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HomeMy WebLinkAbout0056 OUTPOST LANE - Health 56 OUT POST I.N. 172-117 CENTERVILLE j v 0 0%orford, N0. 152 1/3 ORS ;0% u LOCATION SEWAGE PERMIT NO. g, 06 5; h Pv�r to-ras VILLAGE INSTALLER'S NAME i ADDRESS B U I L D E R OR OWN ER 0\V DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED � d� j ►06o PreC�►5i P;t' CpV�tL To �rwX-2 (� n �v Y� {�'�./'l��Yicl,�.V'.I.r1vc� �yl�N',1�-iy�C:1 No.. ��MtA d, d'(y d Eti�ijla)VY PD lJ, P�� FBB........ ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ^�70.wW.........0F............... . Aptiration fur-Diugnuttl Works Tuuu#rurtiun rrrmi# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. � .�. .............. . :: .... ...... .: �7 Owner Address ^•\ `a cX-. _ c.. =•'�. ....... 5..... ..1�}: .......... Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms.._._ .._..Expansion Attic ( ) .Garbage Grinder ( ) Other—Type of Building ........:................... No. of persons............................... Showers ( ) —'Cafeteria ( ) 04 Other fixtures •-••-•-•---------------••------•-------------- WW _ Design Flow........L�,? �—..:...................gallons per person per diy. Total daily flow..... .....................gallons. WSeptic Tank—Liquid capacity aC. .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--...................... a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ GL, Test Pit.No. 2...........:....minutes per inch Depth of Test Pit.................... Depth to groundwater......................... p� -----••---•---••••-••-•---••-----------••--•----.....--•...................•-••--•••......-----••-•----••--•.............•-•-••-•--•-.....__......-•-•-...... 0 Description of Soil..................................................................................................................................................................... - U . --- ---------- ---------•-----------------•--•-------- ---.---•-----•--------------------------------•----------------- W -------. ----------------- ••----------...-•--------------------------------•--------•-------.....----•-•---•-------------. ...:......._.......---..... U Nature of Repairs or Alterations—Answer when applicable...... ....... w � Y�-� �,.l Sip h,`� �•p�p-e¢Q_ V 5 ,� Agreement: - e� The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of:ITLZ. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has sued by the bo o healt ned -. --- _. ..•• � � . . • .. ......: Date Application Approved By----.. C.Zx�............•-••---.....•-••-....._.._..._..:_ Date Application Disapproved for he following reasons-----------------------•----.....------•-----------.......--•---------------•-----------•---.......•••........._ . a • .................................................. .............._.._............ ......................----........................................_................... ..:....••••--- Date PermitNo.....................................................- - Issued---•---------------•----_..-••••-..._..................: Date No.�L Fnic.........15............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........OF...... Appliration for Dispogal Works-Tonstrurtion ram" it , Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ... ........................................... .... ................................................ Location-Address or •Lot No. ...................M I e=..,:" ............ ....................... ................ ..................................................... Address ... ........N.f ......... " ..... ............. Installer Address V Type of Building" 1 Size Lot............................Sq. feet U:I Dwelling—No. of Bedrooms.....:�-"•.................................Expansion'Attic Garbage Grinder aOther—Type of Building ............................ No. of persons........_...._......_......_ Showers Cafeteria Otherfixtures ......................................................................................................................... ..........*------ Design Flow...........5'_�57.........................gallons' per person per day. Total daily flow_... gallons. _' *...... Diameter..._._.._.......--._:.--........gallons. ....... Septic Tank—Liquid capacity Length................ Width..........._.... ... Depth................ Disposal Trench—No..................... Width..._........._...... Total Length.........._......... Total leaching area....................sq. f t. Seepage Pit No....44-_.......... Diameter.............._..... Depth below inlet.................... Total leaching area..................sq. f t. 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........................ G4 Test Pit No. 2................minutes per inch Depth of Test Pit.._.......______.__. Depth to ground water__..._..._...._.._._.... ........................................................................................................................................................... 0 Description of Soil........................................................................................................................................................................ W ........................................................................I................................................................................................................................... U -----------------------------------------------------;-----------------------;:-�------------------------------------------------------------------------------------------------------------------------ U Nature of Repairs or Alterations—Answer when-applicable..._ -4.V-,!5....... ............ .......... Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I T LZ56 5 of the State Sanitary Code— The undersigned further agrees not,to plate the system in operation until a Certificate of Compliance has been-issued by the board-6fl iealth. Si ............................. ....................gVed. .Date . ApplicationApproved By........ ....................................................7------------ ........................................ Date Application Disapproved for he ollowing reasons:........................ ..................... ... ............................................................... .................. .............................. ................................................................................................................................................. Date PermitNo........................................................ Issued-------------------..................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... altrfifiratr of (91intphaurr Sewage Disposal System constructed or Repaired-THIS IS TO CERTIFY, TZ.--- t t by........................................ V ............................................I................................................................. Installer at..-----.: --------- ;------------------------------------**------------------------------------------------------ -------------------------------- ­...*-------------------------*----------------- has been installed in accordance with the provisions of TIT ed in the !kf 4T.45 State Sanitary C e aZ V-i application for Di.5' osal Works Construction Permit N o..........................I..._...._'.. dated...._._...... ..... ..._.....__................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRUE. AS GUA ANTEE THAT THE SYSTEM WILL. FUN q I T19N SATISFACTORY. DATE.....__.... Inspector... .......................................... ...................................... ...... . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... 00 No...... a-[A-oj FRE.....I. .............. .............. Raposal or 11 (911gr1utiatt "prrutit Permission is hereby granted----------- . .................................................................................... to Construct or Repair, an Individual jenrage Disposal System atNo-------------J!-2..fo........ .............................................................................................................. Street J . ......... loc— as shown on the application,for Disposal Works Construction Permit No. 4 Q Da ted........6 ............... .......................................------------ ....................................... Board ealth DATE-------------............. . ......................... ........... ,4: 4 0'7-4d-- a r p r- . �^y ~ y��-. 4 - ���'^���'---- THE oowMowvvsAcr* OF wAssAcHussrTS BOARD 9 f HEAVH ..........OF--.. ------' � � -1M�°���1� ��� ��- ������� ����� '��1� .3�rr���� - -�-�r--_-~- --~ ---�- ~ -----~- ~~--~---~~~'- �r -'- Ayy>icutuo is hereby made for u Permit to Construct ( ) or Repair an Individual Sewage Disposal System a stem a . or - - - - � t -~`~---m~~~�����-------'---'-----' --------------=-~-'r�����---''--'--'-'-----'' Type ofBoJd Size Lot. . feet Dwelling-/ZNo. of Bedrooms--.. -------------------------Expansion Attic ( ) Culage Grinder ( ) Other—Type of Building ---------------------------- No. of persons---.------.. Showers ( ) -- Cafeteria ( ) a4 Other fixture --.-----'^--.------_-.------.------------------------.-- Design Flow �� � -�o� � �� � c� T�� 6�y8� ���� P4 Septic ~4 DisposalTrench 'T-------' - P� 2�u--- L_-' D To�a[ -----------------sq. b. �� Other D�t�boboobox ( ) Dos��� tuuk ( ) ^��^' �-�-~��' '- Percolation Test Dcouhs Performed bv-------------- --------------------------------------------------------- Date-'--------.