HomeMy WebLinkAbout0140 GREELY AVENUE - Health 140 Greeley Ave.
A= 245— 140—002
Centerville
S ME A D
No.2453LOR
UPC 12534
amaad.aom • Made to USA
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THE COMMONWEALTH OF MASSACHUSETTS
�� BOARD OF HEALTH
14
d,4� Appliration for Disposal Works Tonstrnr#inn ramit
Application is hereby made for a Permit to Construct ( ) or Repair (fjI'lan Individual Sewage Disposal
System at: el+-e Vr V tl
........�. ®_._.. . .1. .._ ------ ------------ -------------------------------------
- .....
L cationA dress or Lot No.
----------------------G= ' .................................. ...------------ .-...------....---- --------------------------........---...------
---- ---------
�j ,,�• �wn r ._. .•-.••.Address
....... .T�e�R .... •�/'mZ5.—•............................... ...............•............... .--••----•---............0.................
Installer Address
Q Type of Building Size Lot............................Sq. feet
U DwellingNo. of Bedrooms.._.-.-/------------------------------------Ex Expansion Attic— p ( ) Garbage Grinder
aOther—Type of Building ___mow `! No. of persons.....................0...... Showers ( ) — Cafeteria ( )
d Other fixtures
W Design Flow.............. ......._.._.__._gallons per person per day. Total daily flow............................................gallons.
C4 Septic Tank—Liquid capacity.j ogallons Length................ Width................ Diameter................ Depth....___..._..._.
Disposal Trench—No. .___...--•-------_ Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.....C;-1...... Diameter.__...�..Xf_. '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.......................
(1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 --••--------------------------•-------..................................................••..............
ODescription of Soil...............................-....................................................... ---------------....---------•-------------------•------------....----•-... ._..
x
w
x -------------------------- ----------------------------------- ----------••--•-------...----••---•------•--•-•-----•----------------------------•-•---------•---•...................................
U Nature of Repairs or Alteration,s—Answer when applicable----/-j�0?__-_yA.1-Q___�$�P _T Go.._.__._p......................�__/
---•-•-----•-------------•--•--------•...-•---•----.[+l_%_� f�kz :C rt�....4•A'._------•-••-------=�� •• 1`��"t�-�SR4�--••-•----/_PSG
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TL I TL LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been 'ssued by the board of health.
Signed-- •• ......--- .......... -----••------------- 3
Da
Application Approved BY = �� = ..... ------•-- . ._...... ��..................................` -�
------
Date
Application Disapproved for the following reasons---------------------•---•------------------------------------••-•-•--•-----............. ......................
......................................................--------------------...-----...--•--•-••------••------•--••-•-------------•••------------------•-------•----------------•--•-------•--.........---
Date
Permit No.------ ....... `� ---- Issued------------------- ......
Date
f
No......19VI .::-4'?J t—. Fims...................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH __--
Appliration for Disposal Works Tonstrnrtion frrmit
'A lication is hereby made for a Permit to Construct or Repair ``'
,'�° .PP Y ( ) p ( Individual Sewage Disposal
System at:"
• -..L.YC Q � ----------------- ........................
Locati Address ------ or-Lot-No.
�, ---
.......--=-------------------------------------- ---------------------___ ------------- Ar___..... -------------- ------
Owner dess
...........
.............................................. ----------------_______.-___-__-------•---••-•-•--------
Installer Address
UType of Building Size Lot............................Sq. feet
f-1 Dwelling—No. of Bedrooms..... ...................................Expansion Attic.( ) Garbage Grinder ( )
Other—T e of Building No. of
QI YP g -------------------•----- persons..............-............. Showers ( ) Cafeteria ( )
Other fixtures ......... .............` .,- ---•-•. -'-�_
W Design Flow............................................gallo s per person per'day. Total daily flow............................................gallons.
WSeptic Tank—Liqu#gi?acity------------gallons Length................ Width................ Diameter________________ Depth................
