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HomeMy WebLinkAbout0077 CARRIE LEE'S WAY - Health 77 Ce.At't-fut►JQ N SMEAD No.2-153LY UPC 12934 smead.com • Made In USA �J 2 i SUSTAINABLE FORESTRY INITIATIVE Certified Rber Sourcing —Jf mgramorg r � � � L O CATION�� /��� 3 /q�� /j� � �\1? I�A[ SEWAGE PERMIT NO. VILLA E&" . ' .. .r G �— (o I N S T A LL It AM i ADD SS BUILDER OR OWNER WILDS t � GATE PERMIT IltSIJED 3--Hy 7�2 DAT E COMPLIANCE ISSUED _ � 3f ..,, rfF � ha,' �Rn�.+:� . . ., e s � . it l i �.� .. ,; .. 1 . (�i���� . L� THE COMMONWEAUTH QF MASSACHUSETTS F' BOAR® 9F HEALTH - ..,...............O F...-............--............:......... ApplirFation for. Dispaii al Works Towitrnstiun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System t: r o L•-�-- .0 ....................• - --.� �-C .. 4:x. ....- �- Lpcat n- ddress o t o. -- er a .;r Address = -•------••.. --•---k --•--•-•--•-----... -------------------•---•----•--•---••--•... Install r Address Type of Build#w' ? Size Lot............................Sq. feet U Dwelling—No. of Bedrooms._.-.-_J....................................Expansion Attic ( ) Garbage' Grinder ( J� Other—Type e of Building .............. No. of ersons.___-______._________.__.__. Showers p{ yp g _____________• p (: ) — Cafeteria ( ) a' Other fixtures ..-----•--•---------•---••-_-••- ... w Design FlowZ....______�_S®_...............gallons per person per day. Total daily flow........ i ........................gallons. * Septic Tank Liquid ° y///��gaIlons Length................ Width................ Diameter.........._..... D pt ................ Disposal Trench-3NOV i1� idth_...._.:_.__._._.___ Total Length.................... Total leaching area... .sq. ft. Seepage Pit No_________ ______ Diameter.:___. __. _ Depth below inlet__ To 1 1 chin area__. _:_ _._....s ft. P P r,1 ��% g� �--7 q Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Result Performed by-__==...f lr-i,YV a.--61#Ad 6 G(._._-_-_-Date__.-n_X.En.7-�............ Test Pit No. 1__2,__2_____minutes per inch Depth of Test Pit_._._ ........ Depth Depth to ground water________________________ (x, Test Pit No. 2.............___minutes per inch Depth of Test Pit.................... Depth to ground water........................ ..... Z... -• ...... ... r ............ ...........•------------•-- 1 � T Description o .So _ - A----A-_ --- -----• ----------- ---- ------------------ ----------- ----•-•-- .......42.......••. ...... - U Nature of Repairs or Alterati-ns—A wer vffien applicable_. ______________________________________ Agreement• /�"" ��2� , 7 �(s 7 C/. l The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITiZ 5 of the State Sanitary Code—The undersigned further agrees not to Y place the system in operation until a Certificate of Compliance has been issued by the board of health. igned r Application Approved By..—..... w / D Date Application Disapproved for the following reasons:...................................................•--•------•-------------•----------••••--••--••.._. ....... .............................................................•..............................-............................................................................... Date PermitNo.....................................-------------------- Issued_..... - -°t, 7 ............................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD - OF HEALT ..................OF... .:.. ................................... Trr#i ' atr of Toutplittttrr T S S TO TI T the I vial 'age D• posal System construcxed (�"or Repaired ( ) -- by.:! = , 1 t l Instiller )�/J has een installed in accordance with the provisions of T j of The ate Sanitary Code as described in the application for Disposal Works Construction Permit N '2_k,.�`_______________ dated-: __' �,�`_ r__._.__._.______._ THE ISSUANCE OF THIS CERTIFICATE SHALL.NOT BE CONSTRUE® AS A'GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY c DATE,: 4 - `"Inspector..............................................................Ott r� i r- THE COMMONWEALTH OF MASSACHUSETTS BOAR F HEAT 7 ��( ..............OF... >~ . ..... 2 FEE......................... 1 or it Permission a hereby granted_ r._._ - - ---.............. ,.... ...... to Constr t (' or. pair- in,Indivi 1 Sewfff- D' offal` s em treet as shown on the application for Disposal Works Construction mit . ______ Dated_._X -1 -•-•:•: �.. Board f � rt,` ATEP�-dC................................................ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS ` � THE COMMONWEALTH OF MASSACHUSETTS ������ ���� ' ��==^"" ~�~ QF HEALTH ' �����----��p-- - 6. Appliration for Disposal Works Tomivartion Prrutit Application is hereby made for u Permit to Construct ( ) or Repair ( \ uu id an Z)�omuu ^ ' -a ne Address ' Dwellinm--No. of Bedrooms.....=='.................................Expansion Attic Garbage Grinder NO 114 Other--Type of Building ............................ No. ofpeca000-------------' Showers ( ) -- Cafeteria ( ) 04 ~� Other.+ fixtures .-_—��-__.----_-�--__-_--___'__'-_ -_-- Seepage Pit, No...... .... Diameter!�...... .... Depth below inlet.....t10..... To.11 in re P...fi.sq. ft ~~ Percolation Test Resul ���or��� I�ah��� ' � Test Pit No. lZ bch l)cptb of Ioo Depth to ground vvutoc--.----_ 44 Test Pit No., per ioc6 Depth of Test Pit.................... Depth to groundwater......................... 01 0 �� Nature ~ Repairs� ~ .^ Alterations~^ .~ ^^~.~^^ ..^. --'' . ' ' . ' -'_---''_--._-__-__'__.--'-_----__-____._'�___--�--._-__--_-_-'-----'-'''-_---____- /�6rccozcut: The undersigned agrees-� to 6nstuD'the afore described Individual Sewage Disposal G �in accordance with | � the provisionsof TAITU, 5 of the State,.'Sanitary Code_The undersigned further agrees not �o| - - - | plate' d'� ���' � operationoutd a C�/��cut- of ---� _'_ 6uu been �ysocdbv/t�ebnocdnf��-lth. ` f' | ^ | Date lication roved o"* Application Disapproved *, for the following reasons:.............................................................................................................. - , ^ `~ � r . ,' ._Date ' Permit' Date ^ - - - a ` f / LoT Z �► - yam. � 29�.©o 9z 5� ��oPcsEv /ao� Sz' GAy'E� �� ,�� 3-,= o U/"��Ff ��`rY',¢�%si©if $� •e L 0 T /9 .340 974` t3o `¢ 9s.7 A31 TE 7� HoLE RES ULTS Sew40 PEA 7-0h/A/ REeO)eDS � DR 7-EE _ Z 7 B ' T o w/v L,/FA T-E P L E //I S xP ^4V4 A-01dz A`,3/ M l n// /--/U/-I UJ L D I N G• S E 7_;B/? 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