The URL can be used to link to this page

Home My WebLink About0091 VICTORIA STREET - Health V ; cfib c I sr Cen teC vtIl t► K SMEAD 1 No.2-153LY UPC 12934 smead.com • Made In USA FORYJSWNABLE QSTRY WITIATNE wmuuwovuum CaNBodFi�rBourefn0 I � i .......................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ....... . .............O F.................-.......----•---.....------•--------..._......---------•--......._....... Appliration for Dispaiial Works Tonoitrnrtinn Permit Application is hereby made for a Permit to Construct (!/�or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. ......................—.......................................................................... ..........----------------------------------------------------- ._................-.............._. Owner Address W Installer Address d Type of Building Size Lot........................Cderhl� 0feet____, Dwelling—No. of Bedrooms...........��...............................Expansion Attic ( ) Garbage Gri aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafe aOther fixtures -------------------------------•--••------------------.........-•-•--------------.......------------------------------------....................._... W Design Flow.......s � .........................•_.gallons per person per day. Total daily flow........... �.0..._...............gallons. WSeptic Tank—Liquid'capacity./-OL0.0.gallons Length...P....... Width...Y.�....._ Diameter________________ Depth---'....... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------- iameter..t��-)... Depth below inlet....6,02.._ Total leachingarea.,r�0_..s ft. Other Distribution b Dosin tank p O'Q 7�' `, C�� Z (� g ( ) �iC�G• �-20 Percolation Test Results Performed by........ b.111__�... L a �................... Date_....-------........................._.. W Test Pit No. .._._minutes per inch Depth of Test Pit-&Y........ Depth to ground water...�01") Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 --------•-----------------------------------------------•-..........----------- .................. --••-•-•----. . •-- . • ........•••. . 0 Description of Soil....c E J9 7721.9 ............... x W VNature of Repairs or Alterations—Answer when applicable.......................:....................................................................... -------------------------------------------•--------•-----••---•--•--------------------------•-----•--------•-------------------------------•-.....-----------------------....•--••.....•••....._...--•- Agreement: The undersigned agrees to install the aforedescribed I dividual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Co —T e undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee sued b th board of health. igned .............. . ........................................................ Application Approved B . ...... ...... Z� •--------- D ate Application Disapprov f or " ............................................... Date Permit No.......;k.A ........................ z r No.±................:... F�s.....`?''�-�............._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................O F.......................................--------------------............................... Appliration for Bigpoiial Vorkii Tnnstxnrtinn ramit Application is hereby made for a Permit to Construct (Ll�or Repair ( ) an Individual Sewage Disposal System at: _ _ �1��"d�/'l.....5/... ec=...............Jt)T�.�..✓/-L� ....----........._. . Location-Address or Lot No. •---^................