Loading...
HomeMy WebLinkAbout0001 VICTORIA STREET - Health I Victoria Street Centerville A= 148 -038 5 M EAD NO.2-Iss R UK 126U •mttdmm • Waft to Uaa s ' saum�r�aouaut IN -3- 72-- W PERMIT N LOCATION SEWAGE .0 �, rr 4-:7V PILLAGE kq%m-400111, ,E l . - Le"iten-, LL-e I N S T A LL f R'S NAME A ADDRESS S UILDE R OR OWNER Leo 15 C70.`aoof4 DA T E PERMIT ISSU E D C DAT E COM'PLIANCE ISSUED j � r�-� IL S �� 1 � �� . � �D �l 1 FFi3 T ................. THE COMMONWEA:U•TH OF MASSACHUSETTS BOARD OF HEALTH ...................... ....................OF.......................................... Appltratton for ElWp ottl Works Tonstrnr ton prrmft Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal sysl at em ....o��u. . -... .... e ..C�.,��..1. . "Y�. U�.l .............�d. ................. Location-Address or Lot No. ................................................Owner Add_.....----..._..__...._..........------•----•--•-- -.......-•--•--......._................---•--- ress_--.-......_._...........................-...... a --------•---•.............!..:_.. ................................................. __..__...-------------..._... Installer Address Q Type of Building Size Lot____________________________ et U Dwelling—No. of Bedrooms.............3...........................Expansion Attic ( ) Garbage Grin er aOther—Type of Building ____________________________ No. of persons...................------- Showers ( ) — Cafeterl ) a' Other tures ............................ W Design Flow______ _____________ __gallons per person Depday. Total D . ._________. Diameter................ Depth_______._._..._._ . ______....__gallons. WSeptic Tank—Liquid capacity,i9 ?_gallons Length____ ________ Width__. x Disposal Trench—No. .................... Width___^�_._____...__ Total Length...__f/._____._.i__. Total leaching area__•_____ _____...__sq. ft. Seepage Pit No......... ....... iameter..�(�_t__S.__.___. Depth below inlet__f�_r.a_.____._ Total leaching a ea_ sq. ft. Z Other Distribution box ( ) Dosing ank ( OE 9' . a Percolation Test Results Performed by.__._�.�9/._ _ _� 1t.................. Date........................................ ,.� Test Pit No. ....minutes per inch Depth of Test Pit. _____!___.____. Depth to ground water........................ Gz, Test Pit No. 2________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ a O Description of $oil..................... a� -- � ..:!1Y> ... .. !�--------------------•-----------------------•------- U •---•••----------•-••---•---•--------••-••••-••-•-•---•-••-••••-•---------------------------------•-•---......------•-------••--•••-•---•--•-•-----•-•••••------•--•----......_..----...••--._..._..._.. W U Nature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ ----------------------------------•.-..-----------------------------------------------..........-------------...----------------------------•-•--------•------------------•-•.......--•••---•-........_. Agreement:The undersigned agrees to install the aforedescribed Indivi 1 Sewage Dis s System in accordance with the provisions of iITLL 5 of the State Sanitary Co — e un signed further ees not to place the system in operation until a Certificate of Compliance has ee ued the rd of li It. ign _� .... .......... .... ...... ..................... Application Approved BY t; ... ................... . ' �1 ...._.. .._......_. Date Application Disapproved or a following reasons:.............................................................................................................. ••--•-•---•-•-•........................•_....._....•••-•••---•-••-•---••------•--._..._...-----.....•--••........•••-------------...---•••-----•-....•--•-•--------••-•----•-•--•--•----••---••-•-.._.... Date PermitNo.............................•--------------------------- Issued....................................... -- Date BOARD OF HEALTH Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at Location-Address or Lot No. Installer Address Z Other Distribution box ( ) Dosing tank ( ) --'--''''---'----------------------'-----'--------------''---'----'-'--'—'''----------- Agreenent SanitaryThe undersigned agrees to install the afore&scribed. IndivipA� Sewage Disp,'s System in accordance with the prdvisions of T IT LE 5 of the State Dispo's System i, ' ,pe ^""" until" ^ Certificate of been �uocu vy �oc Date Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TUIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ,Lor Repaired Cod/ s ibed in the -iin accordance with the provisions of TITLE 5 of The State Sanitary Code s de/ has been inst./e a plication for Disposal Works Construction Permit No_6�;,7 THE ISSUAN9E OVHIS CERTIFICATE SHALL NOT BE CONSTRUED ONTEOTHAT THE 00 SYSTEM WILL �GNCP ~ ' THE COMMONWEALTH oFmASSAc*usETrs BOARD OF HEALTH ` ' ? ...........................................OF..................................................................................... �� ^ ^ ~- ��� ~---------- -° �� 1 TQP .�F ��tJti;J� - ----- - -- 8 , 03 9� ---- -- - - _ r --- - - -+ - —__O F �_► 40 ,t ." �o A."O T& / EXTE-ti/D ALL A PPL/C�9 BLE - - ------ exrstrnc� around Pr-ofrle H0ARI Scf9LE / = i0' - S T / 0 /�J — - V E. E' T" LE- f = 01 MA/�JHOLE GOV6,2S TO !.-/fTH/A.J -o - - o-o - Pr-oPos�d 9rovnd Profile /2" OF Fiwis !-QED G 2F� DE S c HE-D. 4 0 P v C Ore ---- EG�uF�L S=PT'ic �m�n�rnurn %" Per foof�T 2 of �6 - �2 washed sfone -7AN�C3 - �3, -/iV T • O O Q O / • 0 D/sT Box 6'dia - • e ` a a /OOO GAL. SEPT/C TfitilC of o e wa5�Cd S-"one r' 1 �O. 5 ----- - D T / L S -- if S c A L E / . ,. - / _O„ L E-� C hl FD 7" L 0 � 10.41 �4 103 � � iO4 DE OG CST 13E-D�eO0M H0U.5E DATE �� -�-- TES ' BY• �L�J �J l� !Erb / L J//01 --- 4E.A?C SAE ! MBA./ AJ H c lC'U '�f l� - �3 / o w ALP A ; JO GALS.fD�9Y Dti7uM r~-.� '� `� S E P T/c T.vnl 3_) x TEST HO L E �/ TEST HoL a- �'z �,f,f F�� \\ /OCR, Del i�J LE�9GH fDiT: L0A�7 � �' � d � �E r�►5 E � r ©! t EFF D g - x, 0 E F.L' D E G T H �_ e/. . b,Es SvB 5 tJ/L 24 . G. P D o-7-T-oM to A7973 J Fes/ / y I 4L tiO I-Jf11-FAI Er.1COU/JT�i2�L� o�ol�oSED o� 7"HE Greoun/z� FPS / T-E G C=7 L /u F,?A'/ D O E S o E' Bf�C� �'EQC// "t=MEfLJTS OF THE O � / �f a rY �: _ ki^..-d �e Z: aeEr°Ae � D Fae: H F O!mil A J LD f9 T E �O fYCRFT" �G I, Vo' l,7Fyj� `1 AJ H;NCKL£Y prla 132+0 l�U l_ � /7 C O o0 - exiS-t-rnc/ e /e ✓atron BLDr,�. SETBAC,� ,lN {� Y� ,� /`�70UTH /VI� SS- o OO Pi noosed e /evatron �2EQU A2EME �fTS �r o of = 2c: 1p-f. - -- -- - -- - - ex IS confov s S . de = ! G> r9PFoe0VED : _ _o—o— -_ P�oPos�d con fOur-5 B o� ,2LD orC 14EALTH