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HomeMy WebLinkAbout0094 VICTORIA STREET - Health �. . 94 Victoria Street Centerville A= 148 —076 rl *PendafleYr 0IssOVA 42101/3 ORA 10% P4 1 L0CAT10N � cu SEWAGE PERMIT NO. LOt 47 W -ek Way Centerville 83-367 VILLAGE Centerville INSTALLER'S NAME i ADDRESS Robert B. Our Co. Inc. Great Western Rd. North Harwich, Ma. S U I L 0 E R OR OWNER Louis Gordon DA T E PERMIT ISSUED DAT E COMPLIANCE ISSUED � ���3 P ar ' s� ._ f ,�, 3 �6 , .. S� .r' O . e No. �. Fss_...YLI_......... _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _... w ..............OF.......��r� s7 .�- �..................._ , _ ,� AvOtratinn for lliopnottl Works Tonitrurtion V.erntit V 0 , Application is hereby made for a Permit to Construct LX) or Repair ( ) an Individual Sewage Disposal System it: Lora on-Address ---------------------'---------- --•--------Owner ... .... �+ ................. or ---_No__... -- - Address a '---.....-•-'•-----•••----••-'---'-•--•--•-----•-•----•----•-••--'--'-•-•---'-•••--•--'---•••.... .........•---•--------------•-•------'------•"-•-•---•--....._...............-•-'---•-------- Installer Address Type of Building Size Lot.....:...................... . f Dwelling—No. of Bedrooms............. ` Expansion Attic_( ) Garbage Grin r,/� --------------------- `j Other—Type T e of Building No. of persons............................ Showers ( ) — Cafet w YP g a Other fi tures ---------------------------------- -------- -• . . W Design Flow W Flow--___ 5 -•-' oa ai o3 .................._. gallons . Y d ` Septic Tank—Li uid ca acitM g�Ions Len ---�-...... Width. ... ... Diameter................Depth x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq.-ft. 3 Seepage Pit No..;j......:........ Diameter---.10t.�.._. Depth below inlet..... .......... Total leaching Other Distribution box (}C) Dosing tank( ) n z �w - �! c- t72 s um S- `" Percolation Test Results Performed by-------------------------•-•-------- •--.....------•-----------...... Date....._....."t.. Test Pit No. 1:---�.._..minutes per inch Depth of,Test Pit.... ` .v Depth to ground water........................�a Gt, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_......__._._...... �.1—�.......-----.......................L -' - -0 Description of Soil--------------- -- - --- V _------------- --------------------- --------------------------------------------------------------------- '-------------------------- ---------- ----------------------- --------------------------------- --- W --------------------------------------------------------------------'----------------- ------------------------------------------------------------------------------------....------.....•..- I UNature of Repairs or Alterations—Answer when applicable............................................................................................... =-------------------------------------------------------------------------------------------------------•--•-'------------------------------------------------------------------------------------------ Agreement: I The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIME 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- ign --------------------•---...--•••....---------------•-----------------._.._...__...... Itle Application Approved B -f--------------------•-----•--•--•'-'---•-----------------........---- ---- Date Application Disapprovedng reasons------------------------------------------------------------------------------------------------------ Date jPermit No------------------------------------------------------- Issued--------------------------------------------------- -- Date r Fim..... IJ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..dE,4►..............OF....... "...................... Appliratiun for Uiiliouttl Workii Towitrurtion Frrmit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: ................................ ...... .. --•--......... - Loci ion.Address or Lot No. ............................................. ............................................... _.....------•----•--......-------•--•-••--•--•--•--••......_...................................... Owner Address W Installer Address d Type of Building Size I.ot....:....................... fe Dwelling—No. of Bedrooms '..........................Expansion Attic ( ) Garbage Grin, r aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafet Q-I Other fi tures -•------•••--•-------•------------ _ . W Design Flow........!.w....................................gallons per person per day. Total daily flow__......* +.'....