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HomeMy WebLinkAbout0000 YARMOUTH-BARN. TOWN LINE a� ca�a � c., N�awz 3y"1-mil LOCATION SEWAGE PERMIT NO. VILLAGE ' t� INSTALLER'S NAME a A DRESS ` s u r o E a OR owa E_Y_0) JA G DA T E PERMIT I S S U E D DATE COMPLIANCE ISSUED _.. � .1 o�� N��^/ � i� e«�cu f � , � / �C-�A/' J ` -- __ ,� _ ezae4 TO N OF BAR, rJST BIwe LOCATION SEWAGE VILLAGE ASSESSOR'S MAP & LOT- k7,-zvl Y INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY (SOD f A LEACHING FACILITY:(type) �'&J-'j e) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: `0 DATE COMPLIANCE ISSUED VARIANCE GRANTED: Yes No .__. �� � � "� N� � 6J`9 e -d _ �� �� �� "� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH u1 ........oF..... ............................. Appliration for Disposal Works Tonstrnrtiun rantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atrN ... - `......................... L ation Addr s or Lot No. .....��� t�. T-f.....�.........-•------- ....... t4n.l •------------------------------------------- _ ... _L :_.. 1G(C Y_f__ � .... Yl- ( dd�1C.._...-•-•----------------•----...---- Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '14 Other—T e of Building ............... No. of persons............................ Showers a YP g --•--•-•-•-•- --•-----•-----•------•P--- ( ) — Cafeteria ( ) Other fixtures .......................... .. - -•------------------•--------------------•---------------------------•------•---------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ 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 ( ) Percolation Test Results Performed by.......................................................................... Date........... ............................ ,.� Test Pit No. 1................minutes per inch Depth of .Test Pit--------_........... Depth to ground water........................ (GX, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ODescription of Soil................. L -�......g.vc.,� .. -----•--------••---------------•----. .-----....------.---- W U Nature of Repairs or Alterations—Answer when applicable-----------�.__-4.0.O. _..__.._ ._.__._. __:_ -_.___.... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'ITT.^ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the board f health. Signed•. a Dat Application Approved BY - -•-----t�/�' 1 ......... ...................... Date Application Disapproved for the following reasons:.............. . __ _ ..__ _ __ .......................................•------------•----•--------•-•-•---------•••--•----------•--•-------.....-•-.......-•----••--••••-••••-•-••....-------•••••......---•-------•-•••••----•-••--••. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH `+ A ..�........OF........', y a .............................. Appliratiun for Disposal Works Tonstrur#iun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System ate � F _ .... ..:.....1'�.....s. .... S:':................i......:......:; .........._..- ........................• ..._..................••..............._. Location Address l ti I or Lot No. r y a .rT r �`� � ; Owner d Address t 1 t r ; i ,1'+rj; ice;�l ;,� ` ................................ v -----.----------- ------- a._ - ... Installer Address Type of Building Size Lot_.___•:--_----------------Sq. feet V Dwelling—No. of Bedrooms.............•................_. .....Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria 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 ( ) Percolation Test Results Performed bY....................................•----------.... .................. Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ w Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Descriptionof Soil........................ - .....................-•-•--•--•----------------------------------------.._..-----------•---•-----------•------------------- V ..-•••••-••-•-•••••-••••-•-•---•-••-••-•--•••-•------•-•••---.....-••--••--••--••••----•••-----•••.....•••-•----•-•••-••-••--••-•-•---•-•-•••••-•-•._.......••••-••••••-•.....-••---•-•-•-......•..... _...- -------------------------------------------------------------------- ------=-=------------•--------•••-•••---•-•••......:.....-•....._....••--- ----------- ------ -------------------------------- VNature of Repairs or Alterations—Answer when applicable___________ _________�_-:3•_�,__-__ j ....t......