HomeMy WebLinkAbout0149 PATRIOT WAY - Health 149 patriot Way
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No.2-153fLOR
UPC 12534
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VO C ! T FQ.,N S E W A G E PERMIT NO.
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INSTALLER NAME i ADDRESS
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BUILDER OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
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ASSESSORS MAP N0:
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THE COMMONWEALTH OF MASSACHUSETit) v
BOARD OF HEALTH
........................OF................................_......----......----.........------.._......._----...._..
ApplirFatinn for Uhipoti al Workii Tnnitrnr#inn Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
P� �}rtoz 1�
•.......
. cation Ad ress Cor Lot No.
.... ... .........._ ....... �._ ..- . ..�... ................_..........._.._......�7. ! ...........................................
Owner •.-.-------._•-_Address
.._... - - --- •-- -- - - -••....... .... . . . r.......................... ---•--^----•--.._...-•--•-•---•----....._.
Installer Address
Type of Buil ing Size Lot.......b.1-3........Sq. feet
U Dwelling—No. of Bedrooms............................_........_......Expansion Attic ( ) Garbage Grinder (At'➢
Other—Type of Building .............. ...._..... No. of persons............................ Showers ( ) — 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.................... Depth below inlet.....,............... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test.Results Performed by.......................................................................... Date........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
(T4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a ..............................................
-•-•••-.......
.....
.-----------
•--------------
•------
-----------
••------
.....
--•---------•-----
... --------
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0 Description of Soil-•.............................••--..............---••---=-•--•--------•---------------------------•--•------------..............-------------•••-•......-------•..._•••
W .....................................................
........................................................ ...
---•------------------....---•••••-•-------•-----••-• .. ----•- -- ...-
U Natur f Repairs y Alte tions nswer when applicable__ N. ...... ......... AC.. . ..... .
= `------------=�-----a- .....$ -•p .....•...•--•--•---•........... ..-•••--..._..--•--... ._..._..-----•---••-•-•-••---•-••--------.............._._..__•-----
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iI'LU 5 of the State Sanitary Code— The unde igned ther agrees not to plac the s stem in
operation until a Certificate of Compliance Bads b : sued by the rd of lth: 1
g
---•-•----•-•-�••..... ..... ........... -•...........�....----....----- e .e/6
Application Approved BY ....
to
Application Disapproved for the following reasons____________________________________________________________________________________________________........----
-•--•--•-•••--•••---.....-•--•-•------•--•--_._....--•----•-------•---••-----•-•--•----------------------._......••..........-----•--•--•---•-•--.....-------------•---------•--••----•---•--------------
Date
PermitNo......................................................... Issued-.......................................................
Date
_ ; a..
No:........ •--_....... - 3 aid � Fas�...._ .
THE COMMONWEALTH OF MASSACHUSETTS i
BOARD OF HEALTH
..................:... ....................OF........................:.............. ........... :::......
Appliration for Disposal Works Tonstrurtiott rrrntit
Application is hereby made for a Permit to Construct ( ) or Repair ( ' ) an Individual Sewage Disposal
Systemat_..................... .................................................•-- -.
Location-Address or Lot No.
........................-......................................................................... .................................:................................................................
W Owner Address
,.a ........... ...............
Installer Address
Type of Building Size Lot............................Sq. feet
.. Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
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.................... 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........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water............:............
Lt. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 ------•••...•---•-•••----•--•-•...................•--•---•--.....---•.....••••--.....----•--•---------......---.........-----•••... -- .......
0 Description of Soil.................•-•---........--•--......................------.....-----------•---•-------.......---•--......----•---...............--•-•---•••---••----•----•••-----•
W
................•---•--••---•-----........-•---------.........------------•--•--•----•---------...----•-----•-•-------------••----.......------.........................................................
..--••----------------------------•-----------•-...----•----------------•---••-----------•-•------•-----•--------------------•------ ........
V 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 TITIE 5 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 the board of health.
Aned _
I
---
Application'Approved B . e!6
f
to
Application Disapproved for the following reasons:---.•....---•...............................•----••-•------•-------......-----------.........._.. ------•--
..-------•--•--------•-----•----•••••--•---•-•--•••---•-........-•--•-••-••-•--••----••-•----...-•-•-----I-•••-•••--•--•-•---•--••-•._...•----•-••-•-••-------•••••••••..................••---........._
Date
PermitNo......................................................... Issued..................Date.............................Datte
THE COMMONWEALTH OF MASSACHUSETTS
___ 0 OF HEALTH
OF.\
... -....�....... -fir .—��.. � ..................
Trrfif iratr of Tontpliatur
THIS IS TO CERTIFY, That the Indi ' ual wage is osal System constructed ( ) or Repaired
by
Installer
V1
at ....1_. Y�'�• ! � •-------------------------•----.........----------- ....................................
has been installed in accordance with the provisions of TITn 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No......................................... dated..............r.................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTIOIJ,SAT A FACTORY.
