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HomeMy WebLinkAbout0054 GREELY AVENUE - Health 54'Greely Avenue A = 246-214 Centerville OPendanwer �Esse/te 4210113 ORS► 10% P4., _ _ �_ _ L CAT ION SEWAGE PERMIT NO. Y I L L A G E � bf IN SeTA LLER'S A A A DRESS �p e ul �S B U I L D E R OR OWNER i DATE PERMIT ISSUED DATE COMPLIANCE ISSUED G� Cl , ilko N ...`:.... Fxs... ------------s� THE COMMONWEALTH OF MASSACHU*ETTS BOARb b1z HEALTH a ........................... ..............oF............:.................................................................----------- S14 y ppliration for Dispoont Works Tonstrurtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ems' c Location-Address or Lot No. s Owner ................................Address M Installer Address Q7i Type of Building 3 Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.............. ............. .Expansion Attic ( ) Garbage Grinder (ue) WOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------•---•--•-----------------•---...---------------------•------------------------------•-•--------.......: W� �• Design Flow........... .S....................... allons per person per day. Total daily flow..........A .....................gallons. W Septic Tank—Liquid capacity' . a9{oons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.............._..... Total Length.....................Total leaching area_._._2,0jR----_.sq. ft. Seepage Pit No.-.4.=P;�.V—Z.... Diameter- I.............. Depth below inlet......L.hT__ Total leaching area.. ....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.... _ __•-._......_�� Date._!'? .s_� �.�'�9 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W' ..........------------•............... O Description of Soil------. f.R-• � -�' � - �?�1�......rLt�?[t a 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 TITi 12 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., Signed._..: .......... >, 1 Date Application Approved By--••----- '../9r �6 y ••-......__... ----•- .... - 2'�-� ............ Date Application Disapproved for the f ollowi reasons........................ . .................................................. .... . ................................................... Date PermitNo................................................... Issued-..................................................... - Date No......................... Fizz..................._........ THE COMMONW54LLTH OF MASSACHUSETTS BOAR® OF HEALTH ...........................................O F.......................................--------------------............................... Appliration for Bispoii al Works Tontrnrtion 1hrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ............... •--..^- ............. .--^....... -I ............- �.... y......... . or Lot N------------------------------------------- ------ ----- .. . ............................::a.:.�::.:a� -:.�:']..............•................. .._.. t �1 /+f• / ! .......................................... Owner Address W $4 Installer S Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms..............' .......................Expansion Attic ( ) Garbage Grinder (No 04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 0.1 Other fixtures ---•''•"-'•'-'-""-'-'-•-'-'-- W Design Flow............ ... ............•....•.._..gallons per person per day. Total daily flow........... r ° ....................gallons. WSeptic Tank—Liquid capacity..M�Qgallons Length................ Width................ Diameter................ Depth................ x Disposal Trench=- Flo..................... Width.................... Total Length.........._......... Total leaching area-----2.r._u------sq. ft. Seepage Pit No.....17:;!------ Diameter.A.............. Depth below inlet......Lb=-.. Total leaching area..- t•n---sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 11 Percolation Test Results Performed by ^ `�.�..............�.. :.__ . ______._.____..._........ Date_.. _-^ 3 "; a Test Pit No. 1................minutes per inch Depth of Te'§t`Pit.................... Depth to ground water........................ Test Pit No. 2...........:....minutes per inch Depth of Test Pit.................... Depth-to ground water........................ • . '�✓may.` �:J Description of Soil--------•........................'---'---"--'-----------------------= _. .. .._..._--•••--•............................. %. V ........................'...--'--...._..----'••""-"-"'..._.......................'-"--"•"----'-'._._'•••-.....-"--'-'...'-"-""'-'--------'---.....""-"'-'•'--'•'-""...--'................ W -"'--•---'-----------------•----•-..............."--••'•-•----------------•--------••'-'•--•"•-'- •--'•••"•'---------•------....--------------•........•"'-....-'_........"........~------•-''- 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 undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. y ..', '�—. A� ..s.sues ;s Q�. 1 Signed == ,--'--'-----•......'-'-'............. ----''.... ""_.._...•"•""............. --^ Date Application Approved By.....".....'- `---- ../t.:,A XI .._ .-.2__r.. i'.�......----' J Date Application Disapproved for the f oll'6wi reasons !. ------------------------------------------------------------ ...........•..............'-----'--..........._....-•---•'-'--------'-----------.........--•-------------'-"'...'-'-"'•'••--- ----•--............................................................ Date PermitNo......................................................... Issued.......................-"---......---..........------ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF......... ........................................................................... (Intifirate of TontpliFatta THIS IS jTO CERTIFY,TKat the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.................................................................................................................................................................................................... tt 1 Installer t,. 1r_Cl-F...•e oL'�..,1 "� 1-.-�•t ,... �.ati.+w •v A /3 ....n.'�"�"'"ea ��1 sT. s`....... at. ----------------••-•-----_.....---------•---------•------------------- ----- ----•---------:-•---•••"---'9•• "'•"'-".... has been installed in accordance with the provisions of TITLE' 5 of The State Sanitary Code as described in the 7�, r application for Disposal Works Construction Permit No. _ _t`%_ ............... dated-_............................................ THE ISSUANCE OF THIS CERTIFICATE i.HALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.DATE........................... L� �. �� ......................... Inspector........`?.' ............................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,.- do...,..................... FEE........,f ............. ' �t�tt]���t or�� �on,�trttrtion rranit . Permission is hereby granted..............................................-----------••.......----------------------------------•-•-•.........................:........... to Construct ( ) or Repair ( ) an Individual Sewage Disposal System ITS at .. , :` .. v'�--�. c..fit_-.,..r 6 �,, �.S—.^ Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... ---/`..... ...... ......-•'-'..................................... / Board of Health- DATE....... ---------------------------- ..... FORM 1255 HOBBS & WARREN. INC.. 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