HomeMy WebLinkAbout0058 SACHEM DRIVE - Health
LOCATION :O� SEWAGE PERMIT NO.
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INSTALLER' ADDRESS I CHO SERVICE
15n,walnw.�•_- .
10lest�Bamstablea Mass. 02668
BUILDER OR -OWN R
DATE PERMIT ISSUED 1a-z,f� - 77
DATE COMPLIANCE ISSUED 7-/y_ 7y_-
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® H EA T
............... ....�...OF.
..... ..0
...............
ApplirFation for Bisvoii al Works Tonotrurtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: lz - .........................
.........
5->- Loion-�/idress t
..L 1 l r t��
or Lo No.
----------------- ..----y--....... :11..� G �--------- 'Q-• -•- ............................................
Owner Addres,�A
............ e�J?CAL✓o`l l e sV 41 f
Installer Address
Type of Buildi / 3 Size Lot............................Sq. f"
Dwelling—No. of Bedrooms..._.................................Expansion Attic ( ) Garbage Grinder ( �
Other—T e of Building No. of persons
a YP g P ��--------------------- Showers (�) — Cafeteria ( )
d Other fixtures -------------------------------------•• -------
P P P Y Y -- g�--gallons.
W Design Flow...��...........................gallons per person per day. Total daily flow____........• _._._...._
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'(t✓)' Dosingtank ) do, /0 - $ - 17
Percolation Test Results Performed by ----------------
Date.... Y..........
Test Pit No. I................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........................
- �.... •------•--•---- ------------
Description of Soil....,, 4 !j� ..." �. y - r,2 --
----• ----••----•• a
c.,
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 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 is ue by board lth.
Sipped ... ----------•- 1 .: y..77.._
.
Application Approved B ''7
PP PP Y �1 � �.Y• 't. 9
- ---- ---
Date
Application Disapproved for the following reasons:-----
---------------------------------•--•----.........-------•-----------•-•--------•---------...-------•-------•---------------------------------.....----------..........................................
Permit No......................................................... Issued-----l^ 7 b
..� au
----------------
Date
THE COMMONWEALTH OF. MASSACHUSETTS
BOARD H EA
C.
--....... + �:..OF...... .......................
App iratilan for i >or jai ,ark ' C� n rnr iun [ernti :y
Application is hereby made for .a':Permit to Construct y( ) or Repair ( )„an Individual Sewage Disposal
System at
........... 1 s.. .. �tit----------------- ----------------- ------------- `-`
...........
oc ion- dres or Lot No.
f�
L
' aft `_................a - , ....... " � = ---
wner Addres
ae/ l.......... .. :......... �C.....eJ E l te.....•+ ,r . ..............................
Installer Address
UType of Building Size Lot......... .................Sq. feet
�. Dwelling—No. of Bedrooms......_ .......................Expansion Attic ( ) Garbage Grinder
a'4 Other—T e of Building ............... No. of persons .._r
YP g --:-----..•-- P �"-�•----•----•-------• Showers ('"�) — Cafeteria ( )
Otherfixtures -----------•----------•-••---••-----•••--••--•••••--•----•...................•-••----•--. .......:
W Design Flow__.XT ______________________,..._gallons per person per day. Total daily flow.......... ....-.'d.galions.
WSeptic Tank L Liquid capacity./gallons Length-------I.. ..... Width................ Diameter................ Depth................
x Disposal Trench—No. _//...•....•_ ...... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No _..1_: Diameter................... Depth belo inlet .__.__ Total leaching area..................sq. ft.
z Other Distribution box (boor Dosin tank
a Percolation Test Results Performed by / , .___e._ l f.e ___ ..................
Date....}d .`s.`..�
Test Pit No. I................minute9 per inch Depth of Test Pit........_ . Depth to ground water........................
Test Pit No. 2................minu�tes per inch ;:Depth of Test Pit.............,__.... Depth to ground water F...............
A
O ...... .,, j Ii
Description of Soil........ -� x
" r ►I ..
U
W .T
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 TITIL _.5of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been is ue by e,.board lth.
Signed...
Date
Application Approved B ~
_. ,....
Date
Application Disapproved for the following reasons:...............................................................................................................
......................................................-...................................................................................................................................
D"ate ""^•
Permit No..........::..........................................-- Issued-.............................................
I.
Date
a,THE COMMONWEALTH OF MASSACHUSETTS
BOARD, OF HEALT3H
..........O F............ . �"°" . ...................:.....
Tr , 'firatr of Toutpliatur
TH S RT F , T the d. idu'l S a DIs6sal System constructed ( e) or Repaired
bY------- . .... ..
.= ' :... �-t . " ------. -----. ......................
nstaller
at. "}' ' e... J �r
has been installed in accordance with the provisions of 5 o The State Sanitary Code as described in the
application for Disposal Works Construction Permit No. ____ _,,T..._....... dated_.-. Q.`._ ..� '�_ --------------
THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUEDhAS A GUARANTEE THAT THE
SYSTEM! WILL FUNCTION SATISFACTORY.
DATE....................'. : ••-----•---• '•.Inspector......:.................................... •
THE COMMONWEALTH OF MASSACHUSETTS
BOARD Z
HEALTH
No......1��-3...... FEE...��
Maps nrk� n and
Permission is.,hereby granted'---:. ------ ••
nkto Cons (�or Repir ( : an Indio 1 Sewa ispo stem ,
atNo... r�•• •--• -- ..' -----•••• -•••••-•••••---•••......-•-•-••••-••.....
Street
as shown on the application for Disposal Works Construction PermNO.___ 1 _.*oaro
ated../A_" Q� - 7•....-...
i ealth r..........................
DATE......................°l. `. ...: --••- •--........ ,
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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SX1' 6" SPOT' ELEVATION ®xO
. .CERTIFIED PLOT PLAN
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VED't BOARD OF HEALTH
t.:L3 TE,.r A®ERT SCALE`:. / —�D ` DATE
ENGIACERINO W Its CLIENT Plc(c y ic�c i CERTIFY THAT THE. PRO��Eb
` Eii13TER LEISTERED JO® Nye ?7U ,S7 BUILDING SHOWN ON THIS YPIti AH
GdVlL' .AHO CS� FMS TO `SHE Z®Ht�3t� LAMS.�Y t .,4.''''i '�tNEEOd VEY -- -----p OF BAR 48LE a MASS.
,,3 MO:'MAIM ST 7tZ. MAID ST. _ CH. ®1f: - / s
S(L YARMOUTH MASS. MYA[dN1S MASS.
e HE9T_L OF DATE REG. L141V0 SURVEYOR
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