Disposal Trench—No______________/.:O 19 didth______.._.__.__._.__ Total Length.................... Total leaching area______________--____sq. ft.
Seepage Pit No_____________________ Diameter.................... Depth below inlet......_............. Total leaching area..................sq. ft.
Z Other Distribution�opc l( ) D,sinoank ( )
Percolation Test Results Performed by........................................................................... Date_•••••-•--------- ......
r;
____________riiinutes per;inch Depth of Test Pit_.______._________._ Depth to ground water........
f� Test Pit No. 2___
HI r .
-�-
per inch Depth of Test Pit____________________ Depth to ground water........................
a _________________••-••-------_.______.....--------__.__...---------•--------•-------.....•--•-_...--.........................................................
0 Description of Soil... =------.--•-----------------------------------------------------------------•-----------•---.____---•---------------------------•----------_...-----------
U ..................... `=------------------------------------------------------------------•--------------------••----------------------------------•------•----
U Nature of Repairs or AlteratiAns—Answer`when applicable_____,��ton.__f,� _________se -Ti_ . ...........
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLL 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.
S, ned....
�........
. �0 ... .....
G -•-•••-- ---•--_
7APplication Approved BY-------•----•• �•--•••----- . � �D1,
Date
Application.Disapproved for the following reasons______________________________________________
......--•---------•.......................•... ----........._
---------------------------------•••-----------•----••-•-------••••------••------------••--_______------.-----____._.--..---------------•-------------------•-------------•-•----•----•-----------•-•--.
Date
PermitNo....... .- ................... Issued.......................................................
Date
5 THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
f e bs
lw?' ............0F........... �3 ...........................
Te rtifirate of fwiaaZtpliFanrr
THIS IS TO CERTIFY,V 1_:� That the Individual Sewage Disposal System constructed ( ) or Repaired Q�,
b ---•----------- -----••..
Y l Q ...
s / Install i
---------------•---•--------------- ___
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code'as�'d'escrlbed,in the f
application for Disposal Works Construction Permit No......................................... dated............. __.___._
PP P
THE ISSUANCE OF TINS CERTIFICATE ShIALL.NOfJ;E CP6T11E® AS A GU ►M1rEE7Ii�cIE-
SYSTEM WILL FUNCTION SATISFACTORY.
DATE. .__ z. - —..... Inspector.. i�
------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
,
M
NO' `�• .3 3 . . ........... Q�?�..........OF........
Disposal Works Tunstratrtion rrutit
Permission is hereby granted.................. . -•-•------•-••-•--••••-•--•••••--•----•--•-•••-••.........................
to Construct ( ) or�Repair (Z--)'an Individual Sewage Disposal S stem
z
at No........1`fo--•---- _�r...:_.._ '� .... . ,
Street �fl'.f/L + G � +�f! '�,,,5""
as shown on the application for Disposal Works Construction Permit No. . _�_.__.___ Dated__________________________________________
S^ .....................................................- _
��- I �� Board otealth .- ,.
DATE.---•------------••-------------•-------•---•---._.._._..-•------------------•-•
FORM 1255 A. M. SULKIN, INC.,.BOSTON
LOCATION SEWAGE PERMIT NO.
- s-a -
VILLA6f
/ r
INSTA LLER'S NAME i ADDRESS `
BUILDER OR OWN ER
Atf o9&N Af Gsi YA"
DATE PERMIT ISSUEDZ �zz .
DATE COMPLIANCE ISSUED
1,
y r-
F' ��
LOCATION SEWAGE PERMIT NO.
VILLAGE �,►� /1F(} (9��
I N S T A LLER'S NAME A ADDRESS
S U I L D E R OR OWN[
DATE PERMIT ISSUED
w
DATE COMPLIANCE ISSUED
isoo
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W
ill e�v�;eS w3t�t e� �
OF o�a-oc�L e
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�� �NGios�o
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aw Fx�.., ....._ .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...........................................0 F..........................................................................................