�..................gallons. WSeptic Tank—Liquid capacity/lAoligallons Length-_- `..... Width....If.. ... Diameter________________ Depth.. ..... x Disposal Trench—No..................... Width..... �.......... Total Length..................... Total leaching area....._ _....sq.-ft. Seepage Pit No...�.............. Diameter gE '0 Depth below inlet....24t........... Total leaching are e .... .- .ft. Z Other Distribution box (ad:) Dosing tank ( ) Percolation Test Result Performed by.. .......-_ -—--------------�AAC Date..:_ __._.. , .. . a Test Pit No. 1________________minutes per inch Depth of Test P------------------------------------- ._.....__ Depth to ground water.---_-._*... � Test Pit No. 2................minutes pet, inch, Depth of Test Pit..__._...._.._._.... De th to g round water 0.. P P O Description of Soil--------------- s--S .. .------.A-*,�`.`��............................................................... ---------------------------------•------.------..........-- 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 TITLij 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. Signd"......................................................•-•-------•--...-------•----. .... __ ... .... ... D Application Approved By. ?. .r. :--••----•••......-----•--- ----------- Date Application Disapproved r t e following reasons-----------------------------•---------------------------------------------------•- -------•------------------- .............................................• --•----••-----•--•--------............--••------------•••------------•••...•---•-•-•--------••-•-••-••-•---•-•--------•----•-------•-------•-----•------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Trrtifiratr of Toutplianrie M-s. IS TO CERTIFY, That the Individual Sewage Disposal System constructed (✓ror Repaired ( ) by..... ---------------------------- ------ -----•---•-------••----------•------------------------•------------------•-•-----•----•-- ' Installe at........ > ..•-- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code Xs c1peribed in the application for Disposal Works Construction Permit No..*! _c_, i_?............... dated__.,'"` 1eflrrl..................... THE ISSUA CE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WJLVFU r�TION SATISFACTORY. DATE..... _..3 d.l- Inspector. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f ........................O F..._...--•--_._............................................_......................... S! FEEJ� ................ UWpoua1 Vorkv T-1unutrnrltion rrmit Permissionis feby granted....'C=`� --•--•----••---------•-----------------------•-------------•-----------------------------.-.--.------------------------ to Constru or Rep 4) n ndivid ����,,�e-Ara e Dis al System Street ------ ......•I. -- as shown on the application for Disposal Works Construction Permit No.................... , ........................................ - 1............ -----_. ....•- B d of Health DATE................................................................................ FORM 1255 A. M. SULKIN, INC., BOSTON Lox EXCr-)Vl9T` To E!_ EV. ?8.00 FOP— SO/ L EXt9NJ10A.T/on> PtJO Tc> ELEV. /02.00 n/ !�// r " C. Efa/J NCB. 1©� - /0900 I p4 - /08,40 �cJ�95f l U �57Z>tilE _ 06, I0o 08• /JZ, c)o a , 4, 0 T& EXTEND 43/ L H PPL /CABL.-E - - ----- e xr,5trnc.� around Toro f� /e _ l f-4 0)2 z S C,9 L E / = /O ----- - S C. C 7- A ._. _ V E A' T S C f� L E ; - / p, C O V C,R S TO —� - - — �—o — Pr'OPOS�d c�ravr7c7 Profl �E' /2" OF FlAjiSHED GA2F-� bE . SCHED. 40 )c:> V C 02 - — ----FLOw -- EOU�LTU SF_r�TiC �minirnc�rn Per �oof� 2 Of �e - �2 washed 5�one �>� lti _ry --�N—T • o o O D D/ST Box (o'dia. ro o 0 e o o n /000 Gf34- SEPT/C Ti9ti1K ° ° e o � � o i De OOM Ho(JSE DAT E - -_� TEST � LOT /�-8 �• �, - s \ 25 �r o disposer w rivESs �7/�CQBI, a9�nf L3 abeP \GPe' � LOw .2 ,9TC- Sao_ GAL fDF7Y' Df� vM Bo�Zr-c7 O . - uo- ' ter, _ T Lo x TEST HOLE #/ TEST HOLE- #Z ill, 0 e© / EFF /0, N �1 E f F La P rH _6, --- " s/z>cw�LL = !97_ S �=. ✓8, 02 LO T TOTAL � © 42 ' �� � � /QED• Ile " -- ► � EL qq, 0 / T�e SE 6,A G E C� �7� / u =--- r�i20POSED 0A1 THE- Gk?C- c1 Jn/D .95 7 ,! s P L .q/v n o E S o,e : l._D 7- 4 7 G'l/4 t~ l e O<�,Af :-� GOA/Fo,E'M TO 7h/E B(J/L D//V(S 5E7-- V/C 7'(] ?/ ,nJ/9 /E' LA,) ' L+J AQ `7'' BHCA::�' ,2E APE TS 0,C7 77-1-4E7 7-41-71 w A/ 0,c /3 Fr,l°n-)STi4 G E Iv'7-E,e ;/ SH Of M,4 �,F. �c� SCF�L E 9S St-Iownl L�FaTE ��i�3 ;J I qef OF EVERErr H. � HlNCKLEY Z` .� No. 11117 ti �O EVERET( H u+ HINCKLEY tin ^ d M ' �"ST�� Q„ 13zva�©A�� •� �rr..� O oO - x Sfiin9 ele ✓atron 8L_ DG. 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