Loading...
HomeMy WebLinkAbout0011 GRANITE LANE - Health 11 Granite Lane Barnstable ., R \ A=316 -045 ' i TOWN OF BARNSTABLE ` L CATION / .4/1J P,`4 1' dt1 SEWAGE # 'VILLAGE `� AJS � 14 t`-e ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. N�s�l2b� SEPTIC TANK CAPACITY / off M LEACHING FACILITY: (type) , X Vic] to (size) 1 R- NO.OF BEDROOMS BUILDER OR OWNER lr VA PERMTTDATE: -5 `-1 o 0- COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility)" Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) �� Feet Furnished by low - fit "44. � _ t 33 'No. (/t Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIppfication for 30ioc l Opotem Con5truttiott permit Application for a Permit to Construct(p-TRepair(ZKUpgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. p r � e a Owner's Name,Address and Tel.No. Assessor's Map/Parcel 3l 6 m ©Y Installer' Name,Address,and Tel.No. Designer's Name,Address and Tel.No. J l Type of Building: Dwelling No.of Bedrooms Lot Size 3 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow - gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /lam ® Type of S.A.S. ou t/i / it A 12.1 �Cf)e 3 C Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ens a the nstruction and maintenance of the afore described on-site sewage disposal system in accordance with,the provisions o Title 5 o the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued this Bd of Hh. Signed,--, K Date Application Approved by Date Application Disapproved or the following reas n J Permit No. a -- Date Issued f _-_7 No. (/`/ Fee r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Yes 2pprication for M gpogal Opgtem Co�nkruction Permit Application for a Permit to Construct(&-)"kepair(4�j Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. ! //>� �Ip� � Owner'ss�Name�Address and Tel.No. Assessor's Map/Parcel P C�` JCJY✓! "'T I t Installer' Name,Address,"and Tel.No. Designer's Name,Address and Tel.No. f 4- Type of Building: Dwelling No.of Bedrooms 3 Lot Size 3FT4t4 _sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria Other Fixtures Design Flow -3P gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /60 p Type of S.A.S. l stl -tli /�_W5 "fit( 3tf r Description of Soil / Nature of Repairs or Alterations(Answer when applicable) / j_e 1 Z.,' Gf2 IF tt Date last inspected: Agreement: The undersigned agrees to ensure thelconstruction and maintenance of the afore described on-site sewage disposal system in accordance with.the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued y this Blodrd of Hleyth. Signed,-_—, - \ Date = , <% Application Approved by _ �l Alit J l Date . Application Disapproved for the following reas�n L v lj r Permit No. Date Issued L THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (tompliance THIS IS TO CERTIFY, that the On:site Sewage Disposal System Constructed( )Repaired O Upgraded( ) Abandoned( )by P ^/J /rt i at i'2.A hJ•I - P�� rt tC �,.aA�_ has been constructed in aff-cordance with the provisions of Title 5 and the for Disposal System Construction Permit No.AM t5 + Gated v� Installer r--r ►-'\ Designer II The issuance of this permits all t be const ued as guarantee that the system w 1 f ne ion as designed. Date V_agZ 5—_ InspectorK_V `. r —————— ------------------------- No- wm Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Digpogal *pgtem Com5truction Permit ' Permission is hereby granted to Construct(, )Repair(k)Upgrade( )Abandon ) System located at ,�lP✓1 Ki f -�� ,—z - and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction myst be completed within three years of the date of this perniit. /�f, Date: ��� Cs`t Approved by f N GN Co NC,govNa "'7 Al/1rE cogrG. 1 r I .