_..1.: �.__�_.......••......... , _. ¢ --------------------------------------------------------------------------------------•----------------••------------------.......-•--••------------------------------------------------.....--•-•---•• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T ITI: y g g p y 5 of the State Sanitary Code— The undersigned further agrees not to lace the system in p Compliance has been issued by the board of health " operation until a Certificate of Signed _ ... r Date Application Approved BY -----`'................ .........,. �.!i'� ....................... . Application Disapproved for the following reasons---------------------------..............................................=...................................... ....-----•--------------•-•----------•---.........-----------....----------•-=---._.......-•------------...---------------------- -------------------------------------------•••••......••-••-•-••-•-•--- Date PermitNo......................................................... Issued....................................................... Date I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -ry .......f. .f:.:r. .........OF...... ...... rl 1 u ............................................................. �; �rr�ifirtt#r of �uut�rliaanrr .IS IS,TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( -- y •--- ---------•-•----•-•----•. ..... ._._..._ } {' Installer r has been installed in accordance with the provisions of 11'i LE r j of The State Sanitary Code as,,described in the application for Disposal Works Construction Permit N :_-., '....... 'ed_... THE ISSU CE OF HIS CERTIFICATE SHALL NOT BE CONST E, AS A GUARANTEE THAT THE SYSTEM 1lVI UNCTSO�I SATISF�4CTORY. !� DATE--.----- f-- ,-- - .................................... Inspector........ .....• •••............................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH { �7 ' xlR.�. P .........OF.... e^ I.. Ada .:Tf..?.. ff ................................. r 1Vp..... ....:....... FEE........................ Disposal Works T11no#rudiun amit 9 ,�*p l.. / e 111/.j'`�" .�" .....- r �C;212 ...............•......................... Permission 1s hereby granted.___.- . ... f " :.. -- to Construct,( r) or Repair (' -•)'an Individual Sewage Disposal System atNo. ; r .................................... Street as,showri on the application for Disposal WorksConstr'uction Permit .No.....-_•..............Dated.......................................... ...r _ 1l!s -H --------------------------•-•-•-----•- r-" oa! ter ' r of Health DATE-------------- - ---- ................................................ FORM 1255 HOBBS & WARREN, INC., PUBLISHERSAli y W �; •Town of Barnstable P�oF.NE r� Regulatory Services Thomas F. Geiler,Director .BARNSTABM 9q, MASS. Public Health Division yA i639• A�� lEn � Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 t Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form /4r9 q o200`�Date: - -. Designer: L94�6� A11 N0WCFVIC;Z_ PX. Installer: &lAy L, kX-C- ,i/uG Address: AMC> _I;,- Address: Q'7 B z - WESTieMovrH . /46- o2G78 0 2G 7,3 On k-<-5 1,4 A was issued a permit to install a (date) (installer) septic system at ##3 .S/MP.5oAj A9V1 '. �L based on a design drawn by (address) DoryA� l.(/ /��DNC�y6G dated �(i7� t (designer) V/ I certify.that the septic system referenced above was installed substantially according to the design, which may 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. Plan revision or certified as-built by designer to follow. N 0'F M4sJ, o?` pONALD yc (Installer's Signature) MO No.2048720487Z O �, G/STE����� (Designer's Signature) (Affix r'��t AID PLEASE RETURN TO B STABLE PUBLIC HEALTH D VISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTIO THIS FORM AND AS­ BUILT BUILT CARD ARE RECEIVED BY THE BARNSTABLE PU LIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form r No. tis Fee yV� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for Migooar 6potem Conotruction Permit Application for a Permit to Construct )R pair )Upgrade( )Abandon( ) O Complete System D Individual Components odation Address or Lot rDty� Owner's Name,Address d Tel.No. C�a 1L y°3 S�MPson e 'Qruce:Tc. a', C041 sessor's Map/Parcel s / w00 J f V e _ If 7 3� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ss__1 Ya r"Ic"A M en w v ';c-z P.G G°7 Tpw, o K rZ a • e o y � 4l0 IPm► Si- . I�JeS �•►AS MA Type of Building: �� s�9 Dwelling No:of Bedrooms c-2 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow /�9, /���� gallons per day. Calculated daily flow �2('� allons. Plan Date �'I® !q y Number of sheets , ? Revision Date 2, 0 Title Size of Septic Tank Type of S.A.S. Description of Soil tr—_a« paten Sa,c,Q 1(7 fc 32 n^Z6 L Song it)y►c /'^ I32� SHE► 10 (v �0 LJ flr"��t ? Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction 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 issaftd by this-Board of Hea�th. Signed Date ` 0 Z` Application Approved by Date l� Application Disapproved for the following reasons Permit No. O 3 Date Issued No. c.C%-k_.I \ 4 t4 Fee t Entered in computer: LTHE COMMONWEALTH OF MASSACHUSETTS . Yes PUBLIC HEALTH,DIVISION"-TOWN OF BARNSTABLE, MASSACHUSETTS Tippriration for Diopood 6potem Con! trurtion Permit Application for a Permitto Construct( )Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components eL.ocation Address or Lot cA rl" �� �V n� Owner's Name,Address and Tel.No. �I �C H 15 "S i MTSon1� 1'1Vi✓0 '" tKIgt- C, . „Assessor's Map/Parcel � Installer's Name,Address,and Tel. o. Designer's Name,Address and Tel.No. rt an 1-�'�SS I�� W s►-.` a rMc� 1 '1 cy)c¢V ' P. C �l7 "'Tow•+ �o >2a • o Z1v�3 14 S+- Wes-), /;ls. 1) Type of Building U � s'9 a1-0 soy o-.7670 Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other_. 'Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 7Rgallons per day. Calculated daily flow 2�2. gallons. Plan Date 4 161110 Number of sheets ) Revision Date_ e g O / Title Size of Septic Tank 1 C7 Type of S.A.S. Description of Soil ' — it �? S.--,,,A lnytc 3 /111 t 0 Y� 6 av C 7 . � l J 5 I Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction 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 issu d by this Board of He th. . f Signed _ Date / 0 �" Application Approved b Date / F Application Disapproved for the following reasons Permit No. '�Ojo tf-- EYm_3 Date Issued -- -- _ . THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certif irate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by at V s '30 has been constructed in accordance With t e provisions of Title 5 and the For Disposal sal System Construction ermit lo. �dfw-.�5 dated_16 //5 loq . Installer�_ ,/J rQ1 Designer r r'1,1-No. ,6, The issuance of this permit shall not be construed as a guarantee that the sy-steiYT-will funCt'ion as designed. Date G� Q � � Inspecto( ----------------------------- Nl� _ Fee_T7 _ THE COMMONWEALTH OF MASSACHUSETTS l PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS ligoaf *pgtem Con5trurtion -Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) r System 1 Gated at ,._, S o a —0 ytu,?_g,11)L2rk MaE6AMIQU!i jyvewvjrz��) 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 must be/completed within three years of the date o�JQ&11@tDate: - 5 A" G' Approved by `a _"_ T ®® No. Fee /310- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppfication for Mie;paaf *raemc Congtruction Permit Application for a Permit to Construct(V Repair( )Upgrade(f)Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. YAC1 f VrH Ca►Mf'C c�a�l� Owner's Name,Address and Te.No. �� /1�. �n. Assessor's Map/Parcel &9 431./7-"ieW Wv® V19 er Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ,Br�i/W G 1C,SSit..//VG 4®8� ®' ��a. ►t.�t Mo�c.�'t�icz, /�?�, Mj®3.6 ®as®.S1r: vtf�• l'��iv�/S� /��®26 m Type of Building: welling No.of Bedrooms Lot Size sq.ft. garbage Grinder("® Other Type of Buildin No.of Persons Showers ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision tB Titletr'At) -ic !� Size nk A 45A s Type o S.A.S.It q toDescriptio �JM �A�� :ZAm f0 ® W,97jkRo Nature of Re airs or Alterations(Answe when applicable) Date last inspecte . Agreement: The undersigned agrees to ensure the co s ction and maintenance of the jdescbed on-site sewage disposal system in accordance with the provisions of Title 5 of Environmental Code and not tsystem in operation until a Certifi- cate of Compliance has been is ed bythis Bo J�ealtb Signed DateUr 251 20" Applicatio ppro Date r` Application Disapproved for lowing rea ns Permit N Date Issued `= =a THE COMM WEALTH OF MASSACHUSETTS L"- BARNSTA LE, MASSACHUSETTS c, rn �ertifi to of Compliance THIS IS TO TIFY, that the On-site Se age Disposal System Constructed ('/)Repaired ( )Upgraded(� Abandoned( )by at �i .S has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector No. a Fee --- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS x3iq gar *p.5tem Construction Permit Permission is hereby granted to Construct ✓ )Repair( )Upgrade(Abandon( ) �( System located at�,� ��r� �1MP ecny/�DS_ 4-3 Sirv�pS®i t /`tvEr'. 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 must be completed within three years of the date of this permit. Date:_ Approved by y / No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in mpvter: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACKOSETTS ZIPPrication for Migogar 6potem Conelruction Permit,, Application for a Permit to Construct('Repair( )Upgrade(f Abandon( ) ❑Complete System El Individual Components ~Location Address or Lot No Yg0e&W0,rq CAA1PC•&tj#4DS Owner's Name,s4ddre ndTe �No. I�A6 h+AtiC /�, Assessor's Map/Parcel. �'� /7'f f. O00 V9r 0,� tQ .347 1�st-aller's N e,Address,and Tel.No. Designer's Name,Add e s and Tel No. t"; ) 1An�aG K�ss�.IlvG �D9) �6 D At.v w M00VCArV1CZj,_R, J 1-1 T'ou��u r3Rootc R.wA wAVIr yttRn�lourl�I,,M/foa673 Type of Building: welling No.of Bedrooms w. Lot Size sq.ft. Garbage Grinder( O fs ail ' Other Type of Buildin No.of Persons ` ... Showers )I Cafe ter a( )� Other Fixtures _ _ ) Design Flow � '�*� gallons per day. Calculated daily flow- _ gallons. Plan Date 4k' ..,off , 4704 Number of sheets a Revision Date Title�Pttr�S.ED1/V 'ARY.. .s'r.�"M !�f' 'AU . . T/OM. I r�G�4T/41�✓ Size of Septic Tank 4_.reO 6A1_ -,Z0 Type of S.A.S. d* Description o ,Soil a,_(9" 4n_g1" .✓A 0YR 32 8-.2t� Ats tji.S ,It I /�y,� Nature of Repai+rs#o rAlterations(Answer when applicable) i---` 1 Date last inspected: Agreement: The undersigned agrees jo ensure the con, ction and maintenance oft,he:4fore'�descr bed on-site sewage disposal system in accordance with the provisions of Title`5 of th Environmenta Code and not X 1p ace eth�system in operation•until a Certifi- cate of Compliance has been ts(r ed..byv H +Btot",al.thr ,. Signed . Date AAX 2cf. 2. d - '"' Application Approved-by. Date Application Disapproved for the o owing Teas ns l ' ry Permit N.. Date Issued THE COMMONWEALTH OF MASSACHUSETTS s BARNSTABLE, MASSACHUSETTS ' «, Certificate of (compliance ` THIS IS TO CERTIFY, that the On-site Se age Disposal Syste Constructed(V*)Repaired ( )Upgraded (✓) Abandoned b ..gip at�,wewlmc�r-H AMP D S /Mfs R/ l/Zhas been constructed,m accordance with the provisions of_;Title 5 and the for Disposal System Construction Permit No` N.t s;� =.dated{' :=,::Installer__ a Designer .. ;, ,. •; /;�. The issuance of this>permit shall not be construed as a guarantee that the system will fanctton as designed. Date Inspector w _s_ No. Fee J Q� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS - ;Digpo.a1 pgtem Construction Permit , Permission is herebyranted to Construct t � g )Re air( )Upgrade(�/j Ab d n,(,. System located atY�J ? i �i4!►�IEC�.1VL�.S� '' `� "•` %'1P..SJ J •.. _ - 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. . f ` Provided:Construc'tion6rnubeeompleted within three years of the date of this peg" .. Date:_ Approved by .t r t ! h a yAIZMOUTH CAMP GROUND SSOGIATIOI�Y,€�Q Cry- Q; f� o Yao tl r. ,gO2) Z�l yA RMOUI'H CAMP GIGO D ASSOCIA.TION lives. Ito . e � Ll i i B I i N� i- I ooY PIam i YARMOUTH .CAMP GROU ASSOCIATION, INC. la- j, w - 6YelA�RW1M4O U.�T q CAMP .G DO U N ASSOCIATION, YrtC. 1 99. ' s --R ec`Y---_E.. -- YARM OUTI� CAMP GR UND ASSOCIATION, INC. ys �n J�-eAAf coK� �e_va -i�o ri._._.._................__ .__..__...__. e`er, 1 ` "0000 / YARMOUTTH CAMP GROU D ASSOCIATION, IN . F 1 t: �i f 14 " Nous.W Cco, ZAtBOAAJ> .AS.• ,- outA- 64eAA R 80ARP ,•AC>„ CORM" So eA5IFA4WJ> Fit GA-carV& SN40 "F" 7; wk .�is,A xr CokF e q lDisrc�r�crr Bmx ",T .Qis�R , tic. �t,�so�e�Tio�v �ysT,�is^ IG ` A5 i �9Y "n /skk OF B -fig 4a. 9 y' h-�. G-11-� �9. •¢• o DONALD G W. rn, ONCEVICZ /�- 23,g f{- , --ra(S M No.20481 O �FSS�O.NAI.��� �o�is /s.�3 �r�ns�v ,4��c�.� ► 9 z«�� Donald W. Moncevicz, P.E. Civil Engineer ,34"7 Y' leeoe - cam/ 40 Pond Street West Dennis, MA 02670 5077 u - - it OUnas�f "U "� Q /' T}14.t#E� /4r, �__ '•/i� ;.. T �° I .Q I� CY' tl �•©�r _ _ 'o °� iii �ii u0 O � 0 \ •\\ �'� 4 � � .