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HomeMy WebLinkAbout0100 PRINCE HINCKLEY ROAD - Health (2) 100 Prince Hinckley 047-092 Centerville i ( !-5 E——�)e) LOCATION SEWAGE PERMIT NO. VILLAGE C:4N - IN.STA LLER'S NAME & ADDRESS Ai G�?�l� r ar,r.�.Q• BORDER OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED 77 { Y®® THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............OF.... ZA:3................................ Appliration -for 43WVviial Works Towilrnrtion Prrutit Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: f / .- G S'-- ---------- ......................�` z ------------------------------................... •---•- - "-' ----- ti" � e -•---•-------------•--------- ................................ �r—i Y /� ,�or o/f 1jo• ................................................. Ow er G Address W , L�� ...v ----�' ---�-�-------•---•----- -----------� �....A........- �' a ..................................... ....... ..... Installer Address Type of Buildi gK Size Lot../A,..'�-�.......Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ) P-4-4 Other—Type of Building ---------------------------- No. of persons............................. Showers ( ) — Cafeteria ( ) Q' Other fixtures ---------------- ----- --- W Design Flow.-........bra.................. gallons per pet-son per day. Total daily flow..__.._.3Jd--_-------------------gallons. WSeptic Tank�-Liquid capacity- gallons Length................ Width................ Diameter_...._ _ _ Depth___-_-_----_. xDisposal Trench—No .................... Width._._._ .___.._____. Total Length -------------- area............-------Sq. Total leaching area.--s .�.�..sq. ft. Z Other Distribution b ( ) Dosing tank ( ) �)v G d-f 7 7 7 0-4 Percolation Test Results Performed by----------- ---------------------------------- -----------------••--••---• Date--..------------------------------------ 1 Test Pit No. 1___,,4__;F:!�_minutes per inch Depth of Test Pit____________________ Depth to ground water...--------------------- Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.-.._----.--_--.-.__.. 19 •----......- ` ••-- - - -- ----•--- - 0 Descri tion,of Soil_____.. _ _ _ v__ W 2- 0 � S -; ---•------------------------------------ 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 Article NI of the State Sanitary Code—The under gned further agrees not to place the system in operation until a Certificate of Compliance has bee i ued by the bo rd of health. D e Application Approved By............. .. .•. --. 7------ Date Application Disapproved for the following reasons-------------------••--•-•-----••----•--•-------•-------•--------•---•---••----•-------------------•-- ------ -------------•---------•----------------.---------------------•--•-----------•-------•------------------------------------•------•----------------------------•---------•-••-•-------------•---.------- Date Permit No......................................................... Issued----- ----- -` ------._e.- . ........ Date .,:M. ...o y.-• q4: x'r,%.,'e 1FF"n'.�,`+ - .xszT t ryy'?a -• F>zs... .Jr.................... THE COMMONWEALTH OF MASSACHUSETTS -BOARD OF HEALTH l .� Iirttt nn -fur T3 _npaiial orkii Tutuitrurtion Vautit. Application is hereby'made for a Permit to Construct ( , ) or Repair ( ) an Individual Sewage Disposal System at _ r^Location-Address saran;: or Lot No. Owner Address _!!� �i iia............•---- -------— ---1- Y .. .1 Installer Address Type of Build* fir Size LotJ6 _4 -------Sq. feet aDwelling—.No. of Bedrooms_____________---------------------------------- Expansion Attic ( ) Garbage Grinder 4) a Type, g ---- - persons r - ( ) Cafeteria ( ) :. Other—T e of Building ._._.._..__. _.___ No. of cl,un5...___._____________ __ __ Showers Q' Other fixtures W Design Flow--? � gallons per person per day. ,Total daily flow-------I� � gallons. Sc,,tic "1'.nl�4_Liquid capacityl g Mons Length_-___-____;____ \Vidth.__ --._ Diameter. --. ------- Depth _ .-.__--- ` x Disposal Trench No �� idth Total Length . Total leaching area.....................sq. ft. R Seepage Pit i�10___--- . ----- Diameter .._:..__{��_..'Depth lielow inlet________ ....... Total leaching Lrea.:-�_ ----�_sq. ft. Z Other Distribution box ( ). Dosing tank ( ) r)�! 1& /7 7 7 ` ~ Percolation Test Results Performed bY- -•-- Date;;_ -- -----• ----- ,a Test Pit No. 1---144•'_miiiutes per inch Depth of "lest i'it Depth to ground �tiater...:__. ___.._.. ._ Test Pit No. 2------------ .,-liinutes per inch Depth of Test Pit.................... Depth to ground water i....- O Description of Soil- -- Gt �'• _t_ ' 1 ........ ------ 2t ........ / t 7 n t� r �- +c4-- - ---------------- ------ --------------------- •, Ux. Nature Repairs or Alterations—Answer when applicable......... .... P PP ---------- ---- ---- --------------------------------------------------- Agreement 4: 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.unde>rs fined further agrees not to place,the system in operation until a Certificate.of Compliance has been,i/ssued by.the boardof health. fined,•'1 L -t--°-- .. a- � -�'�................. /1 z o- __._ _ _____ ____ _ ______ ___ _...._.._ _ _ __ ft� ti 1 5 / Date Application Approved BY--- .!"