HomeMy WebLinkAbout0064 TRINITY PLACE - Health nAervtll
9- a L31
SMEAD
No. 2-153LY
UPC 12934
smoad.com • Made In USA
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SUSTAINABLE
FORESTRY
INITIATIVE
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TOWN OF BARNSTAB_LE
L C OATION_6_ Z �- t- SEWAGE i2 `l-rez
ASSESSOR'S MAP & LOT92/--a`-leJ
INSTALLER'S NAME & PHONE.NO.
SEPTIC TANK CAPACITY tap2�
LEACHING FACILITY;(type) �(��p�,c�rlwSeRS (size)
NO. OF BEDROOMS 51 PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER_
DATE PERMIT ISSUED:
DXTE COMPLIANCE ISSUED:
x -
VARIANCE GRANTED: Yes No
?`/ �R r
No.----..P 2--3----.... Fim.......-12.................
THE COMMONWEALTH OF MASSACHUSETTS
®ARD OF I-iEA TH
... OF....../..c/........ . .. . . "
Applira#i ti for �i�poiial orkii Towi#rur#ion rruiit
Application is hereby made for a Permit to Construct ( ) or Repair ( t<an Individual Sewage Disposal
Syst at: �ot
-. ---- t % •. ------ -•--- - -••••--•-•--•--•--------•-----
Lo.,gion•Address
0 Address
Installer Address
ype of Building Size Lot----------------------------Sq. feet
U Dwelling No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Q' 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-------------------- Depth below inlet.................... Total leaching area.-_--------..-__.sq. It.
Other Distribution box Dosing tank
Z ( ) g ( )
Percolation Test Results Performed bY-------- ---.............................................................. Date........................................
Test Pit No. 1-------_--------minutes per inch Depth of "Pest Pit.................... Depth to ground water.----.---_-_.--.--.-.---
(i, Test Pit No. 2----------------minutes per inch Deptb of Test Pit---___.-_-__-__-__- Depth to ground water--..-.--..-.---.--------
a -------------- ----------------------------------------------•----•-------------------------------------------------------------------------------------
0 Description of Soil.--- ----------------------------•--------•--•------------------------------------------------------------------------------------------
x
W --•---------------- ------------------- ------------------------------------•------------------------------------------------------------------
U" Nature of P.epairs r Alterations Answer when applicable._ .. __.�'._.� .�.....-. __.... _.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has en issued by e bo d V,�heWth.
4Si _ 2_ ;
gned- -- ---- -9 --- ---- - ---- -•------. .----• -- --...-•-- ----
t Application Approved B A
Date
Application Disapproved for the following reasons-------------------------•- ..................................................................................... ..
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Date
Permit No....... 3................................... Issued......................' �� .
41 ,
Date
------�------------------'-------------------------------------------------------------------------------------------
No....... . .3.- .'. Fu$.... �.. • ......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-•: : Avv it a#ivn -fair Di-quiial Varkii Tons#rur#ion Vrxuai#
F A`"�rlication is hereby made for a Permit to Construct or Re air pp y ( ) p ( ¢ri Individual Sewage Disposal
TSY stett'�at � � . Y .
/
Locations-Address v or Lot No.
:- ------- ----------------------•------••---•-------•------...-•--•-----•-......--•••-......__..........
I Addr
ess
a' --•-----------------•-••---•----••-...-•----•----•-•--•-------.............----------•-••-•-
p Installer Address
d ! ype of Building Size Lot............................Sq. feet >f.
U 1
Dwelling No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
p, Other—Type of Building ___________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a 1
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..................... Depth below inlet.................... Total leachiiigarea..................sq. ft.
z Other Distribution.box ( ) Dosing tank ( )
aPercolation Test Results Performed by------------------------------------------ ......................... --- Date........................................
a Test Pit No. 1------------_---minutes per inch Depth of Test Pit.................... Depth to ground water._._______._-.-_._-_.
fi, Test Pit No. 2.................minutes per inch Depth of Test Pit---------.---------- Depth to ground water.......-:-____.__:__--- r'
O Description of Soil----_S_
x
W --------------------------------------------------------------------------------------------------------------- - ---
,�+
U N ture of Repairs r Alterations Answer whep applicable._ "............. '" �LhD Q _.____
--. ---- -
Agreement: -- -
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article NI of the State Sanitary Code— The,undersigned further agrees not to place the system in . ..
4
operation until a Certificate of Compliance has een issued by e boa d of.he th.
Its
1 Signed . /.
. r
to
x
Application Approved By �-------------- --•----------------•--•----------- -•---- •-
Date
Application Disapproved for the f ollouiing reasons:.........=-----•--------•---------------------•------........--------------------------------------- ------
: ,
Permit No - `'�------------ Issued: Date
� ------•-------•-------
Date
`THE'•COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
err#i�iraa#r alf f�aiut�haanrr �a: -
T IS IS T CER ,,IFY t e 1ndiv ual Sewage sposa System con ructed ( ) or RepairC(4-
Iby....- = - --.........................................
--•--- .
�• _ Faller
at : ....---•-•----••-•--
has been installed in accordance with the provisions of A e of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.________ P: dated S'- j"-----L-- ==
THE.ISSUANCE OF THIS CERTIFI-LATE SHALL NOT BE CON-STRUEDAS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTOR.Y-
k 6AZE............. .....3.............f *---------------•---___•--:_--_-__.... Inspector--- . -- 1
THE COMMONWEALTH OF MASSACHUSETTS
kR }
BOARD&-jirALTH
� .
a
r' Z� O F
No:...... ,.. FEE ....................
rVi� a1 park �n #r �un rr i#
Permission is hereby granted ..... ..-•-------••-•••. -.-_ ---- f•�'"�
-to Constr ct ( ) or it ( n Indi I ual Sewage oral S m
at No :..
.. Street
as shown on t e application for Works Construction Permit No._..___.a, Dated_-__ ._ .. __..�....
.........................
Boof He h.......................................
c
DATE-----�- ---------------------------------------
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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Pau
L.O AT 1.O_N SEW i --CAE PERNKIT MO.
�A-DD R F S_S
U 1 L D E_R_5
:QATE-RE R tSAIT 15SU ED'
DATE CO MP LlAt�l - -
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