DATE............................(. `� --- Inspector.... .............•--•--•••.........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD-"-O'F--HEALTH
....................1.. r .o F`�:�� ......`:.' -��j �...... ,°y
_ X
No...... ..G....�..?3 Flamm........................
Disposal Works Tonstruction f rrmit
Permission is hereby granted................ $e r S pe!4 V-YVIA 0
.................
.. ..........
•-••.........
.............
... ......
to Construct ( ) or Repair (X") an Individual Sewage Disposal System
at No...........................................1 L....._)V'? ._!(%°i:.. - .....:"d'A 1 v,.)l�..._.........--••-•......-•.............
Street
as shown on the application for Disposal Works Construction Permit Nog ?.:S ._ Dat ......... ....1.16 .........
.....
VHea...................... !!.
th
DATE.. . ...........�. .J.`...-- ?.......
FORM 12'.j8 .�M• SULKIN, INC.. BOSTON
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LEG e ND CERTIlE.A PLOT P!� AN
EXISTING SPOT ELEVATION. '.. Q,0 � � T � 7 pA�� BUT w� Y
EXISTING CONTOUR - O
FINISHED SPOT ELEVAT]-.r o.oi CE /V rpC A,v-/ G LE -
FINI SHED CONTOUR ��i - IN 4
b
APPROVED BOARD OF HEALTH ������, ���� �, , ►� �
DATE AGENT
SCALE' ,•- S4 ' DATE
tOR'EDG£ £NG/N££R/NG#CO. /1 G CLIENT !�C�Zti � I CERTIFY THAT THE PROPOSED
- � �� �___._�....�.:� _ a1,1I DING SHOWN ON THIS PLAN
:n 4 g
AY C-E
Y l ' L - E ASSESSORS LIAP g0:
RCEL NO.:
�► fi e., r iaW l y ,
INSTA LLER'S NAME ADDRESS
VILDER 0R OWN
i i PERM! T 1SSUEQ _..-.
DAT E COMPLIANCE 1SSUE6 LQ1-2,14 t ,
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t
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N0........ ..2-•.. _a_ '�y Fni&.. ....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HE H
................oF........10 !'✓ C ...........................................
Appliration for Biopos al Works Tom4rartion 1hrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( .) an Individual Sewage Disposal
System itt. ...................... 1S.10
C
Location- ress Lot No.
a
Address O
/r .....-I n ..... .....................� ....._...
Installer Address
UType of Building ✓� Size Lot._._-% �f/.v..._..Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic (�/� Garbage Grinder ( )
pa, Other—Type of Building ............................ No. of persons............................ Showers (/ ) — Cafeteria ( )
a' Other,fixtures ......................... ..........................
W Design Flow.....t.0....... . ............gallons per person per day. Total daily flow............................................gallons.
p� Septic Tank—Liquid*capacity./600.gallons Length...... Width.... _?.__.- Diameter................ Depth................
Disposal"trench—No..................... Width.................... Total Length.................... Total leaching area_....... ./ sq. ft.
Seepage Pit No.-..�_____---------- Diameter.................... Depth-below inlet.................... Total leaching area.. .........sq. ft.
Other Distribution box ( ' ) Dosing tank ( ) (, F,
a Percolation Test Results 'Performed by........A-111 ..... l!%✓��"l�47.... Date......fl,?12,:---•--•-.. }
Test Pit No. 1....cF.......mi4utes per inch Depth of Test Pit..::................ Depth to ground water........................
44 Test Pit No. 2................minu z&per inch Depth of Test Pit......-............. Depth to ground water.........................
.. . ........
O Description of Soils . �.: ..'. ..
Vf ----- ----•--•---------- ---•----
W f�___..__ .._' _ ... T....... ._ _.. _ _ ! ..............................................
U Nature of Repairs or Alterations—Answer whenf/applicable...............................................................................................
..--• -•-------•••--•-•-•-••-•••••-••-•-•••-••••--•--•••-•-----•-•-•••---•--•--•••••----........••-•••-•••••-------------•------•••••--••-•---............................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT Li,,. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has beer.ssued by th boar of health.
Signed ... _ • -•-•-•••.••... .... ------
Date
ApplicationApproved By.................................................................................................. -
Date
Application Disapproved for the following reasons:................................................................................................................
..............•------•----------------•-----•------------------•---.....--•------•--.....--•------.....--I•••••-•.........-••-----•••••-•••-•••-•---------••••••--••-----•••--••......••-•----•-••..•-•--
Date
�r _�d
Permit No......................................................... Issued. -----------•-----._.._....---------•----
Date /�
I
Fimii:3.4...............
ti
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............. ",/................OF........... ......, ...........................................