---' Test Pit No. l----------------nioutonporincb Depth of Test Pit------------------' Depth to ground water------------------------ rX., inch Option of Soil �� ' �� --'--'--------------------'—'-------------------------------------- |U Nature of Repairs or Alterations—Answerwhenapplicable------------------------------------------- ....................................... ............ '----------'----------------'-'--''--'-----------'-------------------'-- Agcceuzcot: The undersigned agrees to install the aforedexoribed Individual Sewage Disposal System io accordance with operation until a Certificate of Compliance h s db t eb of health. Date the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in /ale / ` ______ ____ _ _ __ 6 17 121)\ L m Iv97 t 05 ---- -------------------------- No..........!..!_._•••-•• FEB.. M-.... ~ THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEAL TH I�- ; f Y,�, 't...- of ........ ... -'% ............. Appliratioo -for IN-4 orko Tonstrurtion Vrrulit Application is hereby made for a Permit to Construct ( ) Repair ( ) an Individual Sewage Disposal System a �? '�`` �� - "-°—°• K �ocati� dress or Lot No. - -•---- .. . W Owner !J/� �i f {/ Installer Address U Type of Building,. Size Lot..- feet feet .—I Dwelling—(L No. of Bedrooms----------._ ____,___-__-Expansion Attic ( ) Garbage Grinder ( ) per-, Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) PL' Other'fixture - - - - -----•--•---••-------------------•-----------...._....---•--•-------••---•--------••--------•----.._.-__.. W Design Flow-- — Mons er erson er da . Total dail flow._..._. allons. d g ---------- g� P P P Y Y _�"7J------ -----g Septic lank �Liqu�d capacrty,___...__...gallons Length________________ Width-____---_._.... Diameter_ _-_.._.-_____ Depth._.-______---_-- x Disposal Trench—No ----- ------------- Widtll _ Totyl .__=.__ )ceang area--------------------sq. ft. Seepage Pit No.--------- Diameter-•___._._.__ elo hl"n1etJ Total leac ung area sq. ft. Z Other Distribution box ( ) Dosifig tank ( ) l� /��-�'1�7/ Percolation Test Results Performed bY....................................................................-•••- Date_____---------------------------------- Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ rXq Test Pit No. 2................minutes per inch Depth of Test Pit...................;;,D,epth to ground water------------------------ 9 -�..............- -------------� . ---- ! Description of Soil__-__.. __-d-----_-e j� _ P�'Y�C. W f, V r=I 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 further agrees not to place the system in operation until a Certificate of Compliance h<,Qen • sued by, the bo rd.of health. .____e Sign --=-••---=•-•--•----------• .__'_.......................... ------ e Date Application Approved BY------ ----e�ti- .-•-_..."./ LL- /r--FX7 Date Application Disapproved for the following reasons:................................................................................................................ ---•---•---••-------------------•-----••----------------------•---•------•------•------•-•-------•-------•-•--•--•-•-----------------------------•-•-----•------•---------•------------•••-------------- Date PermitNo......................................................... Issued.--------•------•---• ------.......................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD 01 OEALTH � r ram' -2 ' e ' �rrtifiratr of Tomlianrr TIIIS�IS TO CERTIF , hat the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by......J. - �` = ------------ .. ----•••• --------------------------------------* I sta er f " at sue !_ --�'� _ h: �12 .......................................... ......••••-- has been insta'hed in accordance with e provisions of Arti le of The State Sanitary Cod as de cribed in the application for;.Disposal Works Construction Permit No------- _---------------------- dated__ �irTEE 4_.________. THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARATHAT THE SYSTEM WILL F NC CON S SFACTORY. i% �DATE---------.�'..... •-•-•�- ---- Inspector / THE COMMONWEALTH OF MASSACHUSETTS BOARD O� HEALTH .Nd.`...... --•---- FEE.). %spoikdl Work, �o -otrurtion Prrmit Permission ereby granted_____ .______... _ ��__. .� to Constr ct ( or Rep t ) n Individ al Sew _e�Disposal S st e �' t at No. = ar ' _t ... d!!�% - --------------------_-_------ ----- ': -- ----•--•----••--- Street as shown on the application for Disposal Works Construction P-r it No r_,_______________ Dated � __.._.____.__. / Board of HealthATE---- /---/ -•-------------------------' F RM 1255 HOBBS & WARREN. INC.. PUBLISHERS w /cob t 000 Cr 0 a z© _ )-0 w 4s- i t M u r p©si-