HomeMy WebLinkAbout0008 CONNERS ROAD - Health (2) Co nnocs Rd
S M E A D
No.2-153LY
UPC 12934
smead.cam • Wade In USA
SUSTAINABLE
FORESTRY
INITIATIVE
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W�W'Y
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LOCAjION CU �,� , ,dE AGE PERMIT NO.
VILLAGE _
INSTALLER'S NAME&ADDRESS
BUIL ER OR OWNER
DATE PERMIT ISSUED
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DATE COMPLIANCE ISSUED
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA TH
App irFation for Dispog al Workii Tnntrnrtiun ramit
Application is hereby made for a Permit to Construct (,C or Repair ( ) an Individual Sewage Disposal
System at:
................_..... ?Np 2�- ... -tD............................ .................................... ...... ......
Locati Ad e o
Owner ` ,,' ddre
a `fit.... -= Q9.i� (•-•---�C`?.L �------------------` ....
Installer Address
Type of Building -�-1 Size Lot___��t_79._..._..Sq. fe t
U
Dwelling—No. of.Bedrooms__.___.:tr._ - �____...............Expansion Attic (mil Garbage Grinder )
aOther—Type of Building __N/iA__________________ No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfi�tures --•------••-------•--------•----•---•---•-.....•-•----'•----•-•---------------•---•----•-.._...•------------------------•----_._...•••-•----•---•----•
W Design Flow...........�J.............................gallons per person per day. Total daily�tflow.............3���..................gallons.
v e� a/O w
W Septic Tank—Liquid capac ylo_.®.gallons Length_��b_.____ Width.._.___ ___ Diameter_.N��______ Depth_�_`�___.
x
Disposal Trench—No. '..-.---. Width.................... Total Length____________________ Total leaching area--------------------
ft.
Seepage Pit No-----I............... iameter.__.___J�i_..__ Depth below inlet._ ___.___.._...__. Total leaching area_24_Y_.:__sq. ft.
z Other Distribution box (V/ Dosing tank (��
� 1JL®c✓ - Date_--V' --- _
Percolation Test Results Performed by_________________________________•---•_- --�.....................-- - ��"-��ff-------•--...__.
Test Pit No. 1____4 minutes per inch Depth of Test Pit____/_�__'_____.. Depth to ground water_.N �_.._.._.
Gr4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water__.
- -••----••----------------------------------•---•---.........................................................
Description of Soil -Q.; P_�-?�! 'c..�JofAr ----------------------------------
----
•........
=------------------
--•-•_-----•--..
-----•--•--------•••----••-•••......-------
----•------------------------------------------------------------------------------------------------------------------------------ = ........
U Nature of Repairs or Alterations—Answer when applicable._______________________________________________________________�,_.______.__._._____________..
----------------------------•------------------•-----------------------------------._..............---------•-----•---•--------••---•--•----•••-•----------...........................................
Agreement:
undersigned agrees to install the aforedescribed Individual Sewage Disposal. System in accordance with
the roe sions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place th&_�rstem�n
o era ' tm a ti f' ompliance has been issue the bo rd of health.
Sin
------ - - - - •- ..........................
D'
App 'cat n pproved By.............................
--- �( �
---•--•-••-----------•--
Date
Ap li tion Disapproved for the following reasons:................................................................................................................
--------...•------••...•--•------------•-----------------••-...-•---•-•--_-------•-.....--------•--.......----------------••----••--•------•----•-•-•••--•---------•---•-----•--•-------••--•--------_-_
Date
PermitNo......................................................... Issued.......................................................
Date
No-
THE
..
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
0...,v 1p i.............OF..E�).ArZM-zs j.Ao9C.------------------------------------
, ppliration for Disposal Works Tonstrurtion ramit
Application is hereby made for a Permit to Construct f ) or Repair ( ) an Individual Sewage Disposal
System at:
. S.....
Local- . Ad re s or Lot No. 1
Owner Address
............................................ � �r \i•'s-vcr u�5=y'�..... -
C _...... R ....
Installer Address
Type of Building Size Lot_ 1,._7'?_7.........Sq. feet
Dwelling—No. of Bedrooms....-T_ Aa .....................Expansion Attic ( ) Garbage Grinder � )
a Other—Type of Building .ell /¢-------------------
No. of persons............................ Showers ( ) Cafeteria ( )
Otherfixtures ..---•... ......:......••----------------•-•------•-------•--------•----•--•---•------------•--------•-•---------------•-•--••......•--•-•...--••••--
W Design Flow....... j.........................gallons per person per day. Total daily flow_.__........ gal g -., - - - g P P P Y• Y �_��.._._-•---------•--_ Ions.
f� n / y
W Septic Tank—Liquid ca.pa rt}ic,8c....gallons Lengthr?'.�.....__.. Width=��.._..... Diameter�%.�r......... Depth":�_._._..
x Disposal Trench—No. �............ Width..................... Total Length.................... Total.leaching area....................sq. ft.
Seepage Pit No.. ---------------- Diameter....- .7........ Depth below inlet_. `............. Total leaching areal_&.`f-------sq. ft.
z Other Distribution box . Dosing tank/YA),
Percolation Test Results Performed by.............................J !�'�..� c?t✓..'___.......... Date_ rl "/1_._._..._.._._....
Test Pit No. 1.4ZZ...minutes per inch Depth 'of Test P' ---/0.........._.. Depth to ground water/j e...........
fX4 Test Pit No. 2................minutes'per inch De
a pth of Test Pit.................... Depth to ground water........................
i
O Description of Soil Q: � � 1�_._t_ A� tl ---•-•------•--------------------••-----•----------------•-----------•----------------.-.-------------_-.