ApplirFation for BitipuiiFal Works Tomitrurtinn 11amit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
...., v h, ..._.....-?44...............y 3------------------------------------------------
L
..
o Addr ss / o t No.
��,. .� !!_. .._ G°........... .. _. . _ -;�' _ _... �P .........._................
O ne
G. Ads
..._._. �s-----............... - = .....�
Installer Addr�ds
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms........... ...........................Expansion Attic ( ) Garbage Grinder Q70
Other—T e of Building ______________ No. of persons............. Showers
a —Type g -------------- P ( ) — Cafeteria ( )
Other fixres --------------
,�7 WW Design Flow........., ________________________gallons per person per day. Total daily flow _'_ ................gallons.
WSeptic Tank—Liquid'capacit�1ldVOgallons Length................ Width................ Diameter................ Depth................
Seepage Pit No.___./.............. Diameter.... Depth below inlet________ Total leaching area_______.______.____sq. ft.
Disposal Trench—No______________------_ Width...................... Total Length...........
� pag - p �.�.__. Total leaching area_L13�(1_.sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
'~ Percolation Test Results Performed by........E,�___.__�l ellE'_ ______________________________ Date.....
Test Pit No. 1................minutes per inch Depth of Test Pit___.______________.. Depth to ground water........................
Lz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.........................
a •--•-••-...--•••••--•--••••----••-•---......--•---••--•-----•-•-.....---•-•-•.............•-•---••--..........................................................
0 Description of Soil..............•-------------------------------•-------------..._..-•---•---•--------------------------------.....------------•---------•--...•-•-•-•-••-•-•-•••--_•----
x
U -•..............••-----•••••••••-•-•--•------••-----------••-•-----------••-----•...-------------••-•-------•••----•--•-•--•-••----••--•-••---•----•----•-•----•-••••..........__...---••••••--•-•-•••-
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 iITIEI 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b#9 issued by he board of lth. l/
Signed 11
___----- -••-- --•-•- /1 �
�J Dat
Application Approved By•••-<•-- �1`------. --- ..................................... !` 8�--------
`Date
Application Disapproved for the following reasons:-----•--------•----------------------------------------•---•-•-----•-•-•. -• ----•-•-•---••---•----------•--
.........................................................................................................................................................................................................
PermitNo...................................................-- -_ .............................Issued ` � q
Date
No...80 _GS 4! Fxa.. ....... �
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...........................................OF..........................................................................................
Appliratiou for Uiipoaal Vorkii Tutu trurtiou truat
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
/c-- r ' f y v�. � err. ....1 f_.____ _
Lo on A r ss o t No.
�� . ! b.... � : ... _ ' C � it g
- 1
Y" n(,[/ J ess s....._. ....� w►+►
Installer Add
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms... Attic ( ) Garbage Grinder ( �
aOther—Type of Building _____ ______________________ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fix.Wres ......................................................
W Design Flow............ ........................gallons per person per day. Total daily flow........... ...............gallons.
Septic Tank—Liquid capacit}�640gallons Length________________ Width................ Diameter________________ Depth................
Disposal Trench—No.................. Width_._._..._.__._____ Total Length.................... ___.. Total leaching area ____.______.__.__sq. ft.If
Seepage Pit No.....I............. Diameter....&......... Depth below inlet........ .....__. Total leaching area_, .,;, ..sq. ft.
Z Other Distribution box ( ) Dosing t k ( )
Percolation Test Results Performed b ........ je� e_� __.............................. Date.....
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water__________________.____-
(i Test Pit No. 2................minutes per inch Depth of Test Pit__-_________________ Depth to ground water........................
-•-•--•-----•••-•••-••--••••-•----•••-•••-•-••••-••••--•-•-•••-•-••........•--------------------------•---••-------•••--.....__._......-----•----------•••---
ODescription of Soil........................................................................................................................................................................
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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bA issued by he toard of 1 lt"V�
Signed......... f...-- ........
... •--' f--D
Application Approved By--_,.( ` fix'------�' ` ..................................... ........
