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HomeMy WebLinkAbout0027 DEEPWOOD CIRCLE - Health 2-1 D"Pw"d Cen TtT v+ I R f 6 q - o t_3- 007 ASSESSOR'S MAP 'NO. PARCEL.. I. 00AT N LeC-, SEWAGE PER NO. VILLAGE I( A INSTgA LLER'S NAME i ADDRESS ct ®d U I L D E.R OR 0WN ER �tC) DATE PERMIT ISSUED 2 DATE COMPLIANCE ISSUED y t4 � � ' �� �. �gQ �ro��� �� � i6� 3� �����,, �� . . ���y,, .i ,., }; .� i � THE COMMONWEALTH OF MASSACHUSETTS ti BOAR® OF HEALTH AI Q� ....... ....... ....................OF.....!v ..�... ......................................... Appliratinn for Disposal Works Tonstrnrtion 1hratit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: ----- ........................................... Locatio�nn--Address �j �j ��j 1 �-s,orr t NoC � F� ,d✓ ....'S.9�tJ.!_ --•------•-------•----•--•-- _ �•..l�l^ :1.T� ' �.�1AId_ ....1P J@!.�!`!A ........... Owner Address W Installer Addressg Type of Buil 'ng Size Lot_._______:a................Sq. feet 4 Dwellin No. of Bedrooms......•...........................•___.._.._Expansion Attic ( ) �So Garbage Grinder ( )� a 1:14 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures .---•---------•---------------------------------•--•---••-----------------------------------------------......---------•-•--•-•-•--•••-••--••-••----- W Design Flow................ _ ............gallons per person per day. Total daily flow........... ..................gallon . WSeptic Tank—Liquid*capacit ---•-.gallons Lengthk0.. ._._ Width.. 'Fa... Diameter___ "'-------- Depth_►�i' S. x Disposal Trench—No..................... Width.................... Total Length............ .... Total leaching area....................sq. ft. Seepage Pit No------(5- L- iameter.....LZa........ Depth below inlet_.Z.§..b......... Total leaching area..10._..sq. ft. Z Other Distribution box (1 e Dosing nk Percolation Test Results Performed by...... ? - :. �..�I.lc. ..._. Date.._..a'�_._� .......... Test Pit No. 1_......Z'_..minutes per inch Depth of Test Pit......L?........ Depth to ground water.0mm1r..� E. GX4 Test Pit No. 2...........:....minutes per inch epth f T t Pit.................... Depth to ground water........................ O Description of Soil......0••7;d�-------- _. 4,JJ �_.. � ......................... W w -------------------------------------------------------------- --------------------------------------------- U Nature of Repairs or Alterations—Answer ca e.An when appli -..•..._. _ �i - = ..... ...--- -•--•---------------------------------------•---• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI'AIZj 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation unti a •ficate of Compliance has been issued by the board of health. Signed........... --- -- --------- Date A cation pproved By.... .. :... �?. 2.`-r� ... Date Application Disapproved for the following reasons---------------••---------•---------•-------•-------•-----------•----------------------._...--•-•••.......----- ..--•---••••-••-•---•--•----••---•--•••-••-•--•-•-•••--••--...•-••-•••-••-•-••-•-••.........-••••---•-••-•-•••••••••-•••••••••••-•-••-••---•-•--•••-----•------•-•-----••----------•••-••-•--•••------- Date Permit No..0 .:-fA-� -••_ •'1a.............•----•... Issued....------------------------••-•-••-• --•••- Date r •1 .f No .�-:119 3 Fes$ .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r 7 ......."I�. App'liration for Disposal Works Tonstrurtion Pumit ,• Application is hereby made`for a Permit to Construct V-) or Repair ( ) an Individual Sewage Disposal System at �,4 k�* k" 1 ` � .... ................................... �0 6.tom t lr °e t; x s �y, ! Locat. n Addressf,, p, or t No,#� .gyp py -' •„r i.� OY^�:l'1.'"i,t!6..,.si d�i j-max Y�.-✓t }Qi. r;t'�.�.w,�, - �f ...." � tJ... _.... ' _.__...... t -..----- .- Owner Address W Installer Address dType of Build _ng Size Lot... ._'_e.�... ?.....Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type of Building No. of persons___________________________ Showers — Cafeteria 04 Other fixtures -------------------------------- . Design Flow................f.:� ...................gallons per person per day. Total daily flow............................................. gallons. W ..o _ WSeptic Tank—Liquid capacity�..:-:'f�__gallons Length_1_Q". .... Width s`�'..._�?