•� C5. �� Ti ri ��.�• 1'd ° 0 1 `—rrTr-' o ) dl P\\ o° -O- �t O ,� r \`• /• q \ �� J2 ba'\,•o y0 r O °o o ' l .e. u •o ;)5 _ ©. g lid 0 \�0 u o Q' O o o r Q o � /� Q Ocoy ���� © 50 '• o © rir oO t � `�' '� .4616 �o �o© O•L�°=i q ( / (�� o• ® o o.° o ° o o d ° o � © Ww O O O o1 J °� '�+r��.k Ate u11 ° ° o O� 1 o cY� ' y or '- �j on � �'•t ���`••/ O �. ~p {LL Rad Gr cis qR/ of and - �_ 0 u STAB, b F t -- -- ° p Dunn ©©� Drive -in o\ t(�� © of p ---_ , raeel nd a "Theater © \ � © vim s; d J / I�3 W 69 4614 b I( 0 r _ if u u Q ram' a BARN - �-r-_AIRr-� o _.. .._ _..._ -- J, r! -rs T3-.72Mr-StP/ 11140_ N - - - - - - -- - - - - - - — woe,a - - a.ez Ac l 1 I � PIO e3.3 / r . �cb n 77 � • 4 91 ; i {,} r., I 1 �'iQN= �.,/tom ,'-•7 � _r.-1 :r�'\.� ' s�l� I 5. Jig 16 P I •``,/� 0.71 AC C�' COMMONWEAL OF mus ;aF+. a46 ZL •; 1, sON 21 I 33.48 AC i 1 Ci ti otS3 S chfo�IVIa/Pa ce! 347001 = r �'For�Parcel�Number 347001 _ ..... � � Rental Prvperty(YfN) yBusines'srName � e of Con riLaution(Yl>�[} , � j Zon ''' �� ,, Area� y_um�er � � Con#ammant Rel Y!N yPhone„ 000 0000000 Fuel Stora a Tank hermit� � 4 $ � v �� Card On File Disposa�IWorks "` "/• * r ,�, erG Test �? °.y ,_Well Perm, r ✓" ! . ivy 99 371 i ��FileiPermrt No j ,Issuance Date 06/21/1999 i _ a a ' Gom �etronDate 06/22/1999 P / f Sue of Septicy,; Ty)ell Sizeo1,,4SAS /i J/ Simps 1500 st dbox 2 500 cham in 13x25x2 99 371 replaces DWC 95 1780 a. mapparF 347001 ®wner� YARMOUTH CAMP GROUND ASSO proploc y 0 YARMOUTH TOWN LINE �l ...ate �... A ��s Innovatiue/Alternative Technology Septic Sys. IMM, Sing,e�o . ' l/A Type 1 UA5erv�ce TYP [us E t � addE delete records? y No............ .1...... Fps........./...?...... THE COMMONWEALTH OF MASSACHUSETTS BOARD qF I—IEALT_ ------------t ........ OF......... . ..l"G�/h�....u��� - - .... Appliration for 11bipos al Works Totutrnrtion Famit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systetn t: ess o Lot No. ... -•............... ....... .--' ------------------------------------...... ........_._--------- .---r2r-(-.®// -.--- AOwner Address Q � n a ... ... --+..`- — _•- ------------------------------------• ........-----•--•----•------..---- ......13a-�.�2 . 7 Installer Address Type of Building _ Size Lot............................Sq. feet Dwelling—No. of Bedrooms___________________________________________Expansion Attic ( ) Garbage Grinder �)'A). aOther—Type of Building - ^^ No. of persons..........:................. Showers ( ) — Cafeteria ( ) Otgrfixtures ..------•------------------------------------•----•---------------•------------•-: .......----•---•--...........---.........._----------•-•............ W Design Flow.... ...-��-.............................gallons per person per day. Total daily flow.._..._._` .......................gallons. WSeptic Tank L Liquid capacity/5O.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width............................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..........I---------- Diameter.... Depth belwt _ine _...._ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) L .� Percolation Test Results Performed by...... �A_�.:7. ._.=._. ...0...1.. ......... D ate..... ................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ w Test Pit No. 2................minutes per inch Depth of Test-Pit.___............._.. Depth to ground water........................ 7= O Description of Soil0_----/--------..'__V . . �,` / )A;l �`r < y - -- 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 TITLij 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the boar of health.. l � ` ..1 !---��-- --------=-�------------ �`� - � Sign - V+ Date Application Approved By �._ % �`�- 12.��! l 7 7 t`&2...----E... . • ........................ ......f c� --_............... Date Application Disapproved for the following reasons:------•--------------=-•----•-•-----•--•------------------------------------•--•------------------....._........ --....-•-------------------------•----------•------...---.....------------........-----.....---------•--.-------------------------------------•------------•-•--------••-•--------•----•-•-------------- L' Date Permit No......................................................... Issued--- . `"3 ? .................. Date 1' Z T Fim$... ..L.iZ -THE COMMONWEALTH OF MASSACF,dNJSETTS { BOARD F HEALTH AA :-- . .OF ....