HomeMy WebLinkAbout0021 JUSTICE DOUGLAS WAY - Health 21 Justice Douglas Way
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A= 187-019
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ECOMMONWEALTH�OF MASSACH�U-u TS
BAR r � H
................O F... . .. ....------ .......................
Appliration -for Bi,4posttl Workii Cnomitrurtion ri°mit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual •-Sewage Disposal.
System at: (]/ / //J7 \j
� ✓ .. �1.... ----------G=--------5 ...............................................................-=
Location-Address or Lot No. t
Q
------------------ 1-�-/V.........S. /9-�-------------------- ------------------
a Owner
' 1 /lle
Installer Address
d Type of Building /J Size Lot..........................>.Sq. feet
U Dwelling—No. of Bedrooms-_.----__--.�1 _.--.Expansion Attic ( ) Garbage Grinder ( )
pi Other—Type of Building --------------------_-____ No. of persons.--------------------------- Showers ( ) — Cafeteria ( )
Otherfixtures ----------------•----•-------------------------------- ----------------------------------------------------- .......................
W Design Flow..............67-A--------------------- allons per person per day. Total daily flow----------------------------- .--.--.-..gallons.
WSeptic Tank t-Liquid capacityJ2 gallons Length---------------- Width------.......... Dia eter................ Depth.___..--_------
x
Disposal Trench—No- -------------------- Width__________________1 T ength____ --- ota eaching area--------------------sq. ft.
Seepage Pit No..__ _�._______ Diameter__CiQ ._J_"gept l*et_9 `_�...... 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.-.-_-.---_----.--.-:_
�14 Test Pit No. 2................minutes per inch Depth of Test Pit- Depth to and water--.----__-_-----__---_-
..................- - �. --- -- .......................
Description of Soil----- ._ -_ -. ------.
x Z177-11
...----.L-.•----' !' � -
w
x ----------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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 Article XI of the State Sanitary Code— The undersigned f rther agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of h941th.
SIg
A
-- -
Vte
Application Approved By------ - i� . ...... . L t�? �. (
Application Disapproved for the following reasons--------------------------------- -----------------------------------------------------------•-----------------.
-----•-----------------------------------------------------------------------•-.------------....------•--------------•-•-•------
Date
��
PermitNo......................................................... Issued----------------<-------.-------........................
Date
No......................... FEim...... . ..............
rt , THE COMMONWEALTH OF MASSACHUSETTS
BOARD F LTH
... ...........OF... 't " :......_...................--
Appliration for 'Miyooal Workii Towitrurtion Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: �
----- -••---
Location-Address or Lot No.
Owner d res
a ------•----------------- - it t r.
----_-------------
Installer Address
U Type of Building Size Lot............................Sq. feet
00
Dwelling—No. of Bedrooms--------------- ---------------------------Expansion Attic ( ) Garbage Grinder ( • )
per, Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( � — Cafeteria ( )
Other ff�tu"res ----- ------------------------------------------------------------------------ -----_----••--•------_- ---7�
-----------------------
W Design Flow/------------------------------- per person per day. Total daily flow....P-__-._-_-__-.-__--_--_-______._.__._--gallons.
9 Septic Tank—Liquid capacity............gallons Length..n---------x Width .____._.:..�✓r Diameter................ Depth................Disposal Trench—,-,,No-_______________•-__• Wi�tla-d.la_`_�Ak TAtafole th__ '--= '`._":I'dtodleaching area.........-----------sq. ft.
1
Seepage Pit No...............�i ''Diameter....._............_. Depth below inlet.................... Total leacliitig area.__....._...__....sq. it.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results"'_ Performed bY----------- .............................................................. Date----------------------------------------
,.-I
Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water...__---.-___-_-.-------
f1 Test Pit No. 2----------------minutes per inch Depth of Test-P .__._"__.f4 pith,to gro qd a er__.___._.._.___..___..
a -------•••••-- - -----------------A --------- �' { .. . ..-------- ----------------------------
Description of Soil----- ,d -- ---- X f
r
r � .........................................................................................................................................................................................................
�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 Article XI of the State Sanitary Code— The undersigned f ther agrees not to place the system in
p p f' issued by the board of h Itl operation ton until a Certificate o�Compliance iancge as been _
`'`, 'C
Irl
Application Approved BY ---------------------------�--------------------------- J
/-------------------
------------- Date
Application Disapproved for the following reasons:.................................................................................................................
.........-•---•---•--•--------------------•••-----....----•-•----------------•-••-•-......--•-----------------------------...--------•-•--••--•---.....•---•---•---•-----......_..--•---•---.......-----
/ / _ Date
Permit No......................................................... Issued.-l1- `---~----� ....
_ .-----•
—
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD CIF HEALTH
Tprtif irate of Toutpliaurr y!'�
V
SS T~C R I '' Vjat.ithe ='"dividual Sewage Dis osal S stem constructed or Repaired
Y = ...............•------- /A ...---•--•-•----•-••-•--
at........................................ -------------------------------------•------------------�--
has been installed in accordance with the provisions of ofThe State Sanitary Code/as d scri ed in the
application for Disposal Works Construction Permit No-----------------'__:--�__--•_______-__. dated_._f��!_........................' _
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS GUARANTEE THAT THE
SYSTEM WILL FUNCTION
SAT SFACT .
DATE----�--r..�pt-` - --------------C)-----------•----.... Inspector
THE COMMONWEALTH OF}} MASSACHUSETTS
v'TM. BOARD OF;' HEALTH
•.... ......................O F............. ----..........-----.........---
No......................... FEE_......................
i n V a y1i (ii ,(Itafitdrolion Vrrmit
Permission is hereby granted------ 1....
to Cdps 'Qn ) r I ep i ) a�ndividual Sewage Disposal S, tem
atN ---------------------------- ------•-------------...-•--- -...-•--•----- -- - ------------------ f--------------.-----------------.---------------------•-------
Stree ) �l 1 ., e
as shown on the application for Disposal Works ConstructionaPermi( p.f._.. ...__._. Dated.-,e�,�`:,��1.'-->S...........
�t , '✓ r
---------------------------------------------- ---------------------•-----
Board of Health
DATE...........................................................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
Olt
PLOT PLAN SHOWING LOCATION OF Bp!LOING °
sv ` i S:> IN E1
�d CENTERviL.LE BARN S TA BL EMAs ,
s `; r + w FOR p !
(w�
A�ASN
` `t t E . SMALL INC.
t &tt SCALE: I°B=.60° DATE: APR IL 21, 1975
".
CMRL
: ,f ES N. SAdRRY INC. RES. C.E. L.S. 712 MAINST.: HYAPINIS, MASS,
O. a ,
00
2t14 °®•
411
• �. -
e/%y 21 * N
0 LOT
61
Sbn^
I
x
N /F MAY C. CROSBY
f +:
Apr
^. ,;hereby,certify that the building exists
0 vthe ground as shown on,this plan and a�,sp OF
din accordance with the Zoning ROBOTgG\ -
'S
r uifpmmts of the Torun of Bar 1� ®uwaaaa
O
Pelistemd Land Surveyor
y� r 4�U any
}k
THIS:u!r IS NOT LOCATED,IN A FEDERALLY DESIGNATED FLOOD PLAIN ZONE.
65
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LO TLI �Kl 5EWOCE PERMIT UO.
44 ,7,
Ihl AL E S ►J�, � ADD SS ,
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BUIL ER 5 Q E ADDRESS
tITE PERNAVT 155UED 5�2 L - -
D ATE COMPLI L1 MCE ISSUED : �' - `�
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AsBuilt Page 1 of 1
LO TI N 5EW&G4E PERMIT WC
u L.AGE — — - - -
BULL R 5 f.S bAA E ADDRESS '
DNTE PERMIT ISSUED :
D ATE COMEPLI/ONCE ISSUED - 5
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http://issgl2/intranet/propdata/prebuilt.aspx?mappar=191193&seq=l 12/10/2012