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HomeMy WebLinkAbout0006 JACQUELINE COURT - Health 5 Jacqueline Curt ti Centerville A= 210 - 169 'y r ill No.....o--g 7 a Fmc 30 0®... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH _ It �.�. ............OF......... li .: .T�" -\ ............... Allp iratiou for.Uhipaq a1 Works Tomtrnrtiun ramit IoApplication is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: � A Chu.. .�?.1E...coui1..... C—V IZ4 \��..................................................... ocation- dress r Lort No. Owner ` � A dres ;------•-•------------------------------ - C.An.:a.x..g:��?- - a ............................ Installer Address ,,ii Q Type of Building Size Lot_...5w 0AA......Sq. feet U Dwelling—No. of Bedrooms------------------ ..................Expansion Attic ( Garbage Grinder (kjp) _______________ No. of ersons.__.._...................... Showers — Cafeteria Other—Type of Building _____________ p ( ) ( ) a' Other fixtures ................................. . w Design Flow.............. �-P_......_......._.•.._gallons per person per day. Total daily flow--____.---_�2 _..............__._gallons. g �- g P P P Y• Y WSeptic Tank—Liquid capacity/&&V...gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length......._-------- Total leaching area....................sq. ft. Seepage Pit No..../---------_/Diameter...91 _......... Depth below inlet-6............... Total leaching areal P:�R....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by.-___£'i4.XTEtiX._.! .Y .................................. Date.... ............ ,a2 Test Pit No. 1................minutes per inch Depth of Test Pit... Zn.......... Depth to ground water_.A-2b1/t__..._... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 -------------------------------------------•-------------- ----..-.----------.------------------------------ ----.-- O Description of Soil.........0,j;2 ,G. .......2 -• - ...... x w UNature 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 I I i p 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-----•-- Cam"`=-'- ` .."� �............. Date Application Approved BY --- �AP............. Application Disapproved for the following reasons:................................................................................................................ .....................•-••------•------------------------•-------------•-•-------------•-•---•-------•--•--•---------•-•----•-•------•--••-------•--------------•--------•--------------------------•---- Date Permit No......................................................... Issued-...... -~^1-!, Date _J No...Blq-470 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........VOW^................OF............ ................................. Appliration for Disposal Works Tonstrurtion Frrmit Application is hereby made for a Permit to Construct (4.4or Repair an Individual Sewage Disposal System at: . ........ ....QW. ...k...... .................................................................................................. ,Location- dress or Lot No ..MJ?o�'._s.........!$t...............M.A.............................. ...........k A !i )O, V1. ---------------------.............--- Owner e A dr .................................. ........... . ..... .Xj;�.................................. Installer Address Type of Building Size Lot..\'5,.0.VW......Sq. feet Dwelling—No. of Bedrooms.................. ...................Expansion Attic Garbage Grinder jo) Other—Type of, Building ............................ No. of persons..__.______________.__...._. Showers Cafeteria Otherfi�tures .............................................................................................. Design Flow.............0'XP.....................gallons per person per day. Total daily flow----------3S9�...................gallons. Septic Tank—Liquid.,capicity/M...gallons Length________________ Width._._____.._._.__ Diameter___._____._._.-. Depth................ Disposal Trench—No_................... Width.................... Total Length_._____ _________ Total leaching area....................sq. f t. .......... --------- Seepage Pit No.--/-------- Depth below inlet. ................. Total leaching are2_4;��.....sq. f t. ./Diameter.14911, Z Other Distribution DOX Dosing tank Percolation Test Results Performed by-----V4_X_r$_-1LY---At.).' ................................. Date_._ 0............. Test Pit No. I................minutes per inch Depth of Test Pit--- .......... Depth to ground water-N&O.Vic---------- Test Pit No. 2................minutes per inch Depth of Test Pit_....____.__._____._ Depth to ground water........................ ...........................................................;............................................................................................... 0 Description of Soil-------. ....litp-----PUM.4....Z.*�*tn_!�.,-�r •...S.".4-110..pov". U ................................ .......................................................................................................................................................................... ----------------------------------------------------------------- ------------------------------------------------------------------- ................................................................. 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'LITTLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has keen issued by the board of health. Signed...wmw�r.. E4,V.". u..' 9 ............ -------*-----------*- -------------------------------- Application Approved B Date .............. Date Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.......... ................. .................................................................... Trrfifiratr of Tompliaurr THIS IS TO CERTIFY, T44 the Irldividu I al Sewage Disposal System constructed el or Repaired by.............\�le-APS.In��............. ---­---------------------------------------------------------------- ..... ......*------*­---------------------------------------- Install VA- �jf� at....................................................................Ly. .......A I ( ........... .........t16N&C............................... 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.-eip......41.;;0 .............. dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..-... ............................................ Inspector...........I..C.111-er................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD Of HEALTH ..............OF------------------ ........ .............. No...P!2_:n.1r jo FEE.3.&............. Dispoiat Works....g...un% r A... iA. .o. .. n....Prrutit Permission is hereb granted ....... t . ...................................................... to ConstVuct Re Syst Repair ( ).an Individua4 Sewage Disposal CA^�tA atNo.....�n�Or .................. ..................................................................... Street as shown on the application for Disposal Works Constrileti"rmit No.._.___.__ D�,ted.......................................... ---------- ---------------- DATE....../d Boar 'Health ........................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS (00 �7 v -% LOCATION z SEWAGE PERMIT NO. i.DT w r C o ul z- 27Jo -- J6 VILLAGE INS TA LLER'S NAME i ADDRESS d �Z��, d U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �� o V'd a� �' r , C.c` a �� l�� C _. ` a r��-Y lctia y,r.Ta c.M�t..1nL� G•1/�.'t:l-7 �� �'3�T�.�U/K � �:1-� •.. _ 1��) 4�-.�/af:=}iat..0�• c�(ZI i.JC�rC'..LZ. GG �`~ �Q� T•..•�-I L�� ►=t_c.�.c.,• t t o x � = '33 o G f'•�. 5 ©� 43. 3.3� r. .t,V� uric c r'a k = 330! I�,c % • 4q5 6.F'o. �`� A $ _ 1 I•S'Py,A.sN PIT - t,_.)SE. I ocx> �Al_ . f�' • o . TOTAL -!C;�ES16KI = •42"' G-f'.D- 'i oT�t_ t>,d t L�f 1~Ln�✓ = 330 6.F D. �-- Li o - t .2GOErGTlOsJ tZeT� 1�+IU ?�rtltJ OfC LESS- /000 �¢ ti IIJ �� r �•.r 0�1 - ! ��-� r�-" V 16 ram' IVY /a e -•�...• 4� ram'" Top r,.+o toil �,pp� Ioao Iwv• "I -Box 99,< Sepnc 1►tv. t T-AkK — -- 000 I f f Ilivt ( It1V• L�.AcN FIT e . 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