+ s. ; �r lirtt#i�af �u� Uwvoiik Works Tono#rur#inn Vamit 'A plication is hereby made for a .Per it to Construct' ( . ) or Repair ( ) an Individual Sewage Disposal Syst at � ...._ dress or Lot No. ._ ....... ............................................................. ....------------------------..._...._____..._........_.._._....________________..............__ r�a ................... e y A Owner Address.... -- ------• 4_ A.......................................................... ::...------------------------------------.._...----...-•--.._......---------------••--•-••---- Installer Address Type of Dwelling of Size Lot___________________________Sq. feet U g— Bedroom $ - Expansion Attic ( ) Garbage Grinder ' ~' w., pa, Other—Type of Building _________ ________ _ ___ No. of persons............................ Showers ( ) = Cafeteria p' O xtures .. d -............................... Design Flow _.:: __________________ ___.gallons per person per day. Total daily flow....................... gal W --=----•--••---------•----- Ions. WSeptic Tank V Liquid,capacit3Rb0_-gallons Length___._____________ Width................ Diameter................ Depth................ Disposal Trench—No_____________________ Wid h . _____ Total Length.................... Total leaching area-------_.__.__.._.__sq. ft. Seepage Pit No...____;_1:_-------- Diameter.__:.. . __{Depth be.ow inlet................___ Total leaching area..................sq. ft. M Other Distribution'box ( ) Dosing APE ( ) '/1 w .77 Percolation Test Results Performed by- Gt�ia t_.: ..._: ._:___< . ...... Date___ .......... Test Pit No. I I_______________minutes per inch Depth of Test.Pit.................... Depth to ground water......................... Test Pit No. 2.::.............minutes per inch ept of Test Pit.................... Depth to ground water......................... O y ®''�'jD9 _ �...........j . W� fir-at� sue► j� •______----- Rf�` Description of So'ii'------- --------- - -- --------�- --------- --------- --------- -�!_-_- ---:__:.....-•---- V ----------- -------------------------------------------------------•......-___................................................................:............................. W ....................................=.......................................................------------------------------------------•-----.......................................................... VNature 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 undersigned further agrees not to place the system in operation until a Certificate of Compliance has beeq issued by thi boare of ealth; Sign , --•-, ---- ------ .: W 1.---....?. ..... Da tee, Application Approved BY = :.. / -- �--- Date Application Disapproved for the following reasons_...................................................... ____________________________________________ - . Date PermitNo......................................................... Issued.................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALT • ( rdifiratr of ToutpliFattre . T TO C aiat the Individual Sewage Disposal System constructed ( ) or Repaired ( ) .............. ----•-- --- ...................... .._...__. .._ nst l r wt "" has been install d in accordance with the`-,provisions of f The State� Sanitary Cock. as escribed in the t application for Disposal Works Construction Permit No_ __ _________ ___ _________________ dated--------OP-4 THE. ISSUANCE OFITHIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM'WIL'L FUNCTION SATISFACTORY. DATE................................................ ........................... Inspector...................................................................................... THE COMMONWEALTH OF MASS ACHUSETTS BOARD OF' ; EALTH I 7 Nod.,.r .........OF:.............. FEE.. •. �i pas rkii t$r#Wu Orrmit Permi ioniereby gran d.... ................. ---------------•---- ---------- �:Zj to Constr t ( or Re ai ) ndivld ew D p ss Syst atNo.`- - -------- ------..... •---• --- ----------------------. ...• 7rY"--`- •.................�'. - / Street $ as shown on the application for Disposal Works Construction Per No-- .______.____ ........................ _ --- - ----- ------.. -- > Board of Health DATE FORM 1255 HOBBS a WARREN, INC.. 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