HomeMy WebLinkAbout0744 SHOOTFLYING HILL RD - Health 744 Shoot Flying Till Road
Centerville
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Application is hereby made for a Permit to Construct (V�or Repair ( ) an Individual Sewage Disposal
syst t 4� 1% &Ww...................tv 4P W
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Address
Installer Address
U Type of Building Size Lot.......9��.20D.Sq. feet
Z Other Distribution box V11, Dosing tank ( )
Percolation Test Results Performed by---:P�MA.....C&P es. Us 46
.................................... Date.........31 A6---_-----
'--------------''----'-----'---------------'------'---'--'-----'--''-----------
Agrccooco,: '
The undersigned agrees m install the afoo6esoibedIn6ividual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State EnvironmentalCode—The undersigned further agrees not mplace the
system in operationuntil a Certificate {Complia as en issued b the board u{health.
--'------'— —'
Application '. By ................__------------------- -
.... .......... --------------------------------------------- '~--'^��.—'~--�'
Application
Disapproved for the following reasons: ----------------------------------------------------------............................................................................
.....................................-------------------------------------------------- ------------------------------------------------------------------------------------------------------............... ----------'
^� Date
Permit No lsax6 '
--- - ----- ------
No... .`....G y FEB/...�,v'..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............... .OWO............OF........ ...................................
A1111 iration for Dinpnstt1 Works Tomitrnrtiun rantit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at: '
- 1
0 CA
`/.1 � /,VL_ocati nj-Addtess or,Lot No.
......`. � ..(.. /...............................................
................4:1 --••-^-----•--•--•----••--••-•----..............--
a );j' �v` Owner --"'� -I %fe -Address
' r- .........................................................
Installer Address Q Type of Building Size Lot.......� ;_/r��_eQ().Sq. feet
Dwelling—No. of Bedrooms......................_...___._..__.._.._...Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
P.I Other fixtures ---------------------------•---- .
W
Design Flow__________________`. ._.____..._.__.gallons per person per day. Total daily flow.............
----------------_-- ..__gallons.
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....._...�_O_..._ Depth below inlet......_l-�........ Total leaching area...? ._sq. ft.
Z Other Distribution box ( c Dosing tank ( )
DO(Vt; (_ r��= lr.!�! 3 f�z3 ��i
a Percolation Test Result Performed by................ '-------------•----•-•------------- ................... Date------------ ............
Test Pit No. 1.............
per inch Depth of Test Pit..._..� '_.____ Depth to ground water_. .............
fZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
��
.................
--•--•--••- ------------------
..-----•-•--...........------•-
0 Description of Soil................................. ---•--------I-------:----. ....---- -._..._..---• •--•-• •--
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 Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Complia as been issued b the board of health. f/
Signed ...:............ -
Du
Application Approved By --('-------------------- ---- ..................v...
Dare
Application Disapproved for,the following reasons- ----------- ------------------------------------------------ ---- -------- ----------------------------------------------------
.....-. .............................................................. . -- --.....-- ................................--------...------------. ------------.
Permit No. --.. .�..--�--�-�..................... Igsued -..------�...........
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................/..0..1A.......... OF ................Z-/�/ZIcI5 `QL(r.....................................
Ger#tftoatr of Gntplianre
TJ41S-IS 0 CEffI �',�That the Individual Sewage Disposal System constructed ( �) or Repaired ( )
by ........�.. ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
at .
Insmller
r .-.. ' '.Fv7...... - � G ... .!C: -..... ' - - r' -' -- Vic_
----"--------------
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. --�.., - ...`.'......;7.-d......... dated �^...--_�~-----Z
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE............................................ ` ....... . .................. Inspector -----------------------------------------------..................................................
THE COMMONWEALTH OF MASSACHUSETTS
_ BOARDPF HEALTH
....................T'010?s....OF....... ..... /IIV.ST �.G ----•..............................
No. ......... FEE........................
MoVosal lUorkg Twonstruction anti
Permission is hereby granted-------------------------------------------•--.-
...................................
.................... =
to Constr ct ( orepair ( ) n Indlvid 1 S wag, tsposl System ` .
Street
as shown on the application for Disposal Works Construction Permit No4'' Dated---e__7' !'
.................................... -------------------------------------••--------..--•--
?, Board of Health
DATE................ ~��- --------------------------
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
#SEA��
Z TOWN OF BAD SRNSTA11 BLE
LOCATION Lo4 l � %o& �IY��ti rl.�� fie. SEWAGE # 1-L- 76
VILLAGE ASSESSOR'S MAP 6 LOT
INSTALLER'S NAME & PHONE NO. �,�•���SG01� 771- (8y®
SEPTIC TANK CAPACITY 11000 �- ,91'5
LEACHING FACILITYA ype) 4,eoct, Q,�. (size) 1,000g&lfld ,s
NO. OF BEDROOMS___� PRIVATE WELL O PUBLIC WATER
BUILDER OR OWNER �jA�/y+cat ��,I�;�,s 60.
DATE PERMIT ISSUED: l I Z
DATE COMPLIANCE ISSUED: 6 —
VARIANCE GRANTED: Yes No
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