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HomeMy WebLinkAbout0671 OLD STAGE ROAD - Health 671 Old Stage A= 191 —066 Centerville S M E A D No.2453LOR UPC 12534 smesd.com • Made In USA 0II�I�N1FdN00tICTilt R wwML9FROOPAK06 i LOCATION -G7- /a- SEWAC,E PERMIT -U0. VILLAGE - - = - - -- - - - -I-MSTALL.ER'S-.I I&NAE. .-- -bU1L-DER 5- Q &M ADDRESS .� Ps�— /z — — — -DAT-E -CONAPLi &KiCE ISSUED : - - - 774fe No......... FEE.. (?............... THE COMMONWEALTH OF MASSACHUSETTS BOARD qF HE L d OF.......... .................... ... a Appliration -fur Dhipoiittl Works Turtf#rurtiun Vrrniit ✓ Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal PP Y ( ) P ( ) b P System at: _ Location-Address CVAf;j orS t No .. ....... — ..................... 1M. ----'-•--- ---•--------•---------------------- Owner +� f Address --- I nstal I er Address U Type of Building, Size Lot.... I_�-__f_6&V----Sq. feet Dwelling s—�No. of Bedrooms--------------------------------------------Expansion Attic N& Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — ( )� Cafete-rig'; A' Other fixtures ...................................................... w Design Flowr... .----•__ ______•_ __gallons per person per ff a� y. Total flow..._.._.__Z...__..- ..-....__..._-..,.gallons. WSeptic Tank—Liquid capacity _gallons Length_______-.Q.. 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 ( ) d G aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1_.l___........_minutes per inch Depth of Test Pit.................... Depth to ground water__.____..___-._.__.--... f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water__.__________--.___----- ---------------------•---------•-------------------------------------------------------------.•.............................................................. 0 Description of Soil----------------------...................................................................................................--•-------•------------------------------------ x c, •------•------------- -------------------------w U Nature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------- ----------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: lw The undersigned "agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of CompliancAn n issued by the board of health, o Sig - -... / L -= Dat Application Approved BY-----....... - ----- -•- / ^�� Date Application Disapproved for the following reasons: - -------------------------------------------------------------••-•---•-----••••-- ••--••-•-•-••-•-•--••-•--••-•----•---•--------------•-----••-•----------••-•••--•-•-•-••••................ Date Permit No......................................................... Issued--!!!L P � Z`7 \J #. ---- ...---- Date No... ��/ .. Flc�....f[/................ THE COMMONWEALTH OF MASSACHUSETTS _7,,�,', BOARD gIF H97AI TH Appliratiun -fur ]i.ipusat Workii Tonutrurtion Perntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 1 _ Vn ` •. ........................... •-••-•---- --------•-----•---------------•--. ------------------------------------ Location-Addr ss or L9t&o N owner n Address .............. ....-I------- 1-- . ..... Installer Address UType of Buildi Size Lot.......----/__�-.U__----- . feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic (1)4/ Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers (/ ) — Cafeteria ( ) a' Other fixtures -------------------------- - Desi n Flow.___ ,... W g .............� gallons per person per flay. Total dflow------------ ___............._...._.___gallons. WSeptic "l ctnk—Liquid capacity.._________gallons Length_______._......... Width................ Diameter_-.--...__..___ Depth.___-_--.-.---. x Disposal Trench—No- -------------------- Width-------------------- Total Length.-.-:_-----____-__-- Total leaching area_...................sq. ft. Seepage Pit No..................... Diameter-------------------- Depth belowy inlet------ —...... Total leaching area._--_.-----------sq. ft. z Other Distribution box ( ) Dosing tank ( ) S/� C , aPercolation Test Results Performed bY.......................................................................... Date..............---_-------------------- Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water_.._______-.-._-..___. f� Test Pit No. 2----------------minutes per inch Depth of Test Pit.--___--___-_._.---- Depth to ground water-_.__--._-_--.-___---._. a •---•--------------------------------------------••---•-------...............---•---•••--•.....--•-•......................................................... 0 Description of Soil------------ ----------------------------------------------•------------------------------------------------------------ -----------------------_-- ------------------ �4 U -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- W U Nature of Repairs or Alterations—Answer when applicable.---___-"---------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Agreement: F The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha been issued by the board of h�gJaItth_. Sign ------------- --------....................... ate Application Approved B Date Application Disapproved for the following reasons------------------------------------------------------------- -------------------------------------------------- •-•---••----••---• ----------------------------------------------------------------------•-------------------------------------------------------------------- ------------------------------ ......... Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............O F......... .. - Qwrtifirate of Tomb hatta TH S I TO CERTIFY t the Individual Sewage Disposal System constructed ( or Repaired ( ) by---- E ----•--- i Installer _ , 12 has been installed in accordance with the provisions of : ,icI- / The toe Sanitary Code as de cribed—invthe application for Disposal Works Construction Permit No..._...._.._�. . .................. dated.....��_=�_Z—�J THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE© AS A GUAR NTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-------•-•-•-- .. � .� .....�----------•----•----•-------•-- Inspector.............. . THE COMMONWEALTH OF MASSACHUSETTS �3 BOARD j�, HEALTH J OF_...�✓....4'� ....................................... d No...... -.-. FEE../ �t� tg I urk Tontr " tiutt Urrmit Permission is hereby granted.............. ............................ ..: to Constru ( ) or Repair ( ) n 41 ' dual Sewage Disposa Sys �f i� at No.. (. (r�= Gf L-----`----------------- = treet ���•�••.�, as shown on the application for Disposal Works Construction P -mit o........ /141N. . ................... —S — 7J� Board of Health DATE---- ----------------•--------------------------------------... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS f /Y T T `?0 0 0 N 8 �l ti N _ w 7..SS/ • � /ZS7o i G o7- A L o 7" •5`9 V C E R T I F I E D PLOT PLAN LOCATION SCALE: /' _ ,5�0 -- DATE R E F E R E N C E : �96"i.�4 Lo7 yB �qs .5yo�t/.t/ *3a3 734 GG7- ,B A7- 7-.y� a..�e.��r v®� ,e y�s�-,�ey o� o A 4LR I HEREBY CERTI FY THAT THE BU1 LDING REG L .AND E OR SHOWN ON THIS PLAN 15 LOCATED ON THE GROUND AS SHOWN HEREON AND THAT IT Oo S CONFORM. TO THE 01AOFAf ZONING BY - LAWS OF THE TOWN OF �`" qS WHEN CONSTRUCTED �� GEORGE N U LOW,JR. y BAR NSTABLE SURVEY CONSULTANTS, Ir4c . �y Fc;ST��`4) WEST YARMOUTH MASS SUR*J