Appliratiou for Disposal Works Tomarurtivit Pumit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at:
7-... ............................................. .................................................
................
a — /or Lot N Location- dress
0 e No
.....u2I.- ................. ••-•-•-••-••............_--•-•-
Owner ) /t,
0 t Address
--- ................................. .....................I .......................................................................
7" Installer Address
Type of Building Size Lot.................. �Sq.feet'
Dwelling—No. of Bedrooms............................................Expansion Attic (fr) Garbage Grinder,-(
04 Other—Type of Building ............................ No. of persons.-Z:.............==o.:.-Showers —,Cafeteria
04 Other fixtures ..................................... ............
----------------------*................*........*------ -------------------*--------------
Design Flow._,ep......13_5��.............gallons per person per day. Total daily flow............................................gallons.
Septic Tank—Liquid capacity?��O.O..gallons Length...... Width...!4........ Diameter................ Depth................
0
,nosal Trench—No. .................... Width.....__......_...... Total Length.................... Total leaching area....................sq. f t.
> Seepagtfoit ................... Diameter........._._.__._.._ Depth below inlet.................... Total leaching area...2a.......sq. ft.
Other Distribution box Dosing tank (
may......... ......
Percolation Test Result Performed by........ ...... ...... Date......�/d/Zf...........
Test Pit No. I------ -------mirwtes per inch Depth of Test Pit._.._..-............. Depth to ground water...................
-Test-Pit No. 2................minutes per inch Depth of Test Pit..._............_... Depth to ground water.._.._._............___.I
.....................................................................................................
0, Description of Soil Q' V"�'ZS........ ..... ..... 00.................... ... .......
.................. ..... ................... ...............................
U .................. .... ......... ........................ .............;,,............ __-
.....................................
....................... ...............................................
- --------_---6.............X
U Nature of Repairs or Alterations—Answer whe applicabli................................... ...................................................
............................................................... ...................................w.......................................................................................
Agreement: "7
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees no-t,t
the system in
operation until a Certificate of Compliance has been,n.issued by the board!of health. 1,,_-";, /
............................. ..........................
Signed.... ---
...................;� ......✓1.1 4 0
Date
ApplicationApproved By.................................................................................................
..........................................
Date
d—
A,,�plication Disapproved for the fol.lowin�lgl� reasons:...............................................................................................................
..................................................................7...............................................................................................................................
Z7 Date
PermitNo........................................................ IssuedL......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 017HEALTH
..............0 F........./. .......$.....................................................
Tntifiratr of Tompliaurr
THIS IS TO CERTIFY That the Individual Sew"I&Disposal System constructed or Repaired
by--------------------6,4 ..
................... .. ..................................... Installer
at........................./4.7. /. � A
---------------------------V---C
.............................. --------------------------------------------------------------
........
...................
/ .................nitary Code as described in the..............................
has been installed in accordance with the provisions of TITLE 5 of The State,Sanitary
application for Disposal Works Construction Permit No........................................ dated._.....___....._..___.._......_.........._......
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.......................................................... Inspector....................................................................................
THE.COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...............................OF
. . •......................................
No......................... FEE........................
Disposal orks Tonstnution Vvrrmit
Permission is hereby granted...
.............. ....................................................................................
to Construct or Repair an ivi, ..Sewage Disposal System
atNo................................................7
Street
as,shown on the application for Disposal Works Construction Permit No..................... Dated.......__....._...........................
.......................................................................................................
DATE. Board of Health
F6RM, 1 255 HOBBS & WARREN, INC., PUBLISHERS
E/7'NER 7-NE.5FPTiC 7`AAIk -OR }.
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400-vC PIPE
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LEGEND
EXISTING SPOT ELEVATION Ox0 CERTIFIED PLOT ' PLAN'
EXISTING CONTOUR' - - O - ZOT / 7
—FIN SHED SPOT ELEVATION O 01 PA?r��OT �y `
_
FINISHED ,CONTOUR --- 0 -- - C-E/V7C-/Z-Vtl Z-
N I,
APPROVED . BOARD OF HEALTHAS
r,
. DATE - AGENT SCALE ! SO DATE : /04,* Ile,
• t
L®14fOGE ENGINEERING CO. ING'I CLIENT VVE-1 - E
- - I CERTIFY THAT THE PROPOSED �+
rw
EGISTEREG REGISTERED- JOB NO. � - BUILDING SHOWN ON THIS PLAN
CIVIL LAND CONFORMS TO THE ZONING LAWS
_ENGINEERS DR- BY :SURVEYORS 'a - OF BARNST LE , MA S.
.33 NO MAIN ST 712 MAIN ST. CH. BY R—P_ /3__ �/DA
� �®/_ .gS0: ,YARMOUTH, MASS. HYANNIS, MASS. SHEET
OF -- TE REG. LAND SURVEYOR 'x: