC TANK 3�� 1. (I.S}
REO'D SEPTIC TANK SIZE 1.
�` c ✓ /�/ tj
LEACH FACILITY , ,
L W `[j a ' 91.6t WALL G/D. C, a '
BOTTOM Zo'u'3o lccaa ( t �, ) toc,o G/D.
L ArU An;zb. TOTAL = Cocra a/
USE: __�snra✓ 2a x 3ciT,LEACHING FIL t7. 0-.. ^.. -� =metal ��..+ -
* j 75
WATER ENCOUNTERED
}� NOTES (UNLESS OTHERWISE NOTED) � •_, ._r._---- _ ;b�; `'� �/ //' O
1.,DATUM'(MSL) TAKEN FROM 1� 2 ( ..........QUADRANGLE MAP {—��" A,p -t.N-�Z
2.MUNICIPAL WATER-•- —f.CQ_•-----------_ -•_,----__AVAILABLE 1.
3.PIPE'P.I•TCH: Wa PER.FOOT !^� % '\ �Sr f ty�� L}{ R�eE �•� \• Ul lj
LF 4 DESIGN LOADING FOR ALL PRE-CAST UNITS: AASHO ��'t G•'w •44 �' C.•fr ��� `i+'y' �\'- ✓ �'` 'l � y
5. MIN.GROUND COVER OVER ALL SEWAGE FACILITIES: (1) FT. p ARNE �� ARNE H. d DISTANCE AS CERTIFI T J
" 6..PIPE JOINTS SHALL BE MADE WATER TIGHT �'z IA. � �
7.CONSTRUCTION,D'ETAILS TO BE ACCORDANCE WITH COMM.OF MASS. J OJALA QJALA
+� STATE ENVIRONMENTAL CODE TITLE 5 c, CI1lIL ).HERE ERTIFY THAT THE BUILDIN w
263a �, 97 SITE PLAN
No. 3E)792 .SHOWN ON THIS .LAN IS LOCATED ON THE
r GROUND AS SHOWN HEREON&THAT IT _ LOCUS: t�5 _ C.fiJYY\ `E-
fstSTE� ��: CONFORM TO THE ZONING BY LAWS OF THE
TOWN OF 1.>AFAC YY.t� /
OFES R �..
WHEN CONSTRUCTED. DATE
AEF!
down en Cape I'r1FeIIA r PREPARED FOR: * ' 1 G.N(3?FI741�J
. '
CIVIL ENGINEERS }+
LAND SURVEYORS ------------ ! � .'. I
EA REG. LAND SURVEYOR ,�
^�' I CONTOURS (EXI$T1NG) .+�-1: I ; SCALE gC�
APPROVED F
(PRO.POSEDJj-O-O`-0-0.- DATE . MR Yarmouth&Orleans,MA <Dry