�_� — G4 _ F bbx tA / � tRis7• � lifi .) � rrsr L4 T 38 ID LZ►� � I' CQ1 '00eo NdTF-= EzcV4-rlaNs &6,9.SEp 6AJ CERTI FI ED PLOT PLAN A.S`SvH�D DAry�`1. LOCATION SCALE ' . ... DATE . . -7 Zoo PLAN REFERENCE . !3E'J/VGT'?f-�! OF zzz- i_DWARD GSTETSON E. v�i I CERTIFY THAT THE E3ti.ST!nlE DWL2�/NC— I(ELLEY ^ �3e�s_►. x SHOWN ON THIS PLAN IS LOCATED ON THE GROUND $ No. 26100 rn� ' 527 �� AS SHOWN HEREON AND THAT IT CONFORMS TO THE cST0, �� AEDSPN��PQ, SETBACK`REQUIREMENTS OF THE TOWN OF // fVAIUa�� ' ' ' WHEN CONSTRUCTED. DATEU�wt4, ��eL,5. �iQT%Z/Gl/-� LG-L' �L�T. REGISTERED LAND SURVEYA N6 7- Z or Z EL. .49.:7.°... if TOP OF FOUNDATION CONCRETE COVERS INSPECTION PORT 3Si 0 4��CAST IRON 0 9 SCHEDULE 40 4�SCtIEDULE 40 P.V.C.(ONLY) I'1i P.V.C.PIPE MIN. PIPE - MIN. PITCH FeesT z� /.zt I %ej PITCH 1/4-PERFT. 1/.4aPER,FT. CLEAN SAND BACKFiLL t4 7f GAS BAFFLE IN INVERT �t. EL. ....:f$: SEPTIC TANK EL. _8a s"STONE EL�s4tPA 11 'l., INVERT �S ""' --:... 6s97 iceo..._. GAL- INVERT DIST �� INVERT _ EL.�rL3 e0X EL_�¢•'�e /9N�cy cs►pry CHAMBERS '�6"CRUSHED STONE ......_.... ....... .. r.,-Ia G�?�S t7B .r,/-Zo 4B r �/euE • —� -1 PRO FI LE OF mew 39.z-S P- 81 399 ADJ. GROUND WATER EL........... SEWAGE DISPOSAL SYSTEM SO L LOG DATE /!la�! !S8/ TIME ..�('.°° ... NO SCALE TEST HOLE ..!.... TEST HOLE .L.... VEGETATIVE COVER ELEV. G9•oo ELEV. . 7v,eo DESIGN DATA WooDLe/s^ NUMBER OF BEDROOMS --•• 3--•-- i\`y� �i�� �`i� lWOOD 3L s -So's n'� TOTAL ESTI MATED FLOW ... GAL_/DAY I t \_ , i S�6.So.t_ BOTTOM LEACHING AREA 50-r Nre�f83 SO-,*'BED ,. �, t:S.oa GARBAGE DISPOSAL _Al-E72C. Gv ....--- /s' 34" 6" 34" t,. r TOTAL LEACHING AREA •r �SQ.FT. 3¢i. s„ ' T` - •� PERCOLATION RATE 4C-rV�J: PER. INCH LEACHING ...C3�'b..... W�rsl J.A�+ro LEACHING AREA PER PERC.RATE..-3�GAL./DAY es r.VEt ADJ. GROUND WATER EL...~_... /JZ NL.5:5:C o .BYO.... WATER ENCOUNTERED LoT #� � cDWA `N OF ZHOF WITNESSED BY : _ S:.. ..BOARD ce: ' OF HEALTH ._ i-0J ENGI NEER - ,cSTi�9�CG-�- '. .. 9 0. 26100 527 f R tST s P W/•7itn t.. ,IC�uG .c off. �.9T2�t-//� L�-� � � -. N ' � ,,, .... ./` >• ' PETITIONER ' ��� EVA00 Town of Barnstable � �d o Regulatory Services ` • . . Thomas F.Geiler,Director - �� Public Health Division rED. ,�a Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer& Designer Certification Forte Date: Designer: Apes Installer: Address: // C2RA-A/tTzer 20 Address: On T P N�A I A, was issued a permit to install.a (date) (installer) septic system at // (1)k.4.It1l - C�• based on a design drawn by (address) L'UW,q R I> 4 .. Je4z4 Lam-/ dated V7 2,90 J' (designer) I certify that the septic system referenced above was installed substantially according to the design, whichmay include minor approved changes such,as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State& Local Regulations. flan revision or certified as-built by designer to follow. a (Ins 9.1er's Signature) wad® KELLEY a' No. 28100 (Designer' ature) (Af tamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH,DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTIO THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PIJULIC HEALTH DIVISION •. THANK YOU. . Q:Health/Septic/Desiper Certification Form r L O-C_AT_LO N 5-EWA_64E-P_E.R Ms-ff 1`10. I:t�1_ST Q.L_L._E-R-5-1J- .M-E -h D D-RE 5 P>U 1L _E__ ._S-r- -h- DAZE-P_E_R_M1-T_I_S SU ED_ O_AT E-001�/_l_P_L_I_Q1`l CE-I_SS_U_ED � �L 1 ^!�Ilk a ti No.. .......... Fimc.......Z.4..r.. ... J_ THE COMMONWE TH OF MASSACHUSETTS ROAD® OF HEALTH ... ...._.... . 0F..... .9. ?T.�•, V-,.-.....__ ...............__...... Appliration -fair Ditivaiial Norkii Towitrurtion Prrinit Application is hereby made for a Permit to Construct ( V�or Repair ( ) an Individual Sewage Disposal / System at: � ¢. Loc6on.Address or Lot No. �d-`� �� ................ +k�1� .......................... .... ���J°1 ;I....._,�.6.....D.1..... n a9--•--- Owner Address.......................................... Installer Address Type of Building Size Lot...�dQ). _QQ.......Sq. feet Dwelling—No..of Bedrooms...._... .................................Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Other fixtures W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. USeptic Tank Liquid capacity ij.q�ZPgallons Length-* Width---------------. Diameter---------------- Depth----.--_-_--. xDisposal Trench—No ___ Width.................... Total Length_.__________...._... Total leaching area__._.___..__--------sq. ft. Seepage Pit No....... a G6_pti1 `refer-------------------- Depth below inlet.................... Total leaching area-.-_:__-_----__-sq. ft. z ther Distribution box ( ) Dosin tank ( ) a ~' Percolation Test Results Performed by------ i�----- .`1. f ............................... Date--- _-__-.-.---. Test Pit No. 1................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...--._---_.-_-.-_---_ a' ----------------------------•--------•-•-••••--•-.---- -••-••................................................................ Description of Soil----;L_--9. ......... --- y-.,�I= �t�a� -� � J ��r�-�----------------------------------------- x --------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------- -------------------------- U Nature of Repairs or Alterations—Answer when applicable.-.__-_......................................................................................... Agreement: , The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance witli 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 issued by the board of health. Signed--- i191 _..0..... A-----•-•-•-•............. ..........•-Da--.............. { f(� Date Application Approved By--------�---_./�-----"------ ,t�.. .. 4..------��.�L`�v ........................................ Date Application Disapproved for Mee following reaso ........................................................................................................... ------------------------------------•--------------------•-----------=--•••••-••••--•------•••-•----•-•----------------•-••----•-•-------------•-------•....------------------..._-----------.....-•-•- Date PermitNo....�70--............................................ Issued........................................................ Date No. Fss........................... _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................OF.... Applira#ion -for Biipaiittl Eorkii Towitrurtion Vrruiff Application is hereby made for a Permit to Construct ( M110or Repair ( } an Individual Sewage Disposal, System at ........G M----- -----------------------------=------------1"-0i� lit�C Loc 'o!n-Ad ess w o Lot o. di y - % 3 .__.3p tT A#N �Slw Owner Address sho ...-fY�0.ras t�.11s --•••--•-----•--....................... � Installer Address Type of Building Size Lot... .,R�,OO,Q••••__S q feet Dwelling—No. of Bedrooms_-______---�____________________________-----Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ____________________________ No. of persons--__________________________ Showers ( ) — Cafeteria ( ) Q' Other fixtures W Design Flow______ ___________________________________gallons per person per day. Total daily flow--------------------------------------------gallons. L4 Septic Tank iquid capacit,J)4 allons Length................ Width---------------. Diameter______::-_____ Depth--_---__-_---- 4 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 ank Percolation Test Results Performed by-____ ..........M�+.. I............................. Date.... .______---- { Test Pit No. 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water_--_-___-___--_.__..---. (11 Test Pit No. 2................minutes per inch Depth of Test Pit-________.__________ Depth to ground water__-______________------ ••--r ------- --- ----------- 0 Description of Soil---6.--3 X�_!� "�4AID�0� � «* Ve?�•�. �:00� S>�Ne�. �• �V_A4!i1x_...-'Z.. w!!r�RS. e 4.�_A_ f J_��°•rf. -��a��; ---- .5! - ------------ -- ---- cxj `l W V Nature of Repa_rs 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 has been issued by the,board of h'ealth� f '} Signed -y Pua.