` �i� > "� •: J J~'x.... :7 _7___. f/ Date Application Disapproved for the following reasons-- ---------- -------- ------- -- ------------•--------___-------------------------------- + . Date Permit No....................... --••------------------------------- Issued.................................................... a Date THE COMMONWEALTH OF MASSACHUSETTS } BOARD HEALTH ........... F ... tifirati Of timif anrr THI I 0 C 1R I Tl the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by " - (� 1 f� Insta rF at_ ,- -� ; r4 has been installed in accordance Ngith the provisions of A' X1 of T,,l State Sanitary o e as de rib in the application for. Disposal Works Construction Permit No. `©.-a dated ... ___._•__. THE ISSUA'NCE..OF ,THIS �ERTIFECATE_SHALL NOT BE CONSTRUED AS;:A,GUARANTEE THAT THE SYSTE,NI WILL; FUNCT'LOPI'S'ATISFAC$:ORY: DATE ------- --• -- • ----•--- ---•---- - •••• Inspector ----: -•-•-•••--• - ............................... •. THE COMMONWEALTHt OF MASSACHUSETTS��y ,. ,. w.w, $OARD F' HEALTH' �� x OF. .- ........................ -- No........ FEE f ..�-,---- i n rUffii `rrmit Perrtission s, eby granted ---:' . s -- .................. to Consti t or Repai ) a�a Individ ewage a] System at No.. a /Lrte9A� :.t. % L t. as shown on the a lication for Dis osal Works Construction P rr'iit -_.._ atec _.. .� 7.__L__ _._.•r. PP P , - A Board.of Health :. DATE............=... FORM' 1255 Hoess &'-WARREN, INC.. PUBLISHERS .p,. uesir�:t.a.,..e�,rx.'.... _ :a.e 4...Lfi. ..:ti ��` '�a� w �.y{.,. s�it•L.... ���s a.+ � rr eg .:•.;a ..w ..."e*f r, h r->l&t t_q FLow = I I .4 3 = '33d G.P.D. 1 8 S G F c Tl,E.1►C = SSD e ISo % • A-q9� 6.P.D. USA- t c>C>C� G ANA . (� I 13 PD-AL PIT - usE loco <GA- . --,ax-wal_!_ ArzcA = tso s.t=. IC, Sit 5(' v� Q D•8aC .. TOTAL 42S l-.f?T::>. i7'r�,,r '►-oTQ L U,d.l L.�f FLO��c./ = 330 6.P77. 2 '1 1 z• L Pt:---f1GDL&TI0 J 0,&TE I� tU 2J1r Q' 0fZ I-SS• �$# 111 ? tZ5 tit �►) 9�tS�_� �• It r TEST �°'G 9P.70 L Top i7w LCI A M .Poi i o0o I►N• w 4/�a� vlsr I►lt/. Got.• 70 Zy Svc sa -Box Seprtc L at►t�( I►dv. TANK t,Nv. tuv. 4RAVtL GAL.. L�N 9G,o �A I _ q Vz P�T , reds' WiTta �� ytWASWEV coveSF lla�4���t STO-G- �9 8 ti . - ,o' ��2 LCQTIFI>rD pl_6T" L P, PRvT-71 L �{t� - - LUGhTIC�t-J CctJrE�v�+�l.G r FRS;G u 1 ct,iz-rt t=-! T14A7 Ti-rL- 1 nUEJ'OA'rJoQ s"C>NI.t PL At.� Rr r=�=cLcI.ic_C TOaZ: DELlI-AE— LC>T �Z'q AWL-> t>A�n= �g-• I'l-��__� ..._� G. �JC4s��-�_ t=3/S.XTe tiZ �4. W Y t� t�=- t 1't-I(�� l?i_A til l� E-1 UT t',A;t=.C7 UC..3 p►.t IbtA6. tIJ�;.(-��✓;,rll.-1J i •'/:l�_\/i'�' ;r- '(1•ti:. c.3�'l•:i�=rri �1.1L'Wt..1p A.F�{-�l_I C_h.!`JT 1.�;.0 l.Si . l�•'�L� , I�, i�('• t'i'• C,IV'\��.It~ 1,Ci� l_IF•1��..� _— - "^' �/� A : ►_. THE COMMONWEALTH.OF MASSACHUSETTS BOAR® OF HEALTH S= o®`/ \.c�. ............._0F....... .G ..ca.a_ ..uJb. - ApplirFation for Disposal Works Tons rurtwit Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal S stem at: 5.. ....... v ��: ..._..._ - - .._._...�......... .`k------------------------------------------- Locat4io__n-Address ;� qr Lot No. ............... .�........` ...... nn:�..._......--...... ...............=�c Vic. !` \_.�.... ................................. ()\,p Ownera' hddaress- a ......................X.S,r .�.Si.\-�d ......7m1..��./`..g.....---........._._........ t.. ................................. Installer Address Type of Building Size Lot__P.,.1._3_Y..._._Sq. feet Dwelling—No. of Bedrooms............... ......................... Attic ( ) Garbage Grinder ((10) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures . ---------------•••--------------•------------._.....----•---._.._.....__---- W Design Flow............. _V 0.....................gallons per person per day. Total daily flow._._._._.._______.__�_` _______.__ ------ WSeptic Tank—Liquid capacity_lQo6,gallons Lengih................ Width................ Diameter________________ Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No......,l----------- Diameter................ Depth below inlet__. .............. Total leaching area_ ......sq. ft. Z Other Distribution box ( ) Dosin tank ( ) aPercolation Test Results Performed by... ! !_ ..........._____________ Date......_ :Ilk-_g_-___Y.0____.-. ,.� 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........................ ------------------------ --- ........................................... ------_ - O Description of Soil...... _4-... V ......................................... ------i..................5c r_4,A. -•--• "�-'�e i VNature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ ------------------------------------------•---------•-------------......--------.••-.._.....----••--------•-----•--•----------------------------...--------------------------------------......._...