Application Disapproved for the following reasons: Date
----------
....................
a
t --------------
•----. ...-------------••------•-•-•--------------•----..__._._.._....---•-------------'---•----------•-------
--------•---•---•-----••-------------------------._._
Date
i
Per..m...it ---
Issued_.---..._........-------------._...-------------------..
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..................................I.......O F.....................................................................................
Trrtif irFatle of Toutpliatta.
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Installer
at......................................................................................................................................................................................................
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No......................................... dated_:::............................................
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
'`_ ................O ...................................... tl o
[7 S I FEE. ...................
Disposal Nork.5 Tpomitriatiou punfit
Permission is hereby granted....Gzt •-------Zo.lh------------------------•-•---------------------•---._.........----•--......_.........._._..
to Construct r Repair ( ) an Individual Sewage Disposal ystem
x�
at No.............. e ....__._ '' O ._.__._la
�..
Street
as shown on the application for Disposal Works Construction Permit No_____________________ Dated..........................................
/�: ✓G�
j --- ---••--••----•-----.....--•-•---------.
oard of Health
DATE....................... •- --••••-•----•---
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
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3 NIF C.A. D. 7-Z vs7-
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CERTI FI ED PLOT PLAN
LOCATION /ZyX)-o/! 4{oo)
SCALE DATE NaV 7- /y8b
PLAN. REFERENCE ! o7!vG..L4R!a. -Si46ry.✓
n� � /-74 F.�`'J,D. T,&sT 0"
f-D2 .C:A,,a 722,S 7., ?-4>
LAY
q I CERTIFY THAT THE .",1577 vG
'�' ' ``*• SHOWN ON THIS PLAN IS LOCATED ON THE GROUND
AS SHOWN HEREON AND THAT IT CONFORMS TO THE
SETBACK REQUIREMENTS OF THE TOWN OF
p . . . . . . . . WHEN CONSTRUCTED.
TILvS T DATE n/oY,/2 /J$o
PETITIONER: /�}r//v/S�DOIZT MASS
REGISTERED LAND SURVE R
SN -T Z aF Z JWw-e 7-s
TOP OF FOUNDATION `
CONCRETE COVER
CONCRETE COVERS
4"CAST IRON
PI PE (OREQUIV. 12"MAX. 12"MAX X. """"�'"�•
4°0 ANGEBURG{OR EQUIV.) T
PITCHEQUIV)- MIN. PIPE- MIN. I LEACH
' PITCH 1/4"PER. PITCH I/4'�PER:FT PIT
e e PRECAST
o' LEACHING NVERT . •.
e EL..i8,37. INVERT - INVERT o . eft PIT OR
SEPTIC TANK 01ST. w
INVERT. EL.!7... . . . BOX, ELl.74-4 a: ; EQUIV.
iB /6 /oao GAL. INVERT ..•
EL.....c...... .8Z INVERT v wW p: ..�. 3/4 TO II
EL.7
�c
WASHED
/o' 8 W STONE
DI
PROFI LE OF GROUND WATER TABLE
SEWAGE DISPOSAL SYSTEM
NO SCALE
?"w"RELIM8a
A RwV'
SOIL LOG WITNESSED BY :
DATETwvE Zc /P TIME. %30 �1 PAL u�2iZA BOARD OF HEALTH
TEST HOLE I TEST HOLE 2- s
,71.��!►'sE; .�E�LC�e-�! p� , ENGINEER`
ELEV. . Ze. 9n. . . ELEV. Zo,Co. . . .
�DwArza• �, .tCezt,E� �'L.S.
J
s�a_sn,� svr3_soic. DESIGN DATA :
36•' / 3G� NUMBER OF BEDROOMS 3 . . . . . . . . . . .