+9 _:. .••----••--••-•-• ---•---------------------------- Application Approved By... = f-- r. St!t' kI Date ------------ --------••--•• 5------------------------- Date • Application Disapproved for t e following reasons:...............�,.........•-_-----_--'------------....------------_---_-_•--_-_--_--,--_-------._..__...----------- Date Permit No.--- `J :' Issued: -.! .._.. Date TK9 COMMONWEALTH OF MASSACHUSETTS BOARD OF;'HEALTH , G 6f14J..........O F..................................................................................... `} %Urdifiratr of f�lautphaurr THIS IS TO CE=RT1 Y, Thjt the Individual-Sewage Disposal System constructed ( ) or Repaired ( ) ......------------44"--•-----•--------...-•-------------------------•------------------------------•••- In Il r at.......................................................n� -Cj�'_f_g /P---------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of Articjr, XI of The State Sanitary Code as described in the application for Disposal Works Construction __________________________ dated..... ........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT�BE CONSTRUf D AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. � DATE-- �r + �,' 6 =---- . v -------- - ..__.._..._..- Inspector---- -•--- x THE:COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f ............OF............................................. ..--•---------------.............................. ..... s _...._..... No............ _ , .. FEE----••------- ,wr .`._��.�...; �i����ttl grk,�• �n���r�r�i�at �rr�tit Permissionis hereby.granted...........--'�-�..........................-........................................=----•=:;.................................................. , to Construct ( 7 or Re air ( ) an Individual Sewage Disposal System as shown on the application for Disp6§aa Works Construction• PermitiNo:�.-__1G........ Dated..... ��._ _ __ ri Board of Health DATE--- FORM 1255 HOB" &,WARREN. INC., PUBLISHERS - AV - , L-® `tom C'rr�Niie, ire e� �t�ctisl00b 17��cCQiqJ ►�N Tom} QbSLcV�d � rAvt mvTYAy e �t 3© 2� 30e �8 o _ I a i 1j 1 0 I I ►,000 gott G_ 1— TaA3\e- I ® ►'oGo CAA\ to t2�'e A me- 4 ►-� v��y 9ooe sa• v �Ya"�\ 2 Lu Pnps C\q.� c Ooot ! gANA lTwlo�ec 2 �0e�� ©& SuloSaa�, 2 iu Mps c � V O i i t I I I , fi Yy�r+ otTxr�s ,�k,a w • � DAHr7T � e rasa PAUL C. MURRAY HEALTH INSPECTOR BOARD OF HEALTH TOWN OF BARNSTABLE OFFICE HOURS: i 6:00 - 9:30 A.M. 1:00 _ 2:00 P.M. TELEPHONE 775-1120 EX. 36 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) i IM A DATA r, I I' �/42 ` t. f . 4- f 1 ; f I 1 ' � 1 L.,I]l C A T 10 N # S E W A E PERMIT NO. 1-07,- 4/ VILLAGE Btu I N S T A LLER'S NAME & ADDRESS V f-axli-v B U I L D E R OR OWNER (L:l L L DATE PERMIT ISSUED 3, 9,3 OAT E COMPLIANCE ISSUED � �/� fle,91L, dF l/v�5 -------------- 35 ri°fir, u� 9 -2. 7 Finc THE COMMONWEALTH OF MASSACHU.SETTS BOAR® OF HEALTH .•✓...........O F........�......z�vs `, G '............................. AVVr iratiun for Uiipuual Works Tunfitratrttun Prrutit Application is hereby made for a Permit to Construct (&,I or Repair ( ) an Individual Sewage Disposal //System at: ... ... ... . .#af �TN . Low ....4....11 .. • - ------------------------------•---------------. ..- ........... Location-Address or No Owner Address E'7'?�J l N®...---.6 s.....-----•--•---------------------- ------ �Gr Installer Address Type of Building Size Lot..g_ ....... Dwelling—No. of Bedrooms_._...•...-�............................Expansion Attic ( ) Garbage Grin de Other—Type of Building No. of persons............................ Showers — Cafeteria a' Other fixtures ................................. W Design Flow................ ........................gallons per person per day. Total daily flow............3 50 ................................ WSeptic Tank—Liquid'capacitylP0_--..gallons Length.......... ---._...... Width. ----...... Diameter................ Depth._�._.. x Disposal Trench—No. .................... Width.................... Total Length............. Total leaching area.............._.....sq. ft. Seepage Pit No:..__./._..._...... Diameter....../z........ Depth below inlet....Z._._...._._. Total leaching area..3 _sq. ft. Z Other Distribution box ( ) Dosing tank ~' Percolation Test Results Performed by.-.7.'7.p�..er...................... . Test Pit No. 14.... ...minutes per inch Depth of Test Pit...��''�'•.... Depth to ground water..... ...........__. Test Pit No. 2_L-4.....minutes per inch Depth of Test Pit... .... Depth to ground water....'."........__.. a -----.....•------•--•--••-------------------••-------------•---............---------•••......---.._._.......-•---.........--•--•-•-------•.............. O Description of Soil........ ..............:�........_�'�i-�-- -------&a --®`8 '`lL .......5�}'�' U .17W........................................................... --=- x ------ U 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 TITIE 5 of the State Sanitary Code—The un ersigned further agrees not to place the system in operation until a Certificate of Compliance has been is ed by t board of health. igne --•• -- -• ------- ...................................... �J ........ ApplicationApproved By..... ............ ..................... ................................ .... ............ Date Application Disapproved for e f oll ing redsons:-----••--------•--•-•••••---•-------•----------------•-•----•------------------------••-------•---.._........._ ---•...........................•--•-------•-•---.....----•-------------------.........----------------•------------------------------•---------------•-••------•---•-••---•-•---•---•--................ Date PermitNo......................................................... Issued-----....---------------------------------.......I...... Date N�- . 2-2 FEE....... �.......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 0 %'I'/ :� nr. r v�GG=................................ ,. ppliratiou for Disposal Works Tunstrurtiou tirrmit Application is hereby made for a Permit to Construct (t_)y or Repair ( ) an Individual Sewage Disposal System at: Zo Location-Address or Lot No. ............................. ........ --•--------------- .....---------------•--------•-•--------•---- - -•-• --............._ VOwner �'' _ Address Installer Address Type of Building Size Lot..-, . '� __.....S'/feet aDwelling—No. of Bedrooms........... ............................Expansion Attic ( ) Garbage Grinde p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeterias Q' Other fixtures .---••----------••------•-•----•-•----- • ..... b W Design Flow............ ...........................gallons per person per day. Total daily,flow._._.........= ............................gallons. WSeptic Tank—Liquid capacity.ffn,?..gallons Length.. � ....... Width._'` . _... Diameter................ Depth._ ..-6"'.-, x Disposal Trench—No..................... Width..._...{...._...... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...... ............ Diameter......!.?.__..._. Depth below inlet..... !.. ........ Total leaching area.. 7:3�3.sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.. _�`.�10,o-vi 5__.Z .._..�A-U_.e.`l.._.��C:... Date..'�'"'�..��.� '�... 4 Test Pit No. 1 4:.... ...minutes per inch Depth of Test Pit---•-57_"- Depth to ground water........................ " p p /cad p g _.. . G=, Test Pit 1`10. 2........ ......nllnutes per Inch Depth of Test Pit___................. Depth to round water..__.____........_._._.. _ -------------.-.-.-------------------- - --------. ---------•--------• . --- --- -------.-•-•5.�t-----•-----.---- Ox Descriptionl of Soil./.....!.0✓11"E=SG aa � S . G ........... /w-----••------- - -- --- v-/-:--------•.. ................................•.. : ......