HomeMy WebLinkAbout0107 POINT OF PINES AVENUE - Health (2) 107 Point of Pines q
Centerville
A=230 - 055
S M E A D
No.2-153LOR
UPC 12534
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TOWN OF I3 A NSTAI3I.I. ����
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LOCATION pal,✓r eh �ia125 SEWAGE #
VILLAGE ��1 �11/� ASSESSOR'S MAP LOT
INSTALLER'S NAME & PHONE NO. Ll-
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type),Ze-wlLi, ,/:�
NO. OF BEDROOMS 7 PRIVATE WELL OR WATER
BUILDER OR OWNER e!AV Z IIOS1/��
DATE PERmrr ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
4'40,
A14
CV THE COMMONWEALTH OF �MASSACHUSETTS
BOAR® OF HEALTH
.................. ...............OF...... ����%� /, .........................
Appliration for din as al Workfi Tunkrurtion Permit
Application is hereby made for a Perm' to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
.............9.._ . ......................... - - oV..��; C... 14 ............................
-Address j or Lot No.
-- � �r� 1 Q..:....................................... .......... `:..
Owners.
................... ..e
Installer Address U Type of Building Size Lot....���. �4.....Sq._ feet
Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder (Alo
aOther—Type
of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures ...................................
WDesign Flow......................I.....................gallons per person per day. Total daily flow............................................gallons.
W Septic Tank—Liquid capacity/lAW_gallons Length//......... Width........._ Diameter________________ Depth_-`�....
x Disposal Trench—No. .................... V�idth.................... Total Length..__....._.......... Total leaching area....................sq. ft.
Seepage Pit No._ .__.__.... Diameter...../.2`.... Depth below inlet.....W/.`......... Total leaching area:...... ..........sq. ft.
Z Other Distribution box OV Dosing tank ( )
'-� Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.___--..__--_•__--__-__.
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
w' �. -------------------------------------••------------•-•---- .
O Description of Soil--- .___.�
= -`-�(---------------------•---•--------------•-------•---------------------------------------------------------•---••---------•---------------
U -•-••-...--•-•••--••-••-•-•-•••••----••-•----••••••••--------••---•-•••-•-----•--••----------•••••--••-------•---••-------•......-----•...--•-••-•--••-•--•••.........................................
-- --- - --------------------------------------------------= ---------------•--
x ---- -----------------
V Natu of Repairs or Alterations—Answer when applicable_C_eO _/: �(>�'d 6/�jg-fir,
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T IT LE 5 of the State Sanitary Co T e undersi ne furth agrees not to place the system in
operation until a Certificate of Compliance has bee i ue o ie
Signed--- ....--. ............ ...................................... 11b/ s
Application Approved By••••---•-•- --•-•-•• ••-•-- .................... .-- •••• ..
Date
Application Disapproved for the following reasons-.................................. ------------- ............................................................. 1
------------------------------------------•--•---------------......-----...------•-------....------------I--••-•-••--•----••-•-•-•-•-•••-•-•-•-•-••-•••••......-----••-•--•-----•-•......•-••--•---.-•---
Date
Permit No.......A Y..--------•--•--------•--••----------• Issued---....���.�.. �7---------
' Date
�,'_
No.-� E-- F�$..;......t..:.�..�....:...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
/UGvI{ ...............O F........56/''IWS...."
ApplirFation for Disposal Work,5 Tonstratriiun Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal
System at:
� !,-L : -Address or Lot No.
......................
,—ram-/---. �G:..?..o� 0-.,-.....----•---.�..,.„.�..._.....-----•-----._... ..........` --�-�•"-�-...........,_�_j..�...-•--•---•--...._.�.----...----.......... fin----
W .. fc l7 j wne� cif/ ss / ��
•
Installer Address
UType of Building ,/ Size .._..Sq. feet
�-, Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (A/47
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures ..........................................
Design Flow...........................................gallons per person per day. Total daily flow..........................................._gal
Ions.
WSeptic Tank—Liquid ca.pacityOSoogallons LengthZZ.......... Width_.,`-___-__-- Diameter---------------- Depth..!'_..
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No._�!._'�....___..... Diameter.....Z:2......... Depth below inlet.....G._......... 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----_.-._____-__-------.
LX, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 -------------
--------------------------------------
----------------------------------
•----------
•----------------
------------
--------•-----•---
D Description of Soil.... P
x
U Nat e of Repairs or Iterations—Answer when applicable-_��' � �'_j-_�A/��+ -e-------_---- �crr'� G Q
lu /Sbv G1l/�� ,�,tOJ`�e ._ ✓e' .... l�rs T � x ¢ �' e.Q��j /�' 3
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITL, 5 of the State Sanitary Co e undersigned furtli agrees not to place the system in
operation until a Certificate of Compliance has bee i sue rd o h ,ttH.
Signed --- -_.....:. �� _�_`�'
g ;+.
p',f f ���.+�
Application Approved By............Gie'� , .r �. ,............... --•--` • .
Application Disapproved for the following reasons:__________________________________fl----------• --• •-----......................._--_....Date.._...........
........•---•-•----•••-•-•---••••----••---•--••-...-•••---•••-•---•-•--•••---•---••-•---•------•--•••••----•-•--•••-•-----•-••-•••----•-•••--•-•-------••--•--••------••--••••----••......••----...._.
Date
Permit No........ ..: ... '._.�.... ------• Issued....... ... ..........e
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.® .� OF j,9,�jU5:77`5... /�:..........................
Cnrrtifirtttr of TuntpliFanrr
TH S IS WO CERTIFY, - atAe I ividual Sewage Disposal System constructed ( ) or Repaired
-----------------•--------------------------------------------........--------.......---------....................-•-----
Vol
Installer
at................... .-- ....li�T� U. Diu¢'✓
has been installed in accordance with the provisions of TI'"Vr 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No ✓` ''__. j, ''..r! dated..... r _-, _.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..............................................................r................. Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
✓` '.. r'` �-� .� ...........................................OF......."
N .....
................... FEE........................
tplaal n Tnn#rnriilat �erntit
Permission is hereby granted_.. :....._.. ...... _._____. 14V z--- -
••-
to Construct ( ) or Repair (!,<) an Individual Sewage }spostl System
at No..-•--1 �/�J� C+Z- _ n!:... r
Street „e
as shown on the application for Disposal Works Construction Permit No���_�_�_�Dated----
-
`f r/'f�+ 4� Board of Health l
DATE.....E'' - �' •�% .......................................... i
/ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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