-----._._....----........Owner. Add.....-------•---..__....-•--•--••------••-._... _.......---•----•-•--------•----•--------••••• ress•-••----.......-•--------••.............._....-- W Installer Address Q Type of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms___..._._.............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other, fixtures ............................ . W Design Flow..... ......................... -----gallons per person per day. Total daily flow.........:, %....................ggallons. WSeptic Tank—Liquid capacity)--__--•-.gallons Length-1.......... Width-_Y.......... Diameter................ Depth...-,,...-...... Disposal Trench—No..................... Width............ Total Length....... Total leaching area....................sq. ft. Seepage Pit No....._./--------- Diameter./ :� ._. Depth below inlet.__6.t® .._. Total leaching area_; . =®.._sq. ft. Z Other Distribution box (V) Dosing tank ( ), )` Y*/" V el.F Z) 0-4 Percolation Test Results Performed b � ��-_�...��1�s... �•��.. Date......_��:g _...�__. Test Pit No. 1.4�......minutes per inch Depth of Test Pit.&M........ Depth to ground water___'00 y._.... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -•-•-•••--------------•----...---••-•-•----•-•-•••---•. -------------- •------------ -------- •----------------------- ---••••-••••--------_-•-- DDescription of Soil--=�".�--- •1��G/1£...�....�-? �ot.�---•------------------------------------•-----------------------------------•-••---=-•------ x W -----•-------------•...-------------------------•------•-•----------••-------------------••------•-----•--------••---•---------------------------------------------•----------------------•--•---------- UNature 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 TITIL 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. r Ign ..............•-----•-•.._....-----•-----•-•-•---••-•-••-•---------•---•-----•. i Application Approved B ;-= �......................................•---•------•--..................__.... i .. - .. .......... Date Application Disappro d f the following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Trr#ifirate jot TontpliFanrr - IS IS TO CERTIFY, That the Individual ewage Disposal System constructed or Repaired ( ) by --- --- -------- / � Installer ,e»+ date . has been installed in accordance with the provisions of I_IE C e as escribed in the application for Disposal Works Construction Permit N _.___-- he State Samtary ,, f THE ISSUAN E OF THIS CERTIFICATE SHALL NOT BE CONST AS A GUARANTEE THAT THE SYSTEM WI CTION SATISFACTORY. DATE._19.�if��... ...................................................... Inspector.._ __ ------------------•---------------------...---._....._.._......---._..._.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH PO .._ _ ...........................................OF..................................................................................... F ..... Disp t Works 05lanstra ion "anti# Permission i ereby ranted....._Z`�.............................. _,•._. .-------------•-•----------------------------•--..._._.....------.......... to Construct br' epairj) an ndavl al S gage l p System at No. 7 ,, -- ... ... Street as shown on the application for Disposal Works Construction Permit N ..... _, ......... Dates4.,- __ .................. �. Board of Health ' DATE................... � FORM 1255 A. M. SULKIN, INC., BOSTON LOCATION -* yl SEWAGE PERMIT NO. Lot 14 Victoria L»nP 93..