-••- Agreement: 1\ 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 not to place the system in operation until a Certificate of Compliance has been issued by the board of health. t �y Date Application Approved By.............. -•• ._. -------------- .............. Date Application Disapproved for the following reasons____________________________••_--_•_---------------..__..._____•__-____-_------_..__.____._____.__________....._ ••.................•----......._...._.....----------•----._._...------------•----•------•--------•--...-------.._..-•---•--------••-----••---•---•••-••-•-----••••-•---•••••-•-----•----•---•-•••....... Date PermitNo......................................................... Issued....................................................... Date No. ..�1.....:....... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH - I. ...............OF........��.0 ....- . Appliration for Uiipoiial Works Tunuitrurtiun "rrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: \ .. ......- ................................... ............. U---•.........-••....... -------------•------..__............... Location-Address or Lot No. C'V M c, " � ,, �\., can(\ C e Owner Address .....................v_.. .. cL.� �� :}.. ...---••••----\1 n.:...�_��� .L ..P .... Installer Address U Type of Building 3 Size Lot-.3�2 - .....Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (()u) pa, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ---------------------------•••-- . . W Design Flow.............�A.`_......_.-.._.....•.__gallons per person per day. Total daily flow.__..._.........5-_:'-`:......._..._._gallons. W Septic Tank—Liquid*capacityA� gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......1----------- Diameter..e.............. Depth below inlet...G..._._...._.. Total leaching area z Q:n......sq. ft. Z Other Distribution box ( ) Dosin, tank ( ) aPercolation Test Results Performed by... ............................ Date........................................ ,.� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ r= Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P •---------------------------------------------------------------------------•-------•---....-•--•••.........................................................O Description of Soil Cam.-...r"�.�. *.==------------� -t rY^,----------•--- -``�7�-----` ----------------.--------------... -------•------------ ""� .� `1_ A-------------_-� r,\ a— 1 i\ c../ e � v . •--•---�.... ---•-----------•------•------•---•- W --------------------------------------=--------- -'------�`` " ��--------` '� -------------------------------------------------------------........................... 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 TITLL 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. Signed....... .«!..-..-•---. ...........:.. Date Application Approved By.....---- = :...:..:.....:.�. f �.� S-/ - ----........ Date Application Disapproved for the following reasons--------------------------------------------------------------------------------------------- .................. ............................•----•----------•-----------------------------...-----------.....-------------•------••-----•-----•-------•------••-------•--•••-•---•-•-----------•--••--••••---•.....-•-•- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CIrrtif iratr of Tampliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (V) or Repaired ( ) by...... .......... -==------------------------------------------------•--................---.................------------..........•...........--------- Cl v l `KV(\ r, ( �L-A Installer C at..... .................•---------------•......--------•--..........:----------•----•-----•--•••----...........e........... V has been installed in accordance with the provisions of TI 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.-�_��..�_._`� ............... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................i•'� .......................... Inspector-_.x..5.: THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1. ?. ?.r ............OF.------....� ..� ��--..................... u ............... ........................................... N .._......---•-- FEE...1:10.......... Rupooal Works T-Ponotrurtion rrntit Permission is hereby granted.......... .......... C u ._-__ to Construct ( -�or Repair ( ) an Individual Sewage Disposal System at No.. `.. ........�•-•-------•-.....�__\C__v_ N..�,.�"_r-.C_.. ��. `_Q_ tj `��' �"L r--...... Street as shown on the application for Disposal Works Construction ermit No..................... Dated........................................ .--1/!.��.<''=lth / ...................................... DATE................................................................................ Bo df Hea FORM 1255 HOBBS & WARREN. INC., PUBLISHERS r 1 to -4 3 33 0 6.P.R •r.- �a $ey-n C- T k u4%4 - 310 4*0 0, �li D•' St'v,��6'T � j � �� 4! f '%>1SPoSAL PCT U;6 I000 aL, Si ALL Ae6A . ISO SF . 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