HomeMy WebLinkAbout0012 CARRIE LEE'S WAY - Health 12 Carrie Lee's Way
PF Centerville
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THE COMMO'JWEALrH OF MASSACHUSETTS MAP 1�0$
BOAR® OF HEALTH PARCEL ��,�?►,�
..................OF.....�14-/�/11.5-.T.IQ. G L�.........._...._.....LOT
Apptiration for Disposal Works Tonstrnrtion rrmit
Application is hereby made for a Permit to Construct (V�or Repair ( } an Individual Sewage Disposal
System at: f Z
....--�E/1[T.� ------------------- T..../..�...................................................
Locati Address
.. or Lot o.
T_1.I1 .1yl1. ... lAek _fly-&A..LV A.Y.._ r /�_y� o.11.:tl t_..
,Q-• as.
..�r ...... 'ner
Address 1
w •--- ---- --
a ----------------------------------------------------------------------------- ------------------
Installer Address
Type of Building Size Lot./8..;?'.3.?.Sq. feet
U Dwelling—No. of Bedrooms........... ...........................Expansion Attic �J o) Garbage Grinder (40)
Other—Type of Building ....J._/A.......... No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures -------------------------------- - '7a2a i -----------------------------------------•-------- ...-----------------.......
W Design Flow........... /.0--------_-------_-gallons per per day. Total daily flow.........3-,S-0....................gallons.
WSeptic Tank—Liquid capacity/W&.galtons Length&..�O__" Width._ f24`:_ Diameter_............. Depth_5...
x Disposal Trench-No. .................... Wid-th.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..-------/______- Diameter.._., ........... Depth below inlet.....6.7........ Total leaching area.ZLOO...sq. ft.
Z Other Distribution box (°_� Dosing tank ( )
Percolation Test Results Performed by.._7?40WA.0 b.....& C�--40,f &D,-_94,Date.....
Test Pit No. l..G.�_.2.____minutes per inch Depth of Test Pit---12.�v...... Depth to ground water...-A& ,a6_--_-_.
,-4 +
fL4 Test Pit No. 2._4. ...minutes per inch Depth of Test Pit.Z�.......... Depth to ground water.AA+9At-,r....___
P4 •-•-------•---•-------------•---------------------•------....__....•--.-..........------•--•----------•--••---------•----------------•------••---•--------
Description of Soil �]-..�Q.�r_....G�L� 11� 5.1��350•G a = f
U ------••-------1'2 Jam....... -------------- ..........S a!��---------GmA1.b.,e7Z0Aa5....---<-a----•-••--------
W --------------- ......7'4 6_�.T------..&.424jes.------......-----------------------------------------------------------•----------=...............................
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.'iITI1E 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 board of health.
Sign . ------ ----------•---...-••--------------••----------------------------------•. ..........................
Dat
Application Approved By....... /G
Date
Application Disapproved for the f ollowinc+ reasons: -----------
----------•------•-----------------------------------------------------------------------------••-----------•-------------------------------------------
--------------------- ---------- -
Date
PermitNo........................................................ Issued.......................................................
Date
No 0�t� ...........
- THE COMMOfVWEALYH OF MASSACHUSETTS
BOARD OF HEALTH
...............OF....f, '.. a.. ± -t .---------......._............_. t
App iration for Uigpuaa1 Works CfIln,itrnrtion Permit
Application is hereby made for a Permit to Construct (VII or Repair ( ) an Individual Sewage Disposal
System at:
/= •L.-a ht v c .e �; 7< .!! E 4 ' - ''- ' - • "......--•"'--'•••--'........... ...
... -
(/'•�` Locate ddress - ' 'j(� ��f/-1� y /�y� /fJ� or t - o. �V
i -J-- i) .... -d_-_Y•- l/. i�FL� ___I!+' _Y.. k �.. -415r_ d r&----
nor Address
,Wa 14'���f ;�...............
