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HomeMy WebLinkAbout0433 SKUNKNET ROAD - Health 433 Skunknet.Roa_ d Centerville A = 170 121 i Sllll_ n =J�aEcvctFo�om Illl k(ll�o � y� UPC 12543 No. 53LOR HASTINGS, MN 43-3 LOCATION SE GE PERMIT NO. L r 2h V I L L " E hliO4 17Z) • 11./ INSTA LLER'S NAME i ADDRESS U E 7`Q je 11-a 0le d 5 n• T .dL d� _ BUILD-ER OR OWNER � SM !i H DATE PERMIT FSSU-E D 14 D-A-TE COM-PLIANCE ISSUEU �, �� D A/ o L h 9 1/� a J—• No. Fss.. ......._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH c, c n .k. ►��n 1. ......................... Allp iration for Di-qVuiiFal Workii Tomitrnrtinn thrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: R ..... C\ .c�k n ti A� ........................................... _•-••-•-- ......---•-•........ -----------------------------•-•--...---- LocatiQ�-Address ..�... or Lot -� . No. .. ^rl s.................. � •--•--..... ................ ��. .............................................. Owner Ad` A' a •--------------1c.(! f�-t?. ..Sf...................... S C Installer Address U Type of Building Size Lot... \5.:.................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a4 Other fixtures ................................. . W Design Flow................ ........... __ ...gallons per person per day. Total daily flow____-__--____--3 ................gallons. WSeptic Tank—Liquid capacityk.....P_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.-........... .--. � Z W ................................. Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ••----------. -----------------•----•--•--...-----•------------....._----------......................................................................... 0 Description of Soil------.2q- a r, ..........�1 � CL �...------.. ` . .5 -•------------------------------••-•------ x t U ---------------------------•--------------�--�-�_•------.--�`,'-.--...--•�-e=�-=-•----------$Grp-�`......-•----------------------•----------•---•---------•--------------- 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 LITLL 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 ' .................................. -•....y•�-1 L---.--•-•- Date Application Disapproved for the following reasons:------•-------------••-•----•--•---------------------------------•---•------•-------------------.---••------••- ......................................••--------...-----------------------...-----------••-•-•---...---------------..._...------•------••--------------------------------------•---------------......... Date PermitNo......................................................... Issued....................................................... Date Fimi3 . ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............OF............... .CJ�:�_.(15 .. � -....... Appliratiou for Disposal Works Tonstrurtiuu Prrutit Application is hereby made for a Permit to Construct ( v� or Repair ( ) an Individual Sewage Disposal System at: -' �—\ Location.Address `d �.lu.rn .5_...... K- M\ S1 or INo_... .. ---- .. .........................••-•-----•-- Owner Addres a .�. .n_ ........... �_-y....................... ............. ......_..........•.......------. � Installer Address UType of Building Size Lot....V5!20..v.......Sq. feet Dwelling—No. of Bedrooms............... .............................Expansion Attic ( ) Garbage Grinder ( j aa Other—T e of Building No. of persons............................ Showers YP g ---------------------------- P ( ) -- Cafeteria ( ) Otherfixtures -----------••-•--------------------------------------•----•-••••---------•--•-••------------•••......--........__. ....••--•- W Design Flow...............o.0.............. _..gallons per person per day. Total daily flow............._` j.U................gallons. WSeptic Tank—Liquid capacity.00gallons 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. = Other Distribution box ( ) Dosing tank ( ) .... .. W Percolation Test Results Performed by..... .....-'L'... .... ..................... Date...... .---.p1.'.. Z.... Test Pit No. 1................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........................ a' •----------------------------------n---------•............................................................-•••-••-----•-••••........•........................ D Description of Soil........Q r � 1-�.•.... .X,_1��^�r �� :��.�- .�J.1 � x U ............................................ ?- ...........At..a.............. •--------•------------...------------------•-------------•------------ 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 f the provisions of TI= 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....U.. .. .........................- ! /� Date Application Approved By--• •- •••-.4.A....... ........ ....>l�L=�'f ........... .......................... Date Application Disapproved for the following reasons:---•---••--------•-----•-----------•-----•--------------------------------------------------------•-•---......_ ......-•---------•--------------•----•••--•--•-----------•••-••-----•---•••••••-•-------••••••--•--••••--•••--••---•••-••-••-•-••-•----------•-••--••-•--•-•-----•-•-•-••-......._•-•-------•------•--•- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD aOF HEALTHY , ............. n........._OF...........-1 ��!�.R�.`...G,: a�-'�-..................... .. .. (9rdifiratr of Toutpliattrr THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( „Yor Repaired ( ) by.......... _i..:.-n�------.....y���-E v->----------------------------------•-------....------..............--------------------..............-----------......-------------- Installer r at........... � .�5. -c)-A -'�-` f l.Q �c f -------•---.._. .n �1.1.�-\-e'- 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 �'o.g��.._,l '_,:............ dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.... ,� ..................... Inspector........ ....................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............0F.............. .f C.S\.�.. C.,S. :�....................... us al Works Tonstrurtion Vprrmit Uc --------_-_ a --------•--------------------------------------------------------------- n Individual Sewage Disposal System 1 Street Works Construction Permit No-------_----------- Dated.......................................... th ................ r� is UO GAC�caL�r 6►iZl u'4� I ' i ` 2�Ita{ FLr�+c/ sub +c 3 • 33o G•RA ` .. s G TANK 33o,. Icao 'l• AJR5 t �05 pt,. PIT LiSE l Coo 6at.. — I o �. c c 80r-MAA AZ"v SO 99 ; 99;7 i TcrrAL 1064I6W s 425 i �9 TvTA t, va►u,4 FL DV4 . 3w&P.D. P T /� �� 'PiST. (oo�* I: R�rRC.C1.AT10t.! TE i ~IN F.nnll�•�R �Li. X ' •--��-1.� r a .MAN. ,11 �_.!—. � OF4gss �P�� OFM .3 1t 31 ♦ oks s ©� wlLUAM J, AL 2 21 a C. N Y E XN y is Oak:.S. 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