Pam,
r-"dr TOTAL ESTIMATED FLOW . -330 GALLONS/DAY
BOTTOM LEACHING AREA 7e,S . SO.FT. /PIT
-�- 7z" SIDE LEACHING AREA . . i88So SQ.FT./ PIT
�i /ham• GARBAGE DISPOSAL . /Vo�tt. (50% AREA INCREASE)
S .c TOTAL LEACHING AREA .Zft7.�O. SQ.FT
PERCOLATION RATE 443S. ?•y4ar 7iVo MIN/INCH
LEACHING AREA PER PERCOLATION RATE .6�'7- .. SQ.FT.
!`-?. .WATER ENCOUNTERED
NUMBER OF LEACHING -PITS �.?!r wiTJV•TL.,co��-
APPROVED . . . . . . BOARD OF HEALTH �F S7Dw6 av AtG S!ats,? /T.L 7>wS aF
.SPDA/E Ak--Z of 7-
DATE. . . . . . . THOMAS E.KELLEY CO.
AGENT OR INSPECTOR ENGINEERS-SURVEYORS (�
346 LONG POND DRIVE
YARMOUH,MASS. P�'(K�FMgs
'T
02664 THO S
rJ�1aEDw f t' rya E
o L -
v^ T O N
c
L_EY aid" .24260
< 7
,1 i� FSO�STEP
Z TIZLiS T� . 4 ,:; .. Eh�g. S�ONAL E�
PETITIONER
f->�•giy.v is�o i�•/I-/ASS ��:;��r� l< �
j ya3
LOCATION SEWAGE PERMIT NO.
�13 ee A1/� � �ti 19 V16&1 S �
VILLAGE �
INSTA LLER'S NAME i ADDRESS
1�4)(/ZF /AOFall cr
8UILDEIII OR OWNER
DATE PERMIT I S S U E D
DAT E COMPLIANCE ISSUED _
o
Re-An
0
No:_.... it ..... Frs.... ..................
THE COMMONWEALTH .PFI MASSACHUSETTS
BOAR'Dff H e�TH
------------OF........ ... ....................................
Appliration for Dhqpoiial Vorkg owitrurtion ramit
Application is hereby made for a Permit to Construct oro" air an Individual Sewage Disposal
System at:
pie
... ..../...... ........
... ............. .........
Location-Add 6 / .or Lot No.
l .. - hl-M
................ ............................................................... ....................
Owner. . ..... ..
..................................... .................... ...
.... ...... ..........
Installer Address
Type of Building Size Lot __ r-----
-.Sq. feet
I? -
U oms.........Z_
Dwelling—No. of Bedro ...................................Expansion Attic Garbage Grinder (
P64 Other—Type of Building ............................ No. of persons......_..___....._._.__..... Showers Cafeteria (
PL4 Other fixtures ..................................
-.),e----------------------------------------------------------------------------------......
Design Flow..... ..........................gallons per-y"Woper day. Total daily flow...........,Z.....Z---------................gallons.
9 Septic Tank—Liquid capacit/ P.gallons Length.____...... Width-_,P'/........ Diameter................ Depth..c/.........
Disposal Trench—No. .................... Width.................... Total Length_____ ... Total leaching area....................sq. f t.
Seepage Pit.
No-----/----------- Diameter... Depth below inlet.. .... Total leaching area.74-�...sq.
Other Distribution box Dosing tank
Percolation Test Results Performed by.---_ ..................... Date- zs;e,25. p.........
AvX
Test Pit No. 1_-<771.minutes per inch Depth of Test Pit.,/YY_7------ Depth to ground water-- .....C 7.
Test Pit No. 2.__'r�Z•-minutes per inch Depth of Test Pit../IKY----_ Depth to ground water..__._.....'......_...
...... ......... --------------- ................. ....................I.......
0 ---------------------------- 0?. ........... .......... .......Description of Soil--------r...... ........ ....... :7.1X1.............................
V......0.......Lmo
U 9...-JAc�........................................................................................................................................
W -
.................... -----------ia-L--------- ----------0_4�14_s-------- -------------------------------------------------------------------------------
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 TT 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has An issued by the board ofhealth.
........... ..............
