Loading...
HomeMy WebLinkAbout0045 DONEGAL CIRCLE - Health rc** r r Lb CAT Id L SEWAGE PERMIT NO. '/S V1L.1AGE 15 li INSTA LLER'S NAME i AD-DRESS BUILDER OR OWNER �Y/92 o L n A2 /U", DATE . PERMIT ISSUED DATE COMPLIANCE ISSUED BOUSFIELD SANITARY SERVICE A 451 Route 6A r� East Sandwich, MA. 02537 Name//,9eA-/,O. . . . fi-� '490,-2 e.�. . . . . . .Sewer Permit No. l7x'.' .Location . :��. one . . . . %���e. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i.5' 5.. . . ... . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Builder's Name and Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . .; . . `Date Permit Issued . . . . o?o.-.f^? . . . . . . . . . . . . . . . . . . . . . . . . . . . .�. . . Date Compliance Issued . . . . . . . . . . . . . . . . . . E. ,, . - . . - ,. ' .. � �.. ��o ` l ,, �� �� � � ,� � ,� ,� � y '�f's o� O c.. i �.- ,. ,L--� �. a �� • � N FEim..... .......... ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH y . ........... ......... ...OF......................................... Appfiration for Mipmal Workii Towitrurtion Famit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ...........D:W!S1q.g1......ad..d.&.................................... .............................................................................................. .Goratio -Address or Tel No. C).NA!NZ. ............................. .....................CauTem q.......................................... C7 Owner Q Address ... .................... .............................................. ................. ...... .................... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling,4-No. of Bedrooms............................................Expansion Attic Garbage Grinder �_l pa., Other—Type of Building ............................ No. of persons_-_-_____-____--__-_-______- Showers Cafeteria P4 Other fixtures .................................................................... ---------------------------------------------------------------------------------- Design Flow............................................gallons per person per day. Total daily flow............................................gallons. P4 Septic Tank—Liquid capacitvAq.zallons Length................ Width..............__ Diameter..._......_..... Depth.............._. Disposal Trench—No. .................... Width...._........_...... Total Length_......_._...._..... Total leaching area....................sq. f t. Seepage Pit No.....I-------------- Diameter...... ......... Depth below inlet...4............. Total leaching area..................sq. f t. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ �-4 Test Pit No. I................minutes per inch Depth of Test Pit.............._.__.. Depth to ground water_-___-_______-__.--_-__. fi, Test Pit No. 2................minutes per inch Deptli of Test Pit.___._.............. Depth to ground water_.__._..............._._ 0 Description of Soil.......... U ......................................................................................................................................................................................................... W ........................................................................................................................................................................................................ tv, U Nature of Repairs or Alterations—Answer when applicable.______- Q.....(a.,Ak--- ............................. ........................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beyossuedq the board of health. g?ned/ ............................. .............. Application Approved By.. . .... ..... . ..................................................................... ... ----------- Date Application Disapproved r e following reasons:................................................................... ............................................ ....................................................................................................................................................................................................... Date PermitNo....................................................... Issued........................................................ Date No._.p z.. !._.. s' Fus.......�......... THE COMMONWEALTH OF MASSACHUSETTS B&AR®., OF HEALTH OF...................................... Appliration for Disposal Works Tonstrnrtiun rantit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at .......... N_La__I.5d......( 1 Qd'-e.................................... .................................�cJ -...... .._. ocation-Address or 401G. ro o- o e s�©►v e A B t*1 .t�.�--------------------------- ._........ a.V'T e.wj.i� ................ a •--•--- --- ---�iNwf�.�i.T..a.G`-Li . .................. Address ..........................•----...--•--•--•- ------••-•------- Jaon.w. -k.A-----•-•---•---..._......---.............._..__. Installer Address UType of Buildin Size Lot............................Sq. feet Dwellin No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ----------------------------------------•--•---------.._..----------------------------------------._.._..-----------------------...._-----•---•--••-•- WDesign Flow............................................gallons per person per day. Total daily flow..........._................................gallons. WSeptic Tank—Liquid"capacity.MA._gallons Length................ Width................ Diameter................ Depth................. x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------1------------- Diameter.......40........ Depth below inlet....G..._..______ 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........................ f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ix ------------------------------------ O - Description of Soil........... �td�.Q__ .��U-�•�•---•--•--•------•-•----•----- -------------------------------• ----------------.._.____._..------- x V ..............•---•----------••--•---••-•-----••----...-------------•----••....-----••••--....--•---•-••----••---•---•---•-•-•---•----•-•--••----•--- Z. --••-•--------- ...........................................-------•---•-•••••------------••---•-•---•-•••••----••-••---•-----••---•-••••---•--••-•••••--•-•-••---••----•-••-----•-••-••-------•-•_..._. U Nature of-Repairs or Alterations—Answer when applicable........Rv_4.....(?_ AC_L-t_S 1............................ 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 beqd)ssued.4 the board of health. ig' Application Approved BIre to __r" - ..�_'_..... ......................................... Date Application Disapprovedlowing reasons:---.-.--••-•-----•-•-------•-----•-•---••--------------•------•-•--------------•---•-••••-•••--•--••-...------•- .------•----------------------.............................................................------------------••------•---------•--- .... ••---•-•-----•-_.. PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Trrtgfiratt of Tomplitturr THIS IS TO CEO Y Tha e Individual Sewage Disposal System constructed ( ) or Repaired (\A by.....s................................AJt.1:......1. 0U.S.F-���D-•-••------............---------------•------------.....•--...---------------------•----•-=--------- Installer has been installed in accordance with the provisions of TI?'LE j of The State Sanitary Co as escribed in the application for Disposal Works Construction Permit No.---.I----_r f7..`�_�.................. dated_.. .._y.0_. '... ..............-..... . THE ISSUANCE OF THIS CE TIFIC TE SHALL NOT BE CONSTRII AG ANTEE THAT THE DATE....;...,.�...-=-� TION S T FAC RY. SYSTEM WILL FUNC �i r -........ .. Inspector....,� GCS THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................................OF..................................................................................... No........................ FEE..... ......... Permission is hereby granted....... G3aStp!g 4�................... to Cons ct ) or Repa'r ( ap I}dividual Sewage Disposal System at No. ... - Street 5�ated as shown on the plication for Disposal Works Construction Permi' ' .� ......_.. .._�; ----...--• .-- --------- ----------------------------•-•--------.....-----...... `/ Board of Health DATE ....... ........................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS