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HomeMy WebLinkAbout0058 SACHEM DRIVE - Health LOCATION :O� SEWAGE PERMIT NO. L VILL G _ rr�. ;q yz�l/ 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_- �'� r 4 ���`e� � �� - � ��� _ `�,� ' p � ' 0' �� E � f � �. it <<� ,4 77 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 }�f,-c•.��•,fit �,-c'`11. � , t . k ..` >: ;�i: - : z r - :i ids 0,7 1 1 rul ' r gym it 4, r4 �, n , • � d1� r. T ,,— f:fl`- b PpB /O .S �.i A. '.'a d �.. � �'C• ~OB FAS _ (tl 6 - ..it•�R - ' r n n Ml•4'c•P' r-'� 1- a ,i.._dv 1Y.11 t' _ \ -_ � T _,- �.' A �.".irT 't 'yI _ " > ® K P. i h S .P�_ i� t,v a a LECEND a , a' - s SX1' 6" SPOT' ELEVATION ®xO . .CERTIFIED PLOT PLAN .1�8fS ELEVA .40N• � �. R d i ;, ,CCflY8t��4 -� t1 r/,f?` i � ��!_ Ile ' e 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 t; „• > p ' i 51. ..t �'.` c' ��.5 _ ►r ` �{ ,�: 1 .i. ,.f. V..�' ae �N.a, Fa„ •9.13 �S '. r-ns .�,r kfF,s:4wti�` �.` .,s+ `�5;. �`µ.. d s a7i F'�A p �k y.` ,.�. . s.' '.a.' �y. 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