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HomeMy WebLinkAbout0174 AMES WAY - Health 'I AMes way cfAtervi!i6 i7d- 018- off } 5 M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR FOR AESTR B� MIN.RECYCLED IQ INITIATIVE CONTENTi0% CertifiedfiiberSourcing POST-CONSUMER www.sflpmranorp SF�01270 MADE IN USA GET ORGANIZED AT SMEAD.COM Ci � ' LOCATION SE GE PE MIT. NO VILLAGE oA.n(l INSTA LLER'S NAME. i ADDR.ESS B U I L D E R OR OWNER f 51 /T// DATE PERMIT ISSUED. P DAT E COMPLIANCE ISSUED ��_ �_ Z2 w� �h I� _�� !, , Jf� ca ,Fh � �� 1 �' � ��i� � ;rV, No....-6L.Y ................ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ......0F.............�,. .j.- ............-........ ApplirFa#ion for Bispogal Works Tatt rurtinai Prrutit Application is hereby made for a Permit to Construct (4,f or Repair ( ) an Individual Sewage Disposal System at: .........---•-- ........................... - - ........................... Location-n r Lot N . ...............�c an ..------......--=------ ...............0_�fr.n....A o� --------•---......0........ Owner - ddress a (�!RP �,.5..--.... Gib (1 sC ....9--...- Installer Address U Type of Building Size Lot-1� 09�i .......Sq. feet Dwelling—No. of Bedrooms..............3...........................Expansion Attic ( ) Garbage Grinder (IJ®) aOther—Type of Building ............................ No. of persons.....------................. Showers ( ) — Cafeteria ( ) Otherfixtures ---------------------------------------•--------------•---------•---.....----•--•--------------------- W Design Flow.................`VID.................gallons per person per day. Total daily flow.......... . .....................gallons. WSeptic Tank—Liquid capacityla9Q..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 ( e ' W Percolation Test Results Performed by.... -(��. ..........�['-___J`� ............... Date... - __"_. ............ Test Pit No. 1................minutes per inch Depti of Test Pit.................... Depth to ground water....................---. 4 Test Pit No. 2................minutes per inch Depth of Test Pit.............---.... Depth to ground water.............--......... ----------------- - -----------.......---------••---------- ................................................. -------------- O Description of Soil _�------- m�?^....--*--------..:4-'b S ® . ....................................................... -----------------------•-- °� a.......---Pin c ........ ----------------•------------------------•----------••-------------......--•------•• 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 TITIZa 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------. =... -AdL........... � Application Approved By---.... Date Da t e Application Disapproved for the following reasons----------------------------••-------------------------------------------------•------------------------------•- ---------••----•---•--••---••----•-----•----•---....•---•.............•------•---•--•--•--•---------...•.----------•-•-•-••••---•--•---••---••-----•-•---------------•--••---------••---•-----•••-...--- Permit No. ate Issued............. ... ------. Date No.LLA!P-"/ FEs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... ..........OF.............. <'.U�.°Cl—,J Cl © l Appliration for Disposal Works Tontitrurtion ramit °Application is hereby made for a Permit to Construct (401 or Repair ( ) an Individual Sewage Disposal System at: ................ C)1 ..s- ---•-__ ...............V. �. ��`'" •- _... Location-,Address r Lot N ..... ------...._-T�c:rv�• s t,c irk._.... u t C\ ' - c� ................ .. .................................................... .....-•---••---_._ .--- -••-•-.._._......_.._-•--- Owner "� AAddress ....................••••• ........................................................ CQ Installer Address C Type of Building Size Lot_`5,u_-.'..b__-____Sq. feet Dwelling—No. of Bedrooms.............a.._..__-______.________._._Expansion Attic ( ) Garbage Grinder (PO) `L4 Other—T aype of Buildin g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ..---•-••-•-•.._..--••-•.._.....• •--•--••---••---••---•--•--•-------•-•-•-•-•-----------•---•--•• i•r W Design Flow_________________V�_a..__-__.____-_.__gallons per person per day. Total daily flow_-._._.__._ `? __..____._.__.........gallons. W, Septic Tank—Liquid capacityk AgU._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..__ - ._is '.__ .... ...... Date.... ................................... Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0:4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---------------------- •-----•--•---••••--••-•••-•------•••-••....--•--•..._...------•.........--------...-•-----•-•------•-••---••••....--•--•.........••- O Description of Soil..... .-_-,;x-'.... -"Zcj'- y`-... 5 v\S "`-"-` .................................................................. W 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 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. Signed.......�-c ter. �'�.. <,j Date Application Approved BY ....��._'_/t Date Application Disapproved for the following reasons------------------•-----------------------------------------------------------------------------••-••-••••.._..__ -•-------------------------------•----------•----•-----•-•--••••-----••-••••-•-•••-••-•----••----•--•--•••-•----•----•--•---•-•---•••-•_.. Date Permit No------- `� ........-..44.1_9p................- Issued............. ------ Date 7 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Q�J !.. C,1.? A. y `Wrrtifiratr of TompliFatta �. T THIS IS TO CERTIFY, That the, Individual Sewage Disposal System constructed ( or Repaired ( ) -•----------=--------------------------------------•---•---.......--------------..._...-•-----•----•...._----•-•....----•-•-----. (". Installer \ [; t1 at. - = •----------------••-•-- .�. = �.. ,-----------------------------......--='4..•V......------......-------------•- 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....... �__'__�_7-:'__.•______. dated_._ . _� __`7._'A�-r---_____ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL U TION SATISFACTORY. DATE......1..� .. ......................................................... Inspector--- /------------------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF, HEALTH ........................................... >c�� .-f1_o �_S__ O F.............. ::.............................................:..................... No......................... FEE........................ Disposal Works C-5ottotr iott prrufit Permission is hereby granted.............�_C:.\-v g-::::, (D.- ��C 0 - ---------------------------- to Construct ( ` or Repair ( ) an Individual Sewage Disposal System � at No.. '-`-'--_`----•-----------= --==-=--•-•-----......, CA_!Yl__.. W � n ' �Y V .. �.�:-:--__. --•--•-- - -•-••-- Street �. .y as shown on Xeaicatio for Disposal Works Construction Permit No.. D ed__-.__..__:'.............................. -------------------•---- ••-•• -• ------•--------•-----•.....•.....-•--- ••... Boar of Health DATE----t�l --�-�---�------•--------------•------------- ,. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - uc Ga�.BAGE G¢tN��cz s . 79 F%-oW : 110A 3 = 330G.Pp 5EPTIG -rA►JK = a3oxi5a% :'495&.Po u5c- 1006 GA%-. y A- 32 o15P03A1_ PIT V4E l000 GAL• AN i5-o98 •N S�AG.�A1.L ARGA • 15�S.F p. �50 5.F x �•5 � 3?5 G.Rp v goTTo/K AREA s . 1� SiF.. . . �3 TK•�> n o tdl•O '3 T 4 'TaTA1-. DSIIW414z5 G.PR -TOTAL. DAIL-Y F�-oV! = 33o G.Po. 3� A"? rw� PE2coI-A.TI0I4 RATS I"IN ZMIN oR.t-ASS •a c3� o �°%J i 3z;* i _ •S `ZHOFM V•T IIC'IAM ALA N G \\ \ \ O A. w \ q� SAXTEA JON \ 24048 I� tt� AMES I! TFsST P9S7 : .. __. N; �'G =/0 ?•� TOP FND�103.3 �Z. /oZ•a -�F��`� Imo'. /•o aIoov tN�• ` sv�o•l DUST. INJ. tarA L.* /pp.g z' 100o INS • PIT INY.. INV. 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