HomeMy WebLinkAbout0044 LAUREL AVENUE - Health 44 Laurel Avenue
Centerville
A = 226 — 088
L0CATIO SEWAGE PERMIT NO.
I L "G E _
C-S-24,1, (��
INSTAL ER'S NAME i ADDRESS
FOR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED c ��
C'esJo''�`�
���
�.. _�.
_��
;��'
�1'
�;
;=�.
w
t U
�fj THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HE- ALTH
I� ..... .........OF.......................................
p iration for Etipn.4al Works Tnnitrnrtinn Vamit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
I System
_ .............................. ..........Z............. ..........................................................
f Lo atio dress or Lot No.
... ... ................•---•-----............---
- .. ... .......
O$ne, Address
...... ........
Installer Address
d Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
aOther 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.................... Total leaching area....................sq. ft.
Seepage Pit No.---____-_---_-__-- Diameter.................... Depth below inlet.................... 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........................
Test Pit No. 2................minutes per inch Depth:: _of-;Testt -
Pit.................... Depth to ground water........................
0 Descriprion of Soil- ----��-•�------•--------------- •• --•• - ----.....-- ------- -•---------------- ...--- �-------•-------••�/------------------
w 9`
UN of Rep -irs or Altera ns— w whe plicable_ _:_____�-+-fig___ �------------- -�_.__.� '-•-------.
-------------------------•------------------------�-�----�-----------�_.-�..------.���.�---- {-_ ..� ----••---•---.----
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'T T L.=.. y g g p y
S 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 t e board of health.
9/2/�o
Signed _ ---------------•-•-. . .....--------
/"'
Application Approved By-•--•- e E ..._.. .........
Date
Application Disapproved for the following reasons:............................................................................-•-•••--•-••.....................
----------------------------------------------------------------------------
Date
PermitNo.:....................................................... Issued_-------------------------------------------------------
Date
N �.../� .. . Fps..M..c.q......
• r
+� THE COMMONWEALTH OF MASSACHUSETTS E
BOARD OF HEALTH
r ,
-°'
Appliration for Dhipoii al Works Towitrurtiutt ratnit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System
...... - ..........................
.. .--- . # ----- -------- . .............� - . �.
/or�s Lo a1tio dress or Lot No.
" -- d---�•-•--•................•-----•--• ............................................. .........................................
O ne Addr
...................... ....... ............................. ...................................................ess ----------------------------------
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
`4 Other—Type of Building No. of persons............................ Showers
a YP g ------•--------•-----•------ P � ) Cafeteria ( )
1 —
Otherfixtures -----------------------------------•-------------------------•••••-•---•-•--•-•-•-•-•--....----•••--••••••••••-•--•-•-•-•.............•-••-----••-••.
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.................... Total leaching area....................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........................................
a Test Pit No. I................minutes per inch Depth of Test Pit___-_--_•-_._______- Depth to ground water........................
04 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
--------.
---••-•--•---------•• -
O Description of Soil._ __ - ,P" !_teL .....IV..:..•.Yh
_ '_._ _-___
W ------------ �= - ,. r,. z K
U NaXi of Rep irs o Altera, Fons—A w pplicable_
C-•---- ---- .........
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T i
p 5 of the State Sanitary Code— The undersigned furti:erlgrees hot-to place the system in
operation until a Certificate of Compliance has bee issued by the board of health.
F ,f�
Signed . '" . 6'�= ` r ------•••--
ate
A lication Approved B �.' � _ -._.__ .'•, " .,_-••_._.
Date
Application Disapproved for the following reasons:---- --•---j -------------------------------------------------------------------------------------
-------------•-.•-•------•-_-----••-------•-•-----••----------_--•--.------•-------•-----•---
Date
PermitNo......................................................... Issued------•--•-------------------------------------------•-
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...... .� ...........OF....:.:...::. t';.'C; . t��.l .......................
Trrtifiratr of Toutphattrr
THINS TO C RTIIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by........... , _... ----...._•--••••-•---•. ---••-----;-----
��II / G . l'' J
at........... _ .ICr. � __/... --_..._._•L-s+..._.•....._._... ns___ f+.....................................R __
has been installed in accordance with the provisions of T � 5 of The State SanitaryCode as described in the
application for Disposal Works Construction Permit No--- '___:`�t9__a_.._.._..._. dated---.. -_ ..............:...w
_ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO TRIDE® A GUARANTEE THAT THE
SYSTEM WILL FU CTI - N SATISFACTORY.
DATE------------— ........... Inspector. •--•• ........................................ .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
�. ........ .............OF..... ...: !. = '` ..._......_...... r
No.---..�..--•------••-- FEE.....:..................
wzkl
Permission is hereby granted.-•-•--•-•--• = ........................... ......................•••••-•••-••-••-•.........••-• ...,
to Constr ct ) or Re air an Individ Sewage Dispos St
at
Street �y
as shown on the application for Disposal Works Construction Permit • o._ . :........... Dated-------
/ ��..........
` f
2 y C " ;1 Board o lth
DATE--------- -----------................................................................
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
4�CAZ(
s i
2�- l 0J Q
--
AsBuilt Page 1 of 2
y� ► y6 7
LO CAT 10 SEWAGE PERMIT NO.
I N S T A M
ERIS� NAME i ADDRESS
oe
d�
' c
DATE PERMIT ISSUED ;I Z 2 �l
• i
DATE COMPLIANCE ISSUED .chi �v
i
- i
! �S
i
I
•
I _
I
i -
i
i
http://issgl2/intranet/propdata/prebuilt.aspx?mappar=226088&seq=1 3/15/2016