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HomeMy WebLinkAbout0039 BUCKSKIN PATH - Health 39'BUCKSKIN}PATH x �9J .9� •; a ei' , 7 J:3 a CENTERVILLE;+MA s !'A = .d 170, F 064 r a M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR ©FORESTR MIN.RECYCLED 1 INITIATIVE CONTENT 10% Certified Fib"Sourcing POST-CONSUMER® www.efiproprem.orp S olm MADE IN USA GET ORGANIZED AT WEAD.COM a • Ir 1 No..lf2.:S/5... (_ F :30....:............_ THE COMMONWEALTH OF MASSACHUSETTS Y BOARD OF HEALTH -fa.w.ti......................OF.: flr,v R 6 ...........----------............:......... Appliration for Dispimittl Workii Toustrurtion frrutit Application is hereby made for a Permit to Construct (&-I or Repair ( ) an Individual Sewage Disposal System at: - --.....�3 _....�u.'.Gt. S?, /..:?/........ ' ................ ............................................................. Location-Address or Lot No. -------------•--.....: ,r��i......��1'...c��J..e....... ............. ....... e�. .... Owner Address ,Q .......... ...........••••-••••••••••-----••-•......•...._ �/1��!'����111�....�??'Ce.............f-J!7..r``S% �4Q.r. Ifistaller Address Type of Building Size Lot._<� .'!�g....Sq. feet �., Dwelling—No. of Bedrooms_.�.�:4e e.......................Expansion Attic (� Garbage Grinder W47 M--1 1 p, Other—Type of Building4eVP�.--- o. of persons....... ................ Showers (aR) — Cafeteria (., Q' Other fixtures -----•......-••--•••--••........... W Design Flow................./CU.................gallons per person per day. Total daily flow............�23...9................gallons. WSeptic Tank—Liquid ca.pacityeVM2.gallons Lengthg_..6..�. Width... `/_®_ Diameter.-.".'*_. Depth.AS W._"" x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No.........../-------- Diameter..........(a........ Depth below inlet......6........... Total leaching areal vo G...sq. ft. Z Other Distribution box (� Dosing tank ( ) y Percolation Test Results Performed by._d�?�G .-B?gJ✓. ._..'�.....g4le .1y1'"!�4 �Date...s:'__ __.: .....a.............. Test Pit No. L.Z�`.=_._A.minutes per inch Depth of Test Pit..../ci?.......... Depth to ground waterA.-./.!2------------ (Z Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Q+' -------------------------------------.-_...........................................................................................t....................... O Description of Soil••-•0---./................. Gam•....••-.s/ ................................................................................. v .........-•••••......•-•-----•---•--rot z.....................cS:r2��?Y--......6 r 9!-C �C- - 1- ----------------- ----------5 = ----------------------------------------_............................................. �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 TITLE 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 lid of health. ed- .......... -s�G�.�`----•-------•------- -•- --����-- G---- 1 Date Application Approved By....... lam`-'L'% ...... . ..................... ...... -------- Date Application Disapproved for the following reasons-----------------------•-----•----------•---------------•----------------...................................... .....................•---.........------......--•-•--•-••-----•-••----•-•-----••-._...-••----•-•..........-••••••.........•-•----•-•--------•-•-•••--•--•---------••--••------------• ••-•---------- Date PermitNo.......................................................... Issued....................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ?G.Ls.IA ... ................OF.. G,� ,tiuS.7 eq.ZS. fi•'--•---....._..........._............-------- Appliratiun for Disposal lUarks Tnntitrurtiun 1hruttit Application is hereby made for a Permit to Construct 4o.-) or Repair ( ) an Individual Sewage Disposal System at: ....... ` _;... u�r� .� --•---.... --•-•----••-•-- -- P ... - ......... . .... �flv�.o Location-Address _ or-Lot-No.- - Owner .. - '��Addrgss W i` - 14 ----••-•-•--------•-••••......--•--.----- - A `I'staller l, � -��"CAddress r+-� Type of Building Size Lot_._ ST��.feet p' -Vo q Dwelling—No. of Bedrooms.. `t,9_&_e--------------•-___---_Expansion Attic ( Garbage Grinder Other—Type of BuildingLugjQ!...1rn7..'�lk4Vo. of persons.......3................ Showers (o?) — Cafeteria (�f� Q' Other fixtures -----•--•-----_-----_------------- - WDesign Flow................... 0_.............gallons per person per day. Total daily flow.__.........._ 3...©__.._..___..._ one., W x Septic Tank—Liquid*ca acit .re!Jallons Length Wldth---.�, 0 .� >ameter---f�6-n---- Depth................ Disposal Trench—No..................... Width.._ . o.Kength........ i.... Total leaching area..(96. CI...sq. ft. Seepage Pit No............./..... Diameter................... Depth below inlet.................... Total leaching area..................sq. ft. . . Z Other Distribution box Dosin tank ) '-' Percolation Test Results Performed by9 ' 9tf �'� ate.... ............................. .. Test Pit No. l.... '...Aninutes per inch Depth of Test Pit...... Depth to ground water..X/r'._.__...._.. Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ •--•-----------------------•••--------------------------------------....................------...............--•------•--•--•--------------........-•--....•. O Description of Soil....... ................ A�"r1........ v /' =----------------•••-- txj .oZ.-.5_`._....•----•------•�t?e!l .---•-�' ..�.L...-•--------•--•-•-•-----•------•--•--.....---•---------------•----••-•--------•--- W ......-•-•---------------- --------- /r?t'a.........,Sle9.7-------•-•---------------•-••----•-•----------------••--•--•----•----...------------..... 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 TITL1 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 b KaT4of health. ed. � f ttt't' a- �'✓lv.---. .. e� Date Application Approved By........---•-•-. . u..?...._ ..................... ....... --------- Date Application Disapproved for the following reasons:-----•-------------•------------••-----•--------------------••--•-----------•--•--------.......-------••--..._.. ...............•--••-•-•-----••---•-•--•....•-••-----•-•-----......---•--•....-------•-----------•--••••. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........OF.... + ........................................ Trr#ifiratr of ( ompliantr THI I,S S TO CER FY, hat the Individual Sewage Disposal~System constructed ( ) or Repaired ( ) by.............�'t+i`............ ...............•-----------•-•---•-•----• ................1................................................................................. /� at.................... ........... ................................ AIC11. C' " has been installed in accordance with the provisions of TI`L 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.__.....0..S/-r.................. dated---.:........................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............. dLe / ..`...................................................... Inspector_...: ✓•- ..... — THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF .. No......................... FEE .. Disposal Workii Tong wi It rrmft Permission' hereby granted........ _� ,......... ----•--• ..................................................................................... . to Constr) , ) or-.r�t� Individual Sewage Dis osal Sy§tern at No. P -111AI&A------------ Street as shown on the application for Disposal Works Construct' P mit No..................... Dated.......................................... B rd of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - \A ~~ .T-MiE:D eCoAA, Ito 4 3 : ssc5 6.p.t2. m ---,- uS�- I OOC�o N . P0s/,,.- S,ur.6e,lALL TVL TOTAL T>ESIGQ = .425 >,G.P-rD. a a a'a"1� tv 'T-c>T,&t_ DA t L�f FLOW = 330 6.PD. r a PElZGDLQTI0LJ 2ATE ���lU Zhc1tJ 02 L�S�. �2r�t�o'S 4 �20 1 Of J. ;s} wi..'c ft tyre All oil Tor rrwvo = ioo.c f?��A ljrPP� IW. GAL. -BoX 2 F=- J TA� W- // 1000 t�V lW. �. 7"b GAL. 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