HomeMy WebLinkAbout0106 HAYES ROAD - Health 06 -Haves Road
Centerville
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UPC 12543
No.53LOR O
HASTINGGS.ON
CAT Ob l SEWO,GE PERMIT UO.
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STNLL F-R�S U&NlE ADDRESS
BUILDER 'S Q MF- ADDRESS
DATE PERNAIT 15SUE:D
DATE COMPLI &KI.CE . ISSUED : � LL
VVI
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SCAT ON SEW&C4E PERMIT MO.
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1 STI�LLERS IJ�P/lE � ADDRESS
BUILDER 5 1J vA T ADDRESS
DL�TE PERMIT 15SUED '- - — — — — — —
D ATE COKAPLI b,t�10E ISSUED : A?/ 7�
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
V... --------------OF..... N.S�� .. ..........ap"00*00
Appliration -fur 13iiiVuiittl Works Tonstrurtiuu Vrruiit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
/P'1„ System at:
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� .�s.......................................•••.....--_.......-..---.---...... -.---•----._.__._..._._-•-•.•--•--..__......-----..--•....._•••-••-•--.••--•...--..........--•.__
Location-Address or Lot No.
-•- ........... •-••--••--•................................•---•-------•.........-- ............---•--.............
r Address
W� .............._...-. . .................................. ........ .......
Installer / Address
UType of Building Size Lot............................Sq. feet
-� Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building __________________•---___-_ No. of persons.--____--.--____-_---_--_.-- Showers ( ) — Cafeteria ( )
QOther fixtures --"------- ----------------------------- ------------------------------•------------•-
W Design Flow. ..........................................gallons per person per day. Total daily flow...............__.__..___._.._____._........gallons.
WSeptic "Tank Liquid capacity gallons Length---------------- Width................ Diameter_.---__.--_-_._. Depth.__._--_--_---
. x Disposal Trench—No..................... Width..../.#.......... Total Length----l_J----------- Total leaching area_/.dam .....sq. ft.
Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed bY.......................................................................... Date.........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
�14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---------------------
Ix --•--•----------------------------------- ---------
ODescription of Soil---- —S-G�.e.(....�---- --�6`••- ---------------------------------------------------------------------------------------------
U ----------------------- --------------------------------------------------- --•-•--•-•-----------•---•--•--•---••......•--.........--
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U ature of pairs or Alterat� ns when a lica�C__14-- '� . s e
`S --- 1-------J .•-.. ..-----• z t.h ' < j
Ag eement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article YI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be issued by the bo d of 'alth.
Si =----------- =
Date
3/
Application Approved B
Date
Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------- r7,-•----•--....••------•-•----•-•--••-•-•--••--......-----•--......-------••-•---•-•••-----------............---•••---------•-
Date
PermitNo......................................................... Issued.....`- `: _-n----Z-('-----------•------
Date
rp,
THE COMMONWEALTH OF MASSACHUSETTS
BOAR®®E HEALTH
..!"`l.. .. ...........OF........ �..I�N.. ...... !.- _.....................
Applirtatinn -fair UiBpoii al Narks Ton itraartinga Vrrnlit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
......................................................v :°
Location-Address or Lot No.
/ . w •'hr T
} --.......-•-----------------------•---------------------------
�
Owner Address
W ----------------------- �-- �. mac.-C �..
Installer / Address
Q Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons.--_-__-._-_--__------__-- Showers ( ) — Cafeteria ( )
PA Other fixtures
W Design Flow--------------------------------------------gallons per person per clay. Total daily flow---------------------------------...........gallons.
WSeptic Tank—Liquid capacity-----.------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. tt.
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......................
C14 Test Pit No. 2................minutes per inch Depth of Test Pit_................. Depth to ground water........................
-------•------------------------------------------------- - --------------------------------••---------•------------•-•---------.-----------------------
Description of Soil------- �Cc.-r, '_�_.._"!`:....C-_ 2.%=�`1 ------------------------------------------- -=---•--- .......................--•--......
U -•-------------•-----------•------------------ -
W ____ _
U" Nature of Repairs or Alterations,Ans bl�. /� � `..
U P" �ygr hen a plica ----�`----�/- --,_1`--•�--�..------------------•---•-•---------------'--`��S�
------------------------------------ ------ -�.. -��.r ------------------------------------------
Agt'eement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has burl issued by the board of hh Ith. i
Sig �d='(�' '"- `�'z 6 ( CA �.c. 2 3� <->
-----------------------------------••-•-------------------------
Date
Application Approved BV- ;
`
......•.. Date
Application Disapproved for theollowing reasons:............. ____----.
-------------------•-•-------------------------------------•--------------------••--•--•----•-----------------•----••--••--•---•-••---------------.--•-••-----------------------•-----.----------------
Date
PermitNo--------------------------------------------------------- Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
......... I.........OF.... ......Z_
Trn#ifiratr of TantpliFanrr
THI S O CThat the Individual Sewage Disposal System constructed ( ) or Repaired ( • )
by. --•- -•��l_ Et—�---
! � �_
�j.
a -----------------
t. - ------- --- --- -~ •.. --
has he n iIt
talled in accordance with_tl provisions of :\r XI of The State anitary Code as described jn the
application for Disposal Works Construction Permit No.-. ._....._. J ........__. dated.._-_-.._J�.'.Z: ._..7__!~...........
THE ISSUANCE OF THIS CERTSFICATE SHALL NOT RE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE----------------------------------------------------------------------------------- . Inspector.............................................................................
THE COMMONWEALTH OF MASSACHUSETTS ;§
BOARD OF HEALT t
� ...... D '.........OF....... ' ..... .............. .... ..............
No. /�(- �------ FEE--------------- --------
Difivoli or TonBtntrtion Jt rranit
Permissi n is hereby granted------ ! r......--•-•-- -----------------------------.----•----•
....................................
to Constru ('� � Repair an I dividual Sewag I i p .al`//^��5rfe ,'/
at No. �� ✓ treeth✓f
- -- ,....-•----••--
as shown on the application for Disposal Works Construction Pern 'G- _ ._ _`�'l� .......
_______________________
?7.
� Board of FIDATE-------- ------•---•-----7------�0---------....----------.....------------ . ealth_
FORM 1255 HOBBS & WARR�EN._j NC.. PUBLISHERS