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Home My WebLink About0070 NYE ROAD - Health /V � �� C�.��-w�1�e. ��1�— ��o— pog ,, -:--. �J No........ Fim..... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH v ............. ...........................O F...-..-..---.-..--.-..-......_......... Appliration for llispwial Works C ongtrurtion rumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: . . ..... ......... ... .. ...�. ........ .............. .�'� .. .......... •ocation_ Sor Lot No. .... ... ..................................... .......•----•--...__._......_......... ... �j •--•a•-•-••'-- dress - Installer Address Type of Building Size Lot_��..&: q, feet Dwelling�IVo. of Bedrooms. ___________________________________Expansion Attic ( ) Garbage Grinder ( ) a Other—Type T e of Building ___...____. No. of ersons____________________________ Showers P.� YP g ----------------- P ( ) — Cafeteria ( ) a' Other 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_._ , j Depth below inlet___ t . 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........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G: - ------------ -------- ................................................--•••--......................................................... 0 Description of Soil----- •------••-•-•---•-----,-------•-----------•--•................. V .----------------•---•------•-•---------•--•-•---••-••------•----•-•--•-•----•--- •{Q---•. .42' ----------------•-------•---•------•----•----......__.._........--•---•---- ......._ W ........................................------•----------------------•-------•---------•-----•---------••--- U Natur Repairs �Alteion —Answer w applicable._ _ _ ..................................: ........ ...... - ••---•---------------------------------------------------------------------= Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of HTLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system.in operation until a Certificate of Compliance has been iss d by he board ealth. y Signed- •- -..... ... ..•--•-----•-•--------------- Date Application Approved By.. ................... ................................................... .........../a 'Y- 7 Date Application Disapproved for the (011owing reasons--------------------------------------------------------•------------------•-•-------------...•-••---------•-•••- •..................................•--•......--•-----•----....----------...••••--------••-•••---------•-------------•----•--•--•--._._.__._---------------------•--.................................. Date Permit No------_.... __..._ Issued............... Date TOWN OF BA P NSTABLE LOCATION Al/ SEWAGE # VILLAGE AS''.►ESSOR'S MAP & LOT IY/ -of 0-volt INSTALLER'S NAME & PHONE NO.__ SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER v/ e e g—e- _ o DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: fy a. J VARIANCE GRANTED: Yes No I LOCATION SEWAGE PERMIT NO. r VI L AG E G O, INSTALLER'S NMA & ADDRESS R OR OWNER DAt -C PERMIT ISSUED DATE COMPLIANCE ISSUED Jo . ,T I i 1 No. ---� ....... FimB.................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -•----....................................OF.................................................................................... y . - Appliration for Disposal Works Toustrur#tun Frim,it Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage;,Disposal System at: , ?.el,1.6�o.... ................ NA Y� ocation- ss or Lot No. • - Y _ ............. ` /✓� sdr / Installer Address U Type�'of Buildi Size Lot,;70...?fi�. �,Sq. feet Dwelling No. of Bedrooms.,- "?....................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building a yp g ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other 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...7............... Total Length........... Total leaching area....................sq. ft. f------ Seepage Pit No....*---w.._...... Diameter...,,..!.._..... Depth below inlet..4 ............ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date....................................... Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rs. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x D Description of Soil..... x - ......•--•.................. ...••---••-•----------•----•-•-••----••--•-••--•......-••••......._..... V ---xe- ----Aj.-----........................................................................................ ................ .........•--•---•--.........••••--•••-•-••------•---......---------••---•...._... U Natur Repairs �Alte do —Answer w applicable " Agreement: . I The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TT�~; 5 of the State Sanitary Code-The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issped by the board f ealth. ' Sign , --------- Date Application Approved By..............j t"....--....-- ,/ Date 1 Application Disapproved for the following reasons:.....................----------------------------------------------------------------------- .--•---.-------- ...................•----------•----•-•---•-•-------•---•-•--••-----.............----------•--•--•-•--•••.-----------•-•--------••----•------••-•-•--- Permit No.. Date --------•------------------------ Issued....................................................... Date THE'COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......;;. .!..............0F.......'4��h��cs T......................................................... T ntifiratr of Toutpliaurr THIS IS TO CERTIFY,CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (K ) . .9........�R�.re.---Q+.......... Gfi�dlCr.by................ ... . .....--•-._....._ �at.. Installer /�./ �1 U +c..................' sr._,?' -.�.,r .....-------•-------------------..._........_ has been installed in accordance with the provisions of TITLW, t 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permtt No.__:,.. Z29...... .................. da.ted_...-_._...1 a.t+�'" THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY DATE... J ...� .:.- -----= -•-= --- Inspec or.......---!--• " ....................................................... ..r..a 7udiu.LYw J1, THE COMMONWEALTH OF MASSACHUSETTS a BOARD OF HEALTH ..OF...... J ??Ae,f'`Y I— ............................... u� 4-At, Disposal Works Tonstrudion rrutit Permission is hereby granted---- ....A /G reC/.......X-G,/,._- to Construct ( ) or Repai l( A) an Individual Sewage_ Disposal System at No....1 .% ...!�u�F....=;'----•-... /�'�.C�.!":= '�i r,�c .•E-u,:..r./......-•--------•---•--------•--••---•------------------••--... •-- ,. _ _ .. . ;• � ,,; _+�Street x as shown on the application for Disposal Works Construction Permit No..... � .,e _._ Dated........_ `� -,7. ---....r... r ` f Health Boar o DATE -R �� .. =,- -= .... FORM 1255 HOBBS & WARREN. INC.: PUBLISHERS