HomeMy WebLinkAbout0177 GLENEAGLE DRIVE - Health (2) I-7 6,I-en e�j1e �i.
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No........... .......... �. Fss...,`:..................... i
THE COM WEA[ ";, i—OF MASSACHUSETTS
BOARD OF HEALTH �
..----....�'ot�m...................oF.........�asn�t.abler.....--------------_.............---------------
Appliration for Uhipsai Works Tomtrnrtiun jVrrmit
Application is hereby made for a Permit to Construct (X; or Repair ( ) an Individual Sewage Disposal
System at
------•--- ............................
Location Address or Lot No.
............................................. k _R 7 A�1 E .........
Owner Address
Veter n:q...Bro lfro.--•--•................................................. ....B.armla la.---...-•---......-----•-----•-•-•--..............---•----•---...
Installer Address
d Type of,Building Size Lot.15.s0�4.........Sq. feet
aDwelling—No. of Bedrooms............3.............................Expansion Attic ( ) Garbage Grinder ( )
p-, Other—Type of Building -__r, .......... No. of persons....6..................... Showers ( ) — Cafeteria ( )
a' Other fixtures ...............................................................
W Design Flow.........59.............................gallons per person per day. Total daily flow------------ OG........................gallons.
j W Septic Tank—Liquid capacity............gallons Length-_4........... Width...... ........ Diameter________________ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inl t....F-n.__._._.._.. Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) °{9' /✓e--AA1 -� " 9-'�---7/ /
Percolation Test Results Performed by..........J e:S---CrOWell--------------------------- Date.._._1l281_77..._..........
a Test Pit No. 1........?.....minutes per inch Depth of Test we
.................... Depth to ground water.........................
44 Test PitrNo. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
ai ....---•-•--•-------•---•-•---•.............•-......--•---_--------......----------.....-----------------------------•----------------..........-----------
0 Description of Soil._o.-36'T_..Lo�I1..& Subsoils 36-144'r Coarse sand and gravel
-.. .... ------
x
UW -•------------------------••-----------......•---...------•---------•-------•-----------------------------•-----------------------•-------•-------------------••-------------•--•----•------•---.......
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 TITL% 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.
Siyg//n/ed_ �f ( rn�ts_ yn� 7�28�77........
-�I /ice/ / 51T�4xJ�� Date
Application Approved By-- �. - -,f ..... s .L! .................... 7.'. Dat
Application Disapproved for the following reasons----------------------------••-----------------------------------------------•--------------------------•-----.._
...................................................•------------------------------------....------------.------•---•--•-•-----•---------------•------...------------------•---•--••-•-------------------
Date
Permit No......................................................... Issued--------V28/7-7------------------------•--
Date
HE COMMLTH-OF MASSACHUSETTS
Y BOARD OF HEALTH
......... Town--......---_---.OF.....--...��r72t�tat?�:11�` _..
Applira#a n for Bi-silos al orks Tomitrnrtiun Prrmit
Application is.hereliy``made for a Permit to Construct (XX or Repair ( ) an Individual Sewage Disposal
System at:
L4I---- 7-Meneagla._Orive..---Canter a-le --•------------------------------------------------------•-----------_____--__-__-_-___---------
Location-Address or Lot No.
�PfMES.
Owner `�+:, ' Address
a Veter9.no._ Q rnstalle---......��- ----------------------•- Bamatabls--__------Address_____._____---------___------___----•--•--
� •,g Installer
d Type of.Building�' Size Lot---•_ ._ Sq. feet:
Dwelling—No. of Bedrooms_._._._.._::�_____________________________Expansion Attic ( ) Gartage Grinder ( )
a --
p-1 Other—Type of Building ...r`3.oth...__...__ No. of persons....4.................... Showers ( ) — Cafeteria ( )
P4t Other fixtures ..................L _..............................................................................................................................
Design Flow..........5_.............................gp" ons per person per day. Total daily flow..........._ _ ....gallons.
WSeptic Tank=ti uid capacity allons Length._4........... Width.....8........ Diameter________________ Depth................
xDisposal Trench-;-,No..................... Width.................... Total Length.................... Total leaching area•___--.-____-_______sq. ft.
Seepage Pit No. Diameter____________________ Depth Belo 1 .....___. Total leaching area..................sq. ft.
Other Distributio box,, Dosingtank I'4+ "7" X:P-77.
Percolation Test esults P- iHor d by...__.....JI P-a...f o*e.1 ._................•_. ._. Date...... -. _ ..............
0_1 Test Pit No. 1"w....._2_..._.mmutes per inch Depth of Test Pit.................... Depth to ground water_-__________.____----__.
(i Test Pit No. 2__ry`::..........minutes perk inch Depth of Test Pit.................... Depth to ground water........................
R+ :. .............................t} 'mc ..................................................................•-•----- ---•-----...----•.......__..._._.
O Description of Soil 0" �sZt' 1}1-_.8S.. ? .0j.1 t......3&d.4 tt---00 ��- { -•- g ' �E.' ..............
x"
j. ;
W ---- -•--== ------ -- --------------- ....----------------------------------------------------------------------------------------------------------------------
UNature of Repairs or Alterations—Answer.when applicable......:.........................................................................................
Agreement
The,.undersigned agrees to install the raforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITIE 5�of the State Sanitary Code—The undersignedfurther agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
,.A. Sig _- K�------- -AZ/77-•-- .
Date
Application Approved By. ---- � ✓ : �7►ru-�.rl
r
.' • Date
Application Disapproved for the following reasons--------------•-------------------------=------------------------------------------------- --------.....------
' ............................................-............................._.................................................-------------------------------•----------------------•-•--•------------_..._
Date
Permit No....... ............. Issued fad ---•---•----
h �
'i THE COMMONWEALTH OF MASSACHUSETTS
a.
BOARD OF HEALTH
.............Town...............O03., . st.able..........................................: .........
Trtifirate of Toutph aurr
TH%J.R CEI IOF 7 That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by .-----no ..... ---..
= -----•------------ ••---------------•--------•-----•--•-------•-----------•----•---•-------------------•-•-•-----------
at •------- -•-- .•-------------••--•----- --•-----•-
Lot 17.'Glen agle Din ive, Centery to
- --_------
has been installed in accordance with the provisions of TITLE, j of The State Sanitary Code as described in the
application for Disposal Works Construction Permit ................. dated_... -__.___.._._........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE? AS A GUARANTEE THAT THE
j SYSTEM WILL FUNCTION SATISFACTORY. � -
1. � r �
DATE......... "... ". .__ _... --. .__. Inspector ------ - `.
�.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH a j
ToYn.............................OF.....8 '2>S'E:3b 43...-----.....-----...._.........-----•--•-
No.__ FEE.-_____-___-•...........
Disposal Works ®rnustrudion prrmft
Pei.inission is hereby granted_j C'ino B-f6ther$ -- ..................
to C tr or Rep it ) a Individual Sewage Disposal System
'G e(nda 1 p �1ri�ve Centerville
atNo.........................----•- -w ---•----------�=........................... •--••------•-•-••------------•-----------•------....................................... .y.
Street +I; i / /
as shown on the application for,:Disposal Works Construction PermAi ____.____. _ ated, ..._____ _________ _____------•--........__' ---- ------------- -
��� ,r Board of Health
DATE-----=---------
FORM •1255-, HOBBS.& WARREN: INC., PUBLISH:eiii�_ "''+.
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