�� VILLAGE Centerville, Mass. INSTALLER'S NAME i ADDRESS Robert B. Olr Co- Ina- Great Western Rd. North Harwich S U I L D E R OR OWNER Louis Gordon DATE PERMIT ISSUED ' DATE COMPLIANCE ISSUED ` , J. �O 35 ' �s TO aF F Ou D, —�- - J 6�LE f�GH �/T /off--�----- ---- _---- _ -_ . _ � - --- --- w-_f H E D o�1 E 04 h. _Lf1B —. __— —--- -- __ — ----- ---- - - -- --— -_— --- -- ---_ -- --- --- - /Jz -- - ---- — .�_ - qG --- - - - -- ---_ - - --- EXTEIIJD AL L / ) PPL/GABLE -------- ex �sfinc� ground Prof /e HO�?lz SCALC- / /0' - A'J ---- -- V E � 7- SC �9L� / ' _ / O E.� MA/VHOL CO ,2 VES T T O 4AJ/ HIA-1 —�— �—�—� — Pr-oPose•d c�rovnd Profile � � � � � � /2" OF F/Al/SHED Gam'-HDE . SCHED. 40 P. V C. O,e FLOW � 2"I EGOuigL 7� SEPT/C Cr lin/r,7urn X Fier f'oo-0 -T /A/T 1D/ST- BoX �'d,a.of 3/4'-O GAL. SEPTIC TAA A-- c.�aM ° - LE-19CH P/ T _113 - 1DE- 5 GAJ TEST --/ 0L � LoG oo' • Q, HOusF_' DATE : ZO - TEST BY -%/•j � 41)4=i,L.E /�JC T / AE G C. k? r� -E /+�, iiv.f/.�./CN "Qr7-f :�u ,-7L�1ct�� L CO (- / ,e ATE a GAL 5. DAY i \ DATVM SEPT/C T,9w,� 33o x /. 5 = -4 # +' l � TEST HOLE / TE9T HOLE Z y/ US& . Gi9L. 7-gQAd� .off Ze G�/•(//" O LEACH P/ -r S/DE WALL !•gJf. F. G-s. P. D. GPI. •!�Q T07TA L r j�/ G. P. ZD D• S T. H . E `1~ C]C-T 7. 0 USE --- LE.9CH Fo/ T C,oT / / -Tv EL• ?. S 4C41 67 E,2T/F Y T/--I AT THE 8 u/L D/Ai G ` �j P,2oOOSED OAJ Tf4E G�2oun/D ,95 SH 0 CAUA/ OAJ T-/-// S PL- ?q,4,/ D OE S / Bf�C� A2EQv/,E'E/`MEAJTS OF THE- ; ''" G r- ems. .,._ T' e. ``,% 4 y� S C,9 L E ,9 S S •N O lnJ nJ WNCKLEY , No. 27R H. HINCKLEY SCALE / No. 13230 `"� su 4y ` O OO - ex /S - t/nq e /evation BLD ��. SE-rBAc,� / ��+6:E�' 8 `70UTH 0 0 0 = Proposed e /e va-f-ior7 ,2E Q(J/A2 - - - - - - - ex /St/ nq confour-5 S / de � ,. ,9oP,20 vE D - — - - -- ProPc�Seo/ cOn-tour-S j � Qr 3vA,c2D OF /-lEfQLTH # 61753 of Foci [D. /08 /06 - _Ioq oo /o¢ wi9 H E D OA/E - ------- --- - --- - .. cam? _----- ---__ - /v 0 T-E EX7-C-A./D AL 4- f� PPL/Ci495 L - - ------ e xlsf inch c�rovnd Pro e H02/Z SC;9LE - / " = /O' C �, V LG ,QT. $ Ci9LE : l ' _ /O' /")AtiJHOL E GOVE,QS 7-0 (A11TH//lJ -e— o—o—o - PrpPose'd c�rovnd Proflle /2" OF Fi�//SHED Gam'-FADE . SCHED. 40 PV. C. O,e F1-0C-/ -- �-m rnurn �.. r foo-t 2" of cwashed s-fone EOUfjC TO SEF�T/C in� /�/" ` J• O O° / ° O O DIST SOX G'dla. ' o 6., sump o Q . o . ° C /000 Gr9L.. SEPTI T;9•VK o¢' 314 - /%" ° ° ° • o 0 .• . - cva 5 hed sf o ne o �: l Q o c S - D E- S G AJ 7-4E- S 7 o L E- L O G E-D,e O OM HOUSE DATE : TEST BY: 010 P E,2 C ,e A 7-E <. M;ti. I A N/C _ L O tA," ,e ATE T/C T,09N/C 3 o x /. 5 = __. . # q ✓,� �' �i \ TEST HOLE / TEST HOLE Z USE : /000 GAL. TAAIA-f � �-; 3.tea �' � ` �zl.LLL•� � • v�e�,e i13 LEf�cH P/ T. L-o�� <<. p, /J Z EFF. DEPTf-il ``,- � �'. � �W I ,w� '9•�. G � o T S/D E L L = ' F7 � - : r% G S q�-�,S BOTTOM = S• F , s Gylo• Co ,. TOTf�L = �2 4 G G. D. NJ�D• 5 C T. f-t pG .,_ USE. --- LE�9CH PIT ` C_0 T / / 7o EL. 97• aaSe A-1 J KJ,- r7' / G E,eT/FY THAT THE 8U/C.D/AJG -7-- / . / \�� P;2OPC1SED 0AJ THE GA2oUn/D f9S / 5 r✓V / S H O l-/AJ O A./ -VI-4/ S P L Fq A-I D O E S ,c O L 0 - / i1 ":; CON!`O,eM To THE BUILDIA/G sET- / Bf�CK i2EQC//QEME�/TS OF' THE V lc � T' } / /=- T" T o t.A_//V 0 F ��, T,` c C r- f� T' V f L_L.. ;9,e r= D FO,E?: C,9 6�/A./ 0F o � ' NiM�XI cY �_1 EVERE ''=', 1 • H. '�► 13230 4 �6N0 cT� f/ s C E NN _ - lAJ E- L L E- �Q n c . O oO e x ;Stinq e /evation BL D6. SETB19cAf M�tV"" } AA2 MO CJTH N7 -q5S. 1000 pr-ropo,Se d e /e VcZ-fion 42E QU/,2EME A•./TS . - - - - - - ex /Sf'inc/ Contours S / f�PP20vED = Pr-oPose'al con-f-ours de i o „ reaLt- _ ,o ,. Bo,q,eD of HEALTH