-------
9..'2
e/e—�0 ,62Az� )......f/Date
Si ne ......
—7
Si
/j ............................ .... ----- e ..Application Approved By...... --- ---- --
Date
Application Disapproved for the following reasons:...............................................................................................................
.........................................................................................................................................................................................................
Permit No......................................................... Issued---.....!._. _.�0..............Date.......
.. ... ..... .....
Date
No...... y jJ� Fim .............
-„ THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
--------- / Wit----------
.OF......... .. . --------------------•-----.-------.--
.���rlirtt#g�an�
Application is hereby made for a Permit to Construct ( or air ( ) an Individual Sewage Disposal
System at:
s
__.
-Location-Address f or Lot No.
�n,.Y✓zwF r / Y.r .. - ----------- -------------•--------------_------_---••------------.----.--.---_-------•------------------------
Owner Address
W //A
Installer Address
Ty
pe of Building Size Lots:-9...:__.Y' .......Sq. feet
U Dwelling—No. of Bedrooms:_:..... s.............................Expansion Attic ( ) Garbage Grinder ( )
�4 —
i
pa, Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) Cafeteria ( )
Ga Other fixtures ---•---------------------------- --•:--- ------------ -
-17
W Design Flow._...✓ ~�-:..........................gallons perr .per day. Total daily flow............. c_.
........................gallons.
W Septic.Tank—Liquid capacity/��.gallons Length---_:��_.�__--__ Width..fi-- Diameter-----------------Depth.-Y......__..
x Disposal Trench—No..................... Width.................... Total Length...............____ Total leaching area....................sq. ft.
. .. Depth below inlet..'- _ _.._ Total leaching area. _.s ft.
Seepage Pit No...__ `':.____.... Diameter.._! :. p g q.
Z Other Distribution box (w Dosing tank
Percolation Test Results Performed by-------.�-F.....f �_'f _�,..=��'"�.----- ... Date._ ri._� /`_��.......__.
_ � w
14 Test Pit No. 1___�'___minutes per inch Depth of Test Pit. `'�`.--____- Depth to ground water.: __-
(i, Test Pit No. 2 S.7%minutes per inch Depth of Test Pit__4XY—',... Depth to ground water-__________--.......__.
Description of Soil
----------------------- ............................................. fi `„ .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'TT y g g p . y
5 of the State Sanitary Code— The undersigned further agrees not to lace the system
operation until a Certificate of Compliance has en issued by the board of health.
Sie _ -• -••------------------------------'-•-•---------......--•-••......•--•••.-- •--••••.... ..................
ate
Application Approved By........
Date
Application Disapproved for the following reasons:...............................-----•.................................................... .__....._..___
----------•---•----------•-••--------------------------------------------•------------.......---------------••-•-•--•••-•-•--•---••-•-•••-•••---••-•-••-----------•----•••------••••••••--••••--••-••---
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEAL
_
1
Trdifiratr of (Suntpliaurr
T Ss CE TIFY,/That the Individual Sewage Disposal System constructed ( �or Repaired ( )
b t y......_ , _ ......
Inse
le . xhas been installed iAaccordance with the provisions of Tf The State Sanitary Coe as de- r' ed in the
application.for Disposal Works Construction Permit No._ ........... dated----._P.-127.�.....................
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
1 DATE Inspector.:. r Zvial-44- ..
................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF H ALTH
...........OF.-- �jL!YI!/..':...............................
ff J
No ......... FEE........................
t ion rrnttt
Permission i reby granted...... 'Lt_ :.�._. ----••----------------------------------•----.............-•••••-•-•--•....--'---
to Constr ( or epair ) an I ldual Sewage Di, osal Syst•
�� greet
as shown on the application for Disposal Works Construction Permit-,No....... ............ gqted....... ...........
'Board of H alt��
:. DATE........................- -----------•---•--- ....................................FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS '1'�,
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CE,E'TIF'y' THAT THE BU/LO/ti/G 517 om- _ S � V A / ~
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