Installer Address
«� Type of Building Size Lot./6---�'�____ _?..Sq. feet
Dwelling—No. of,�Bedrooms___________ _____________________________Expansion Attic (00) Garbage Grinder (NO)
p, Other..—Type of Building ___!'! _t!Ll AS No. of persons____________________________ Showers ( ) — Cafeteria ( )
a Other fixtures - • = •-
Design Flow........../�'_��_.........._..........gallonsper person per day. Total daily flow........___._ O__.__..___._________gallons.
WSeptic Tank—Liquid capacity,✓,Pe2P__gallons L--ngth&_. ._.___ Width_ ':__>4_ _ Diameter________________ Depth.'`—."*.._....
xDisposal Trench— No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No---------/........ Diameter....A_---__..__. Depth below inlet.....(............ Total leaching area.'. -0 ....sq. ft.
1 Other Distribution box ("' Dosiri$,tank ( )
Percolation Test Results Performed by._ 'l;-°,� . : `.___! i__..+ s 'rt�':r�?,.R' .Date..... ! .]] r_4.7.._..
Test Pit No. L_�''___-__..minutes per inch Depth of Test Pit.../1__'_______ Depth to ground water-
Test Pit No. 2.4t_. ___.minutes per inch Depth of Test Pit_ Z.. Depth to ground water.M.4W.<e'_........
at
----------•-. -•--•-•--••--•-• ••_-•--• ......................••••••-�-••--••- ----••_............................................................O Description of Soil----------- -f.•••---40A.A-4........ --- � .
V ...-•-••...----. _ ! ll �!`7--------.... ± i--------------- ?.,I_e_!_:! .R?�-•-•-•---•S- �l:--•---...r.?_±v..�✓7f , �"'I
W - �
............... - ----- _J�_ -- ------- z . `15_.--•-------------------•--•----------•--•---------•--._._._.---•-•---•--•---•-•---•------------•--•-------------.._.
V 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 TITI 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 board of health.
Sign , ..
at
Application Approved By....... ---- ----- --- -- - --� - �..................•- --`-----��--�-�--�a---------
Date 3
Application Disapproved for the following reasons-----------------------------•-----------•-------------------------------------••'-------------------------•--••'
w. ... .•
•-••••••••--------------------------------------------------
Date--------.. - = `._.......
PermitNo.-•-•--•-__-•--- Issued.......................................................
Date
i
P. THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEALTH
k."r.. ... ... ..........OF...... ....-.................................:.:..:_.._ ,
•Ra y
(Intif.iratr of Tontpliana
IS IS TO CER IF , gate Individual Sewage Disposal System constructed ( �r Repaired ( }
--•--
.............A..........
ct� I
•• -- �
has been installed in accordance with the provisions of T r 5 gf he State Sanitary C2`�e. d ed in the
application for Disposal Works Construction Permit No _.____ '-_. _____________ dated.""_-`_.� .�
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM JWILL.FUNCTION SATISFACTORY.
DATE.... ._. .- Inspector-- ................................................----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD:AHEALTH
.� ..� S... ...... .....� -...O F:...... Cif:�y..-!�..--.._......__._...._........_._.._..:......
N :. FEE._...-•'•-_-............
inns 1nrknn5, ion r-er-mit
Permission •s reby granted_.._ __. ...... ......:.... .. .. ...••__•...•- ...
to Constr t (. or Rep ( ) a Indi v ual Se a Dispos ystem
at No.__' ._ ... :+-= .--- f-�'----L•ri�! P
Street ` ..�
as shown on the application for Disposal `orks Construction P.,er No____ _____ ______ ated..____. _.. __.__..__ _.___...._..
............. _•• y
Board o Health
DATE...... -----f----------s---•---•f••---•..................-•.--•-•--••.._._...
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS `
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1 CERT/F7' THE BUILDING' ShiOWN 014 TNls PLAN DE.S/G/v LOnD//vG /S u5e2:%
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