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HomeMy WebLinkAbout0413 SKUNKNET ROAD - Health 413 Skunknet Road Centerville A= 170-119 S M E A C) No.mimLOR UPC Inu a- �"�» • r.a.a use f 'r��w�muow O;SFI MXMWAM i LOCATION $ EW .GE PERMIT NO. G-© l * I q Sri v n-frA-9 r- /1,0 VILLAGE INSTALLER'S NAME i ADDRESS V /c /tio dt3 6,5 6 /�w 3T 4/1L SUt-LDER OR OWNER v DATE FERM1-T ISSUED DATE COMPLIANCE ISSUED .��_�� � - i ?I n�£C � - ,,l,,l_ __ . , t�� - � ��7��. � i jl r - No.... .Z 3a 6 Fmc.............................. THE COMMONWEALTH OF MASSACHUSETTS q 3 BOAR® OF HEALTH 110^ I 11 ..---^1OWA................OF............. .. A 1trFathm for Utz ii ai Workg Tomitrurtinra thrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: \\ ................k ............ �.G.a........... `' a'\ °� ---..... Location-Address ............... .Q.............s---•--^....�$..._..�?.tv�` -_•_----.. .....-•--------•..... •� ...._..----------__........._..___• 1 Owner Ad res WW1 -•----•----•.... �l ................ .......................... .................. r n.s... .................................... Installer Address UType of Building 3 Size Lot___vs N., .�__.___._Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic CVO) Garbage Grinder (N() Other—T e of Building _____ No. of ersons____________________________ Showers a YP g ----------------------- P ( ) — Cafeteria ( ) d Other fixtures W Design Flow................. _.__._._.______.gallons per person per day. Total daily flow........... 3_ ..................gallons. WSeptic Tank—Liquid*capacityAQW.gallons Length................ Width................ Diameter______________- Depth................ 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 ( ) Dosing tank ( ) Percolation Test Results Performed by.___ CZW.k.�'1l_...._ .._ ---__________________ Date___._ '__ _ .._-. Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................... - ------------------------------ - ---------------•---•-•--•-•••---•-• i O Description of Soil----•-------0.:::3--------� ----•---�........................V O_i-.\ - -- - - - - - -- M ---•--•--•-----•-----------•--•-••••-.....---- �---�••.._._MILa...............�_G n_ 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 iITI.. 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_../_. -a.f.__. i_,..... ......... ............ .. _ Da ..._." Application Approved By---------. ----------------•-•----•-- --••---•------------ .----------••...- Da te Application Disapproved for the following reasons:................................................................................................................ ---•-----------------------•-------------...-•-------------•-•------------------------•----------------------•-•-•-----•-•--•---••--- -'-•-•-•-••-•-•-•-•-••-----------•----------•-•--•--••--•---_•---- Date Permit No......................................................... Issued---------------••----••--•= Date Ficz THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .1. :'.'}....-... .OF............ CY...r.is.. .. .. ? J,--............. ........ Appl atiou for Disposal Works Tonstrurtion Prrutit Application is hereby made for a Permit to Construct (t/) or Repair ( ) an Individual Sewage Disposal System at: - - ` _...._..... ------------------------•---•------ ................ ..---------•---- •--..._..--------........__......._------ Location-Address or Lot No. ............. ' t o t �`......- - - = �-`-Y"-------•............. ..........•.........----...------------•----....- .......-•--------......----•-............----- Owner ".; Address e.X... -..i.. ...`.......`. ..."`..`..Z-...._"..............•-••---.._....-•---- Installer Address Type of Building 1 Size Lot.._ ........Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder (N O aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ..................................................................................................................................................... WDesign Flow_________________... -:•._................gallons per person per day. Total daily flow...........:-> ?..................gallons. WSeptic Tank—Liquid capacityAQ�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 ( ) Dosing tank ( ) Percolation Test Results Performed by...... .'_ ...... .___ .•.�.................. Date..... _ ' _ "�_.... 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........................ 9 •••-•-----•--•-----•--------••-•-•••••••-••-••••------••-•-•••......•--•._.........-•• •--•----•-------------------------------- ® Description of Soil............. == ----• �a,t t g r-r`•-•-----... ..........S"i\o 5 h _ _ .._.......•........................................ W ----------------------------------••-••• ••---..._...---------•------•-•••.......------••-••-••--...-------•--••............•.......................................................................... 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 TI T Li:, 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......... .............: ' .... ` . ........................�. �y� y ,f .................. Date------........ Application Approved BY--------- -••-,�-�------�-�- �"_-_"""-�-�'-�/-�. ?''F-"•`�-----------------------•----- '� Date Application Disapproved for the following reasons------------------------------------------------------------•--............................................... .....................--................................................................................................................................................................................. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ .� J�4�f-� � .� � s.............................O F........................................................... ................. Trrtif iratr of Toutplianre THIS IS TO CERTIFY, That..t-he Individual Sewage Disposal System constructed ( d or Repaired ( ) by.............._ L� ------------••--Z�' �,'Z Q ,a ----------------------------•-----------•--•-•-•------------.....----••--...---•---•---...._........ Installer f at--------••- •�•---•-......-'..-e------------------.��-�-� - . - 1 _.:....--•---. \ n Cam. _�_.... ^"- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit ............ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATEf ......................... Inspector......,/ /4 —------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... . ..F�\........ O F................... n > C .......... FEE „ ' .. .... No........................ ... ........... Disposal Worke Cyoatstrttr_#ion Prrutit Permission is hereby granted......... .: °-? "*.f?.0....__...__.._.__. � --------------- ...................................... to Construct ( ) or Repair ( ) an Individual Sewage Disposal System / at No..---.- ............. -1. 1..-•---------- = !. 1.�..- ==- - . (� o b Street as shown on the application for Disposal Works Construction Per • No..................... Dafed.......................................... . .... .._ X'- ------....-•••-•-----•................._ oard of Health DATE. ---------------------•-- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS i pSIGN DATA a y; --- 4-4 rol ,: aI I .( Flow = I l o x = 33 v G.Pp (IJOT- 5E.PT1C U5�- 100'o GAL. PRI►�C-E •• HINCkLr-y -ROAD o15Po5AL F7tZ' y5� t000 COAL. � 11 8•SG' . � g 973 99•.3 �� 50TTOM A2EA- 5p S.F, 5o S.F x I. o 5 o G.P p z zal. 00 -ToTA�- nESIGN = /}25 GPO- Pir d -ToTPAI- IDA I LN( F�--oV�( = 3�0 G.PO, 1n47.0 ° i PE�ZCOLL�TtO�I RATE :.I•'tt�t ?-tAW oVLL�55 Ie CIF 'u^ I I f nE,lAX FEJR v,' U. 2 I TV---�-,T FG - 9q TOP Ft•ID=too.o 4a0LE gin- L 7,� I"v9� LOAM lo�� iNV. li DtST. INS. oaL. Q5 g i ` S£PTIG 3 9U6 SOS (d00 INS/ gUX Q5.(o TANK WITW I 11 G�RT1FlGp PLOT P1.._A1I +` � PR.OFIL<! LOCATION CENTER�/1 �.�.-1:. + It WO 5 GALE SCALE ��ty,50FT. VATE=_ N o .TER. 4 �z- /e v p L P,r.r RED EPCN GE• 1 CE 2TI=Y THAT TNT S"oww !� ut~R�o►,.1 GoMF�I_Y5 1nIITN Ti-tE. �,,I oEL1N G— I,. 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