__. Diameter-_-_-'-. Depth.5'--_1-: x Disposal Trench—No..................... Width.................... Total Length...........,;r...... Total leaching area____._;••••-•--_-•-sq. ft. M ___. Diameter....�__4'......... Depth below inlet--t.r.`'t......... Total leaching area 1.0._.s ft. � Seepage Pit No.___. �,._. . p g _ _ _ q. Z Other Distribution box (1-� Dosing tank ( ) Percolation Test Rest�ts Performed by...... .......... _ .. ... Date... f ._..�_. r_: ...._.... aTest Pit No. 1.°:-_.':_._.minutes per inch Depth of Test Ptit..... ...___. Depth to ground water. Test Pit No. 2................minutes per inch Pepth Hof t Pit Depth to ground water........................ �s x A O �' `� < d t ✓rat "" i / ` ¢s+ Description of Soil , ' _' a sW• � .r_ 'f4,0 # ',� x --- ••.. ...-•-•- ••....... ..................... ....... V ..............................-.......................................................................................................................................................................... W -•-•-------•----------------------------•--•----••••----------------------------------............._--------I— - U Nature of Repairs or Altvratjons—Answer �endplicab q....________-A__ (. . _! { G'r •S - .c =......................... r •-- l Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT?,;. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until erti sate of Compliance has been issued by the board of health. Signed ---------------------•-----••----------- -- Appation Approved By._.. ' `'''� -----------•----------- Date Application Disapproved for the following reasons:-•-•---•----••••-••-••••••........-••-----•••-•-••••---••--•••••••-••-•-••••••-•--......•-••...................• ..................••--•--•._....._....----_....._.......•-----•--••---••--•-•._......_____..--•---•••--......----•••--•---•••..._............--..........._............................................ Date Permit No................ .'..�,�'t Issued Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �=-- ►"�jIACe_(- "rn Czs t7-� ..........................................OF..................................................................................... Trtif iratr of Tomplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repairedby ( ) ---------------•---.--.-..-.---------...----•----•------------------------------•-----•--------------------------------------------••----•-.----------------- Installer x >w- rt w T. •. has been installed in accordance with the provisions of TITLE 5 of The Sta e Sanitary Code as described in the application for Disposal Works Construction Permit No._ c "_!.�_['!.'�a._...... dated............. :I.. �T1- ........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL F NCT N SATISFACTORY. DATE.............. ..................................... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD RA ���-TT-. 1 e uG�D H 77� N........ . OF..................................................................................... No.�r_'->.'. �� I 3 FEE,,,, ....... Disposal Works TOns#r ion rrutit Permission is hereby granted............................................................................................................................................. to Construct._( ) or Repair ( ) an Individual Sewage Disposal System f e .... Street as shown on the application for Disposal Works Construction Permit No..................... Dated.....1.��?"7.�-� ........ 0 21. ...... '�; c- . �� ', r O/ -Board of Health DATE ,• ------------------- --- -•-•-- FORM 125 HOBBS & WARREN. INC., PUBLISHERS u,, / a 4A i'r�/ i a ` zp�(id7FiD z2. IS I TN 000, • I , __ _ l 'tag •.�„ '[Z�►..11�- .� �� I / ._ _ i r .R , r : l �� i , I . 1 1 � (` C . t d �t I SST i115 © - IN1� ry 9 i } r 5Tr>ktE� / � 1 ` �1 G1J DST PETER UIVAN 1� Nq. 2973 4- r�SEJI7tx� 6o �n _- E • , l`I C.,..'�Nk_- ._4�C>'k i`�_ i .G LG.,I h,,t;.5 , ..� . _. C-1 IN 4.1 :--` a��. ��s.� IkQCI�- v5� 'Z G4� Gdc•.. 2.2? � . • E , L' �1 TS f r - - �.. 1 �•-•� „, y•� .:h-•� #. N�� i 'R? �� gssC r S t 1 ,AWS- G,r Ttfi TWO' 2, Z'7 8 MUM 41 N Y y� � No. 193340, mvtf , -