W ------------
•----------------
- S -J.:
x .............. ---------•---•----••••----••-•••••-•-----•--•--•••----•--••--•--•••••••-••--•••••--•-•---•••-••••-•••--------•---•----••......---•---•-••••--•---••••••••••--•••••---•-•......--•-.......
U Nature of Repairs or Alterations—Answer.when applicable..................:.............................................................................
----------------------------•-----...--•----------•---------------•-------------------•-----•.••--•--------•------------------------------------------------------------------•------------------
Agre ent:
T e undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
m rr -�
e p visio 5 the State Sanitary Code—The undersigned further agrees not to place the system in
o do til a Compliance has been issuedby the board of health.
ry
A li tion Approved By............
............................. ......................................................., r z ..
Date
A ication Disapproved for the following reasons-------------------•-•---•-------------------------------------•-----------•-----•---------------------------•---
---•-•--•-•-----------•-••---•------------••--------••-----•-----•--...--•.....................•-•-•-----'••....•••-•-•.....•--••-•••----•---•••••••-•-•••--•••-......----•--•---•••-----......•....-----
Date
PermitNo.........................................................
Issued....-----•------•.....................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
E
..........................................OF..........................................................I..........................
(Irrtifirate of ToutpliFatty
THI�Sv� CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
`y --- •-_----__----•--•---------
by •• ...
/at. ---------------------------••----...---•------------•---••••-----•------------- ---41-951
has been installed in accordance with the provisions of 13I'he State Sanitar, ibed in the
application for Disposal Works Construction Permit No......................................... dated----------......................................
THE IS vAN E�OF THIS CERTIFICATE SHALL NOT BE CONSTRUED Z
ANT THAT THE
SYSTEM (L gU , N SATISFACTORY.
Y DATE................. .----- --...................---•------------------.. Inspector...... --......................... ..............................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
` 3 ......j. .,').................OF......---- ca.i -------.__.._.__.._.................
No......................... FEE........-----...........
Disposal Works IVITUantrndion erani#
Permission is hereby granted......__12A l.........-e............0'l J.2 .-------Co--••--•••-••- -•--•-••-----•-----•...............................
to Construct"(y,) or Repair ( ) an Individual Sewage Disposal System
at No.....••
��-=�� - ��- C �-� -�-- - ----------------------- -- ---------
Street - ---------
-:5 j ���
as shown on the application for Disposal Works Constructior>,..Rer�p it—N.o..--___ Dated........../_________-- .............
------------------------------------------------ _
Board of Health
DATE ••-•---•---••-....._....
FORM 1255 A. M. SULKIN, INC.. BOSTON -
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NO. 19367
�SS��iISTIQ A OF!,.
ALSER
: LEGEND WID
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c EXISTING SPOT ELEVATION OxO v �No.1��1n
a EXISTING CONTOUR --- 0 --- A�\� �;T %�`%t� CERTIFIED PLOT PLAN.
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NQ2$ -The location of any existing underground sewerage,
wells,; or other utilities shown on this plan is approx- IN
imate only as determined from records and/or verbal •f�A ,�l S-�'A���, +
,information. The contractor is responsible for the _
verification of the existing locations in the field. gCALEs - 30 DATE 4 ks
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ORE'DOE ENGINEERING CO. IN CLIENT. I CERTIFY THAT THE PROPOSED
EQISTERE REGISTERED JOB NO. 8-5� 6¢ BUILDING SHOWN ON THIS PL AN
CIVIL LAND CONFORMS TO THE ZONING LAWS
ENO NgERW .SMRVZYQ DR.BY A �� � OF BARNSTABLE , MASS. �?
{ 712 MAIN STREET CH. By, *DT
�HYANN1S, MASS, Z SHEET./- OF E EEG. LAND SURVEYOR
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lYO.TE /F E/TN<'R THE.SEPT/C TANK OR �.
LE^CNI,IVG P/T ARE MORE TNAN /2~eEl0IV
!O FT M/N ,J,RAOEj A ?4.0/AM ETER CONCRETE COfiE�
SHALL eF B.?DUGNT TO GRADE.,AN -XTR/g
CONGRCTE 4 PYC P/pF T htEAYY CA ST /RON COVER Si/AL L BE USED
COYERS MiN, P/ �F/N OR/YEyVAY
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• . 1 • • OL'PTN • • • . WASNED STGNE
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INLET LfACN�Nfi P/T no."Fr. SEN/AGE T/tEULATlDN
LEACH/NG .40/7' oIMEivslOav Il 3 FT.
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DESISM CR/TERM. Dl�rwsraN 5--�—fT
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OF BEDROOMS 3
D/ME/YS/ON G `f
CsARCAGED/5P0_514L UNIT Wei S4/L LOG SD/L TEST
TOTAL EST//r!A'1rEG FLos�t/ 3 3 tv G,�G. DAY SO/L TEST 0/ SO/L TEST#2
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NUMALe OF I.-ACNIM:.P/TS I - �+EtEY. /0/ L�LEY, DATE OF JO/L TEST / -
S/DE L1`i4 CHI NG PL•R.PIT / SQ,. FT {, -'3 RESULTS IVITNESSED gY f rrvj fO
"7-rom L ACHING PL°R P/T )I 33 $Q.. AT. PERCOLAT/OX JeAT&r j*/ LEss' Ml/yJoI/KCH
'OTAL LEACH/NG AREA Sv�95w�L I�J�COLA7"/On/IrioTElf�2 T�'}'V M!A►flJVGH
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