HomeMy WebLinkAbout0014 GREENBRIER LANE - Health (2) t
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l0 CATION � SEW G E HERMIT N0.IV
VILLAGE a/0 -ail
I N S T A LLER'S NAME i ADDRESS
3 UILDER OR OWNER
9)9 C
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DATE PERMIT ISSUED zi -t fig
DATE COMPLIANCE ISSUED
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No. •-- ..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HE . L H
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Appliratiou for Bhgvvii al Workii Tomtrurtion Vamit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
Sys at: `` r --- 4 ..... ------
------
Location-A ess or Lot No.
Owner- ddress
1.4
M Installer Address
!4 Type of Building Size Lot__ _U __...Sq.�pfee�t�
Dwelling—No. of Bedrooms..................�a____.............._.....Expansion Attic ( Garbage Grinder r�6
aOther—Type of Building ............................ No. of persons............................ Showers
a' Other fixtures __________________________________
-----------------
w Design Flow.................................//...........gallons per person per day. Total daily flow......... - ...................gallons.
w Septicq P 3� g g . P ---------------
x
D sposal Trench Jl Noc. ac.t _. Width
dthns Lent Total Lengthidth..._-_-- Total leaching area.--�e Depth sq. ft.
Seepage Pit No-------/--------- Diameter....Z0------- Depth below inlet... Total leaching area... .sq. ft.
Z Other Distribution box 0<7 Dosing tank
Percolation Test Results Performed by__.....__ l_.�Lf�r.� .��__..... `..... Date____--.( �_r9..._..
Test Pit No. 1_____ ..... per inch Depth of Test Pit...../�....... Depth to ground water_.___.I7_?ZW:
(� Test Pit No. 2................minutesper inch Depth of Test Pi _-_____....f _ Depth to ground water........................
2 l
------•------� ` '�1 V , -�A?/--•--•f--
Descri Description of Soil................... ..^._ !�`7.$.,....•._-� '�t-� �' ✓
x P �' .
•---------
---9---'.1 a-----
w
.0 Nature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________
-------------------------------------------------------------------------------------------------•-•-•--•---••-------------------------------•--------•----- ............................e.............
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of 1 T':�..;,
p 5 of the State Sanitary Code—, he undersigned fur r agrees not to place the system in
operation until a Certificate of Compliance has been ' s by thajodard of i th.
Date
nin �,X_Application Approved By..................... -•�� -' _ - .......
Date
Application Disapproved for the following reasons-...................................--------------------------------------------•----•=------•-------•-••-••-••.
Date
PermitNo......................................................... Issued.._/ 71 4� -------•----
Date
r'
No......................... FES...................r......
THE COMMONWEALTH OF MASSACHUSETTS
,,BOARD O HE L H
...... ......... ....OF....... .:....... ? .....----.----
Appftrativn for Uiipnaal Wark,5 (famtrnrtinn Vanfit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
SlIG 's�►'171`f C";1'• 6 / i1++/�'�S f1J�' -•................ ."6 - ---
Location-Ad ess r Lot I
............ r ,! r�r� .. .�... �.......... ................r! �r . ........I.........................
r,,// ......
W ............... f_..... 1� �I'`Own C, ---IJ,,•---•--•------- -•-•----•-•--•-------------------- ---- .. ........
P Installer Address Ua
d Type of Building Size Lot..........................Sq. fee
U Dwelling—No. of Bedrooms......................S
...................... Attic 4/0 Garbage Grinder
Other—Type of Building No. of persons...................... .. Showers —
a YP g ---------------------------- P ---- ( ) Cafeteria ( )
dOther fixtures --------------- •-••-•-•--••--•---•------•----.......••----•------•••---•--•- .......................
Design Flow............................. gallons per person per day. Total daily flow___..._
W ---•-gallons.
W Septic Tank—Liquid capacitAgallons .Length---------------- Width.............___ Diameter................ Depth................
;rt
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 to (/ }'
W Percolation Test Results Performed by._---_._____ _,__--- /►1� _........ Date...........,I... �r
a Test Pit No. 1..... .:.......minutes per inch Depth of Test Pit-----:..........----- Depth to ground Water........A11?7 dt
-•---
(i Test Pit No. 2................minutes er inch Depth offTes Pi __._......�t...... Depth to ground water........................
t o s" �Qrt'
-
Description of Soil___________________r�r. . .. e. `� 3 �"Q`rtr
= --- - - - -
x '!
c, ------------ -
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'T':...`
p 5 of the State Sanitary Code—eYhe undersigned fur . r agrees not to place the system in
operation until a Certificate of Compliance has bee s d by the
/ `aAr .,. " lt-h
Si ed ---... "�'
------ --------••------•-------..._....
ate 7
Application Approved BY...................... ..... ...... --- .---��. ......................... .../ . l
Date
Application Disapproved for the following reasons:-----------•---•---------------------------------------------------------------------------•••-•---------•.•--•-
..---•---••..................••--•------•-•--•-•--•-•--•-------••---•-•--------•-••••--------------•----•--•--•---•-••----------•------------•------------------------------------------------•--------
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS'
BOARD OF HEALT
..........o f..........................................................�.�.`...............:::..
Qxrtif,/iratr of f�ompli anrr
THIS IS T + RTIFY, That th n�i vidual Sewage Disposal System constructed 4-$ "'or Repaired ( )
by.............. ....�. (� 't/ �''i�� t f-•----.. ........................ ............_...
Ins
at...............f�-.`----. � .---40r, �`"�!".iissrl: �CA'---- �"°�..----- ............ ..................." e �1
has been installed in accordance with the provisions of TT ` State S nitary Code as d scr'b d in the
application for Disposal Works Construction Permit No....:................�__............... da.ted_-_.IQ.....��`_�......_._._......
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION ;SATISFACTORY.
DATE.......................•---.................------------._...--•-•----•-•------. Inspector...........-•----------------------
THE COMMONWEALTH OF MASSACHUSETTS
,,.,� BOARD O�HEAL
7 .........�/,�...-�....,�"L..........OF.......-- �. i. .........................
C 30
No. _... FEE---------------•-.......
i �a �a1 ork.5 To tr inn amit
Permission is ereby granted------------ . '
to Construe or �>r Individual fa e Dys js��l System
( )� g P Y
at No.••..-_ . ................ Ca,.�. . �:�.... .`.-�. _. 0.......
. ®�......
Street ..._._. .. _
as shown on the application for Disposal Works Construction Permi /19 T/-7.
�/.Aated......•----•--
--
Board of Health
DATE ..................... .............................................
FORM 1255 HO_BBS & WARREN. INC.. PUBLISHERS 5 - K
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I . CERTIFY THAT THE PROPOSED:
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,j EGIS'TERf REGISTERED JOB N0.7 ' �' �_ '1BUILDINCa ':SHOWN ON :T'HI'S PLAN r''� r}
CIMIL L.AND,' �� CONFORMkS; .TO: 'THEe. ZONING LAWS` fy�
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GIPlEER SURVEYOR DR, BY �_. i;; :OF BARNS ABLE 'f'MA Ss. r ' �' �' rIIL� t
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