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HomeMy WebLinkAbout0080 PINE TREE DRIVE - Health (2) -rre(Z- Dr. , W4-, �4 - i �I F• \ p . ., No.-ITer ............... THE COMMONWEALTH OF MASSACHUSETTS �OARD Z06r%E /�� ld �. .......OF..... . pphratiun -for li,ipu ial Warks Tonstrnrtion Vrrufit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at 6 ......... . . ......... .......... -- ........o Ad es -No W Owne Address ............. .......... . _._ _..., ......... _.___.__'�_.__________....____. ......._.... ................................................... Installer Address Type of Buildi, g / Size Lot......... .................Sq. feet �-, Dwelling No. of Bedrooms__------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other— Type of Building ............................ No. of persons.--___-_-.-__-______--__--__`Showers Cafeteria Other fixtures ..----------•-----------------------•-----••------- ( ------- ----••------•------------ ... ..............(•- -)--- - - __ _ --- W Design Flow..................................:.........gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity---:_._-_:_gallons Length---------------- Width......-......... Di ei&-:-. .._... Depth.--_-.-------. 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 by-------------------------------------------------------------------------- Date.................... - a Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------_------ Depth to ground water.... fz Test Pit No. 2................minutes per inch Depth of Tes Pit.................... Depth to ground water-_---..--------.-._..--. 0 ---------------------------------------------------------- -------------- ODescription of Soil--------------------------------------------------------- _—A:-,--- rtr�� x x -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued b the board of health. _ g ?6 .- I ned. ---••-•---•--- ate �I Application Approved By... �'" ,� = "�'� a -- , 6/ D e Application Disapproved for the following reasons:---•---.•--•-•................................................................... .............................. K. Date ,:.,. , ,;. .. 3 ------------- ------ /Permit No.. Issued. �V e NO._0e., ___ Fly$ THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEA ,�_. / «./0 OF....._e.,s;Z-44...... .......................:.. ::.' 7o��, - - ------ Appliration for Uiopuiittl Workii Tomitrurtion Vanift Application is hereby.made for a Permit to Construct ( or Repair ( ) an Indi,v"idual Sewage Disposal System a op�f\d s * of No . ........... ....... --------- Owne Address W n ________--•-- # "- •_____-- - -- -------- _ ----- ---- --- --------------- --- -- -- --------•---_---- war" Installer Address Type of Build i 0 Size Lot.... Sq. feet Dwelling No. of Bedrooms. .............:..........................Expansion Attic ( ) Garbage. Grinder ( ) aOther—Type of Building ........................... No. of persons-..._......._-_--_....__---- Showers ( ) — Cafeteria ( ) a Other fixtures ------------------------•----- - W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. W. Septic Tank—Liquid capacity-,....,._.__gallons Length................ Width--------- --- Diameter_........ -. Delnil f_, Disposal Trench—No--------------------- Width_-- Total Length.....................Total leaching area. .,... .... .._sq. ft. Seepage Pit No..................... Diameter_._....... Depth below inlet------- ---- .- Total leaching area......_._.......sq. It. z Other Distribution box ( ) Dosing ae Percolation Test Results' Performed by --------------------------- ---------------------- Date--: Test Pit No. l.........:......minutes per inch Depth of "Pest +Pit........_.___--_.... Depth to ground water..-. ... .. Lr, Test Pit No. 2----------------minutes per inch Depth •of Tet Pit..........__.__..--- Depth to ground water---------------------- ---------- ---------------------------------•-•- ---/-�t - ------------ 0 Description of Soil-..._...-_.._ _ • ------.-•---•--------------------------•--------•-------•-•------------ W VNature 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 Article YI of the'State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of(Compliance has been issued b he board of health. �. 6 �_ Igned- -- ----...- -------- �. __..----� ate rl Application Approved BY---.... f' --•---• ! �1... Z ' Da Application Disapproved for the following reasons:.......................:. -r------------------------------------------------------- y. --•-----------•-----------............................ PermitNo----------------------------------...................... Issued------ ...............................................Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTd., -�-"" ��,, .,y. .......OF......M . .. .. �... Ulrrtif iralr of om'haurr TH S . O CERTIFY, 1 t the Individual Sewage Disposal System constructed ('; �rRepaired ( ) by...... - ,. r Installer at---- ------------ - -- -- -- --- ------- -----------------=-- ---------- has been installed in accordance with e provisions of Article 1 of The State Sanitary Code s descr bed in tie application for Disposal Works Construction Permit No,-.:...... ...�-._......._ dated.... THE ISSUANCE .OF THIS CERTIFICATE SHALL NOT BE CONSTR E© AS A GUARANTEE THAT THE` SYSTEM,.WILL FUNC ION SATISFACTORY. ...�.� DATE. .. . Inspector._.--- --- ---- • � i THE COMMONWEALTH OF MASSACHUSETTS BOARD. OF HEALT / d ✓ •... .. OF........'. a s' _ FEE__No. rk CIT, rrrmit Permission i y granted----- = = ---------- ------- ------------------------•- to Cons_ c ( .. o VRepair' an Irrd v 1 S, ,wage Di` cs 1 Syst F Street as shown on the application for Disposal Works Construction Pe o. .... .:.-_. _. . ed. .f~� .- / s„ ,B. - o rd of Healt DATE._"t.�--�• " 9 FORM 12.55, HOBBS & WARREN. INC.. PUBLISHERS • F I f yOFTHETp� TOWN OF ARlIETABLE r o , e BARR9TABLE, S .9 MASS. o�i639. Board. of Health pp �0 FROM THE OFFICE OF r A rat Ir r � V .i. r .c (A G D � TI C n C f S (i® V