HomeMy WebLinkAbout0251 CAP'N LIJAH'S ROAD - Health (2) M 3 / 133
' No...... C Fizz....$.. 7 5.... 0..
THE COMMONWEALTH OF MASSACHUSETTS
/ BOARD OF HEALTH
;? ----`Fown-----------------OF...........Baxast:ab.le...............................................
Appliratilln for Uiupusa1 Works Totw1rurtion thrmit
Application is hereby made for a Permit to Construct ( ) or Repair (X� an Individual Sewage Disposal
System at
V \fl ocat -eA`d ress 2 or�Lot
-•_...............��..c S.I.. �� :• -
�Se Owner I Address
W :_t C-s��_�1' .................................
------................._..........-------•--•-----........-------•-------------.....-------•--•-..
�-� Installer Address
� Type of Building Size Lot___________________________S q. feet
�
Dwelling—No. of Bedrooms-__-jj..... ...............................Expansion Attic ( ) Garbage Grinder ( 6)
pa, Other—Type of Building Wu ...��C'.._ No. of persons_......._.Y............... Showers ('llf) — Cafeteria (�l/o)
__.P4 '.. Other fixtures ----------`-------------------- - .
W s` Design Flow............................................gallons per person per day. Total daily flow....................._......................gallons.
1:4 Septic Tank—Liquid capacity------------gallons Length................ Width................ Diameter................ Depth................
W
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 b ................................................... Date........................___-__----____-.
,a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-_____-______-____---. i
t%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---_-______-_-_----___-.
P --•--------•-----------------------••--•----•-•---•--------•-•---...._.-.._..--••-------•--•------•-.........................................................
0 Description of Soil..................................................................................................................................... --------------------•---•--•-•----
x
V --5-a d----&---Gr av-e-l--•------------------•-----------•-••----------.............---------------------------------------------------
W ------------- ------------------ ----------------e----------------------------------------------------------------------------------------------------------------------------------------------------
UNature of Repairs or Alterations—Answer when applicable_____1,2-0-OQ__taxlX-----------------------------------------------------------
------------------------------------•----------------------•------------------------_--_--__------------•------------------- t�---------------------------__.-•----•----
Agreement:
The undersigned agrees. to install the aforedescribed Individual Sewage Disposal.System in accordance with
'^
the provisions of f l 1T"1T t sL1 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b'en i)sued by the board ff health.
Signed_,.1'_.�J__......CA.���11!��L�;���:---_------•---------- -------�D116�$7
Application Approved By---------- 4�►► --" ---------------------------------- ----------CCU.,_.
J Date
Application Disapproved for the following reasons:................................................................................................................
---------------------------------•-----------------------------------------------._....._....----------------------------------------------------------------------------------------------------------
¢¢ Date
PermitNo........ ----------------- Issuecl_.......................................................
Date
..d
No..... 1- �1._3 Fizs..$.....7.5.....0Q_.
THE"COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
x
---------Town-----------......OF..........Bairn-s-ta __e------------------------------------------------
Aptiriatiun for DiupguaI ark 1, Tamitrn.rtiun rrmit
%Application is hereby made for a Permit to Construct ;( ) oi',�Re air ( ) an Individual Sewage Disposal
System at:
X
................_................................................................................. . .........
-`. .. .................................................................
or Lot No.
-----------------------•--•• . \
LocatiOwrer dress �-=:`r----"..............................................................
"b Address .....
a ........................................ .... 2�
� Installer � � Address
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!.........__!^._____________._.__._.__.__.gallons.
Lkk
1:4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter' .`::� Depth................
Disposal Trench—NTo..................... Width.................... Total Length.................... Total leachi' g ..................sq. ft.
Seepage Pit No..................... Diameter-------------------- Depth below inlet..................... Total leaching area------------------sq. ft.
'-' Percolation Test Results ) Performed by.__g._________.(. )
Other Distribution box Dosing tank
a ----••-•••-•. Date---•------- -=
Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground wate ._._.._.__.
Gzl Test..Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.....................
ODescription of Soil....................................................................................................................................................................I
x
v •--••-----------------------------------------•Sand---& &rriavel----.-------------•----•--------------•----------------------------•------- _.
VW -----------------------------•-------------------------------------------------------------------------------------------------------------- ---------------------------•----------------------•••-
Nature of-Repairs or Alterations—Answer when applicable.____1 20.OD...tank-------------------------------------------------------- _.
---------------------------- 3-.. 1.000-1a tS-------------------- --------------=------
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance witl
the provisions of T-j E 55 of the State Sanitary Co e— The undersign � further agrees not to place the system in
operation until a Certificate of Compliance has en, sued y the board f'health.
Signed.•• ... ..... •_... ...---------•-•....... ....... 0D 6 8-7----
te
Application�`A.pproved By...�; •-----l -a_�_`__ _
i Date
Application Disapproved for the following reasons:..............................................................................................................
_
................................................. -----------------------•-----..........------.......---••--•......•-•--•-------•--•---•----•---•-••••-•••-••••--•-----•-----•-•-•-•----•--------•---
Date
C ,
PermitNo......... = ...... ��------------•-. Issued--•-------------------------------------------=
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF .HEALTH ,
Town........................oF.......Barn.s.t4bke...........................---.................
C�C�er�ifirtt�e of �u�t��iunrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired)XX)
by-_—, ...J.1P_..Ma QMber......................................................................•-----..........-----------..............------....------....-----•-•-------------
Installer
at.........................2511 �-ta._.Cazn.-Lij.Ah'S.-.RoadCenterville
---•.....................................••-_.____........
has been instailed in accordance with the provisions of T i T E j of The State Sanitary Code as described in the
application for Disposal NVorks Construction Permit No.___.._...__ 7.. dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE .
SYSTEM WILL FUNCTION SATISFACTORY.
DATE....................... .................................. Inspector--•-•----------3-".....L........�s.---•--------------...-----•----
l THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
4 7.. / .........To�zn_...................oF......Barn 5:t ble..----------........-------•--........... Q,
NO._...L...,1.:_.._C.Z�J ...... FEE....T-••75,.-00
wiupuual Vorku 01.1,11nutriun rrntit
Permission is hereby granted_. >P tM.acomber__
to Construct ( ) or RegairKt �X) an Indivi ual Se
vva a is osal System
at ptain Lis ah's 'Road Centers 1 '
Street ]
as shown on the application for Disposal Works Construction Permit No.__f... Dated......
�
..................................... ...A
Board of Health
DATE 1__2-------_----------
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS __