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HomeMy WebLinkAbout0061 PINEY POINT DRIVE - Health c SMEAD KEEPING YOU ORGANIZED No. 12534 2-153LOR BLE O FOR SUSTAESMMRECYCLED INITIATNE CONTENT 10% CQnffwdF68rSmrcing pOST�ONSUMER vv mafipropram.Qrp W12M MADE IN USA GET ARGANV.EDAT SMFAD,Gom Iran•'. - w No......`a 5:... 3 FEB.•. ........... THE COMMONWEALTH OF MASSACHUSETTS - - BOAR® OF HEALTH ............. ....-------..... --••------......-.-•----- ApplirFation for Ehipaii al Works Tnnitrnrtiun .eruat Application is hereby made for a Permit to Construct (tiWor Repair (t-jr an Individual Sewage Disposal System at: I I ..........(.I pine�P..�alrif ..1<Q4i..eevieu��Ie....... -----••--•---l�rnt,E--••---o�-----------•-------------•-----------'---�--..-..........---- I Location;Address L. x� Lot No. f ...................................... ....�L �. P-----••---�-°°�---.CQ��C-P.dL,% .---.......-- Owner Address W (wCitrxeo FYle_- _C°Q jmlmra'--�j° k!: 1.4.4 --------------- a Instal r Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons____________________________ Showers — Cafeteria $14 Other fixtures __________________________________ W Design Flow________________________________............gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity.l6 __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. 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........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit____________________ Depth to ground water........................ _._..---•--------------------------•------------•-----------------------............•-----•--••-•-•--. ----•----•--•••----•-----•--••--••---•-----•----•-•-- 0 Description of Soil........................................................................................................................................................................ W U ---------------•--••---••--------------•--•----------------•---•-•-•---•--------------------------------•----------------------------------------•------••--........................................... ----------------- ---------------------------------------------------------------------------------------------------..-,----"--.---...----------------------------------------•-----�,�,,-,----rr------- ------- UNature of Repairs or Alterations—Answer when applicable._._I?7 _it[tK..._I_ _-_'__r1. pa.glk� 4_ !.K+ 2L¢a. ...................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI.,I 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. Si .._-•---- ,�,,^ Date LApplication plication Approved By.......................... ....C�_�_ &V._.\..._........_.......--•---... _..------• Date Disapproved for the followin easons_.........................___________________________________..........._........................................ .........................•---•---••---...._..---•--•----•-------------•-----------......-•-•---•-•------•-----------------•-•-----------------..................................................... Date PermitNo......................................................... Issued....................................................... Date � Fxo.l ____ � THE COMMONWEALTH orMAssAo*ussrTs BOARD OF HEALTH "- ig���.----�_-��F-� ���° ��pplirati�«� �� Uispoiial Works TonstrurtKon 11amit Application is hereby made for Permit to Construct (,Q&-)-or Repair (4.°Tuu Individual Sewage Disposal System at: -__----------- ,--'-_-_' --'--'-----------'----_--_'--_'---__-__----__-- � Location-Address Lo -- �� � Owner Address _---(��l���c�'����z�4_1�c�l_'_-_-'------'-'-_-- -� �lL-�l8-/��-��'-' .�.. .���� w z=�K�' -' - ---Ad��s---r .................... Iype of Size Lot-- Sq. feet Dwelling--No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................'Showers ( ) -- Cafeteria ( ) Pw Other fixtures Design Flow.............................................gallons per person per day. Total daily flow............................................gallons. ScpticIaok--Liquid' _gallons Length................ Width................ Diameter................ Depth................ Disposal Trench--No .................... Width.................... Total Length.................... Total leaching area----------uq. ft. Seepage Pit No'--_--._- Diame1cr-'-----. Depth belmrioloc---------' Iotu leaching area..................sq. b. Z Other Distribution box ( ) Dosing tank ( ) '- Percolation Test Results Performed by.......................................................................... Date........................................ � Test Pit No. l................minutes per inch Depth of Test Pit.................... Depth tv ground water........................ � �Xq Test Pit No. 3................minutes per inch Depth of Test Pit.................... Depth to ground water........................ � _ --_--_---''---_--_'__-__-----------'-'-'-_----'_-'-----_------_--'_-_-- ��. ofSo�_-___-__---_-_-. -___.-_-___________________________________ --------------------------------------- --------------------------------------------------------------- _------------------------------------------- --------------- --------- '-_-'-----.- ^ ' Agreement:U Nature of Repairs or Alterations—Answer when applicable...-- 1.n.... ~ � The undersigned agrees to install theafore6escribed Individual Sewage Disposal System in accordance with � the provisions of TITLE 5 of the State Sanitary Code— The undersigned further ugreeu'oot to place the system in operation oobl o Certificate of Compliance has been issued b the board of health ` �//` �� � ���.��.���. . � ] , , \ / - / - - - L ,0 -CA TION 5Ew ir. E PE RM. iT No. VILLAGE ; NSTA LI. ER'S M A M E A A D 0 A I S S Ei U t L D E R 0R OWNER _C � tl,4 e e Sys cvs - 13ATE PERMIT ISSUED OAT C 0 M P L ! A H C E ISSUED 10 v - `v F-7Y LA N C6 0 41 qQv 4 LJ is-