--•-•----- - . - -------U ---- ------------------------ -------------------------------•------------------....... .._. U 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 cf TTLE 5 of the State Sanitary Code— The un ersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss d by th oard of health. igned . ...................................... at Application Approved BY . rf -----------•---• ------------••....------•-----• ..............{sx�..._ y Date Application Disapproved for e f oll'4 ing reasons-.............................-•-•-----•---•--•---•----•-----••-----•---•--•...........••---------•-•...._...._ Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH i..✓n.,? ?teas. _;; .�'G..0 (Irrtifiratr of Toutpliaurr T TIFY, That the Individual Sewage Disposal System constructed (j.�r Repaired ( ) by Installer - -; ' = •. - --------------------------•--------------------------------------------------------------------------- •-------------------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Cr;�d as Scribed in the application for Disposal Works Construction Permit No---K3.--2_�7-_____________ dated :,.....�'�..__.t�, ................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . 7/13 /^ ... .........OF...................................................... No.. .. -A`_: .. FEE........................... Permission is hereby granted... E. y_4_-t-=•---------.---•-•-•-•-----.....--••---•-------------------------•-• ...................................... to Construct ( or Repair ( an Individual Sewage Disposal System at No.... _•. �/.......... - Street as shown on the application for Disposal Works Construction Permit No................... ' ed.._.... ........ ......................................... "... --- ------------------------------------• DATE---- �..Z ,��---� Boar's of Hea>� -----------•....................................... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS 0 SNE�T o f Z Sys a 3 �7. TIST\ $ ! P gr x p 4or"� 8 a g� 69•� ry 10 6g a Exi„�G Lo T'y'¢� �. �S 7o 38.34� 7 f o s N CERTIFIED PLOT PLAN I-OCATION Smarr c SST%JLE j MASS- SCALE DATE Zg 4W PLAN REFERENCE .8�?i�/G' . Lo7... ¢/. . . S/h,wAv �T% OF << . . NiGLS ��I� . . . . EDIWRRD. S I if -,%,0.25100 h �01STOL I CERTIFY THAT THE Mo s U 114 SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON AND THAT IT CONFORMS! TO THE SETBACK REQUIREMENTS OF THE TOWN OF WHEN CONSTRUCTED. DATE .�`? . 29 � 3• �-► jr�/iGG/A�r F. .Stn//FT_ �G-7/77o,O--, REGISTERED LA ND SCRVMR Z- L. . . f:7.�. . ... . TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS ''� 4' CAST IRON 12°MAX. 12"MAX. -�► PIPE (OR 4"ORANGEBURG(OR EQUIV,) EQUIV-)- MIN. PIPE- MIN. LEACH ' PITCH 1/4"PER. PITCH 1/4"PER.FT. PIT o a - PRECAST o' INVEST Q LEACHING ` e EL...'-`• INVERT INVERT o . e•; PIT OR SEPTIC TANK EL �4$. DI ST. EL� !¢4. ' ° >_ EQUIV. a INVERT �oov BOX , �� 0. .�. e; EL.�s9.7.. GAL. INVERT INVERT G �a 0' 3/4"TOIVZ EL......,3 w w W. �. EL.GSpo a.' �� \: WASHED o w STONE '`. PROFI LE OF GRouND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE 8/- JF9 SOI L LOG WITNESSED BY : DATE HJ.�` .!/`ei. TIME.!!-oo A?7 2-A. Gib/v/Z�� /Z S• BOARD OF HEALTH TEST HOLE I TEST HOLE 2 Ti��.r�s�s 4-�7 ENGINEER ELEV. . . .1�--. . . C oo. . . ELEV. . 771777 woz XDESIGN DATA 3(.. .t S 3-So. �- &7-66,00 SuQ-SoiC. NUMBER OF BEDROOMS 3. . 17e= 62-- g Go" LZGScoo TOTAL ESTIMATED FLOW . . -330 , GALLONS/DAY 90 HG-'7J. Sq�va7 BOTTOM LEACH ING AREA SO.FT. /PIT INi T,t/ 5 .� SIDE LEACHING AREA . . ??C.' Zo SO.FT./ PIT Gi.vC S �n/iT'i tiNts GARBAGE DISPOSAL . .NO (50% AREA INCREASE) TOTAL LEACHING AREA .3.�J�. 30 SQ.FT PERCOLATION RATE MIN/INCH No. .WATER ENCOUNTERED LEACHING AREA PER PERCOLATION RATE '�o. . SQ.FT.NUMBER OF LEACHING PITS .� �iT. tNin�. . . . APPROVED . . . . . . . . . . . . BOARD OF HEALTH - • • • • DATE. . . . . . . . AGENT OR INSPECTOR OF .' a4 >EDWAI� 1 o���p1tH OF Mgs�9c H Q a; I+b. saNrt�a�a'� PETITIONER �/��/�q�•-i FSINi�T �'�' •