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HomeMy WebLinkAbout0023 OAKVIEW TERRACE - Health l of c� C� V\�� -TPJ� j 1"Ilh1I a�yl . I I I I :---A I I . � . I I -.-- 1.�I 1. I I I- I I I I . I � . I � I � :. 11 - 1, .. r . .. 1, 1. 4 . n v - e 11 f'• V k o' d i k 6 I P B d 6 :. � ' , -. 1. - , .:' v : ' - .. F '_ _ . . '. `I r t' , e a a` I ', 6 `' ,- - o p . n `c ,:t , LOCATION cA. � SEWA6 �PE I NO. VILLAGE INSkTA LL.ER'S NAME i ADDRESS 3 U I L D E R OR OWNER /Vi(/!.S DATE PERM-IT ISSUED DAT E COMPLIANCE ISSUED illaA/8d - � ,fi � o , .�� ,;�' �� ` . o.. C1. .5�,., .� �� • Fus...E.�.(.. ... THE COMMONWEALTH OF MASSACHUSETTS hl BOAR® /OF HEALTH .--_---......_..�.c.�-.�.---..--.OF.....-..! - .J�.Y-...Y�I / ................. Appliration for Uiaapaasal Works Tomitrnrtiun Errant Application is hereby made for a Permit to Construct or Repair ( } an Individual Sewage Disposal System at: T' . .. _ .......... �9 ./✓e C:: ... nlz1 ' 'r ° Jl. �t_ �. ............... ••- ---- Loca is Add ess or Lot O er Address W ......f�.................... ............................................... a staller Address Type of Building Size Lot.................... .....Sq. feet 1-4 U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (No) `� Other—Type T e of Building No. of ersons._.._..... ........_._ Showers — Cafeteria a yP g ---------------------------- P ? (�) ( ) a' Other fixtures .................................. W Design Flow............................................gallons per person per day. Total daily flow.... ...._.........._.................gallons. WSeptic Tank—Liquid'capacityfP-&?...gallons Length................ Width................ Diameter................ Depth................ xDisposal Trench—No................_.,_:-Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No._ /............. Diameter..../P.......... Depth below inlet.6.. ............ Total leaching area..��.A...sq. ft. Z Other Distribution box ( ) Dosing t ( ) / ® � t / (J_ r / / f a Percolation Test Results. Performed by......1 ..� �.�_.�........... .. .�.,._�..�'�=_L1S. Date_._. .,.._�_._.._.___ Test Pit No. &...............minutes per inch Depth of Test Pit.................... Depth to ground water....................... (r, Test Pit No. 2.. __ minutes per inch Depth of Test Pit.................... Depth to ground water-_____-_-. ___-----___- 0 --- . ..._.._.. e Description of Soil... 3_-'12.l-------C--s4! � C 1.a U ' ........................................................................................................................................................................................................ U Nature of Repairs of Alterations—Answer when applicable................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of ilTU 5 of the State Sanitary Code— T e undersigned further rees not to place the syst in operation until a Certificate of Compliance has been i ss-i ed th oar th. Signed..... _.. Date Application Approved By---- !-... ....................................... --A!�1✓,1.0f) Date Application Disapproved for the following reasons----------------------------••--•----•-------------------------•-------------.....------------•--------•--------. ..................................•-------------------------....----------------------------------------•-----------------------------------•------------------------------•------•--------------------- Date PermitNo......................................................... Issued....................................................... Date 4 THE COMMONWEALTH OF MASSACHUSETTS �- -- BOAR® E HEALTH ..........[Ou.0........OF........ .� - ................ Aplifiutt#iou for Uispniitt1 Works Tonstrnrtiun Frrutit ' Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at /J .. of .. ... ... : , ...... v t - J ............... .Loca' Add r ss or Lot .._ ` � ! " ... ............. !Ka!_. ...................................................Address................... ............ W ..... ...._ ........_. taller Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms________________________________ _Expansion ttic ( ) Garbage Grinder pa, Other—Type of Building ............................ No. of persons._________ ...._.._.._.__. Showers (/) — Cafeteria ( ) a' Other fixtures ............................... W Design Flow............................................gallons,per person per day. Total daily flow....................................... .......gallons. WSeptic Tank—Liquid*capacity./POV-gallons Length___--_::___.-___ Width---------------- Diameter................ Depth................ x Disposal Trench—No....................: Width_.................. Total Length.......... __...... Total leaching area....................sq. ft. Seepage Pit No...... .......... Diameter.....111......... Depth below inlet_. .............. Total leaching area. �_----- ft. Z Other Distribution box ( ) Dosing t k0-4 ( ) a Percolation Test Results Performed by ----- ---- ---------/ _. ._ _ .d .........40 Date... ._._........r__ ___.__ 4 Test Pit No. 1__4_ minutes per inch Depth of Test Pit...................: Depth to ground water........................ (s, Test Pit No. 2................ livtes per inch Depth of Test Pit.................... Depth to ground water........................ O Descri tion of Soil Q �'Z P 6 -.. - .......$U... l.�/ �� � «� ��C�79'/Z� ,�'�"/0+� W UNature of Repairs or Alterations—Answer when applicable__________________________ ••----------------------------------•-----..........----•--•----------...._....--------•-•--.......----...-•----------------------------------------•-•-----------••--•--...----:...........:_•--_----- s Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TiT?E 5 of the State Sanitary Code— Th undersigned furtheer+aEwes not to place the syste in opf'ration until a Certificate of Compliance has been.r' sff�jbne and . Signed ,d! -- ...... BCD '�'p,� Date Application Approved BY ------•-----•-of `�-�•-�'.... • ••................•----........_..__.... ... .. j ��i 1. f? Date Application Disapproved for the following reasons:-------•------------------------------------------------------•------------•------------------------.....-••••- ....---•••-•--•---------------------------•-•----------•---•••--•-----•----------•-......---••------•---•-----------•----•---•---------••--------•-•-•-•-••--------------•------------------•-•-••--•--- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH !rpj .` Trr#ifir t of (tnrnt�r 'anrr T�IERTIIThat the In dal Se a e Di o,al System constructed ( ) or Repaired ( ) by Gt�-�... - ' �:,� v. v taller has been installed in accordance with the provisions of 5 of The State SZnitary Code as described in the application for Disposal Works Construction Permit .:...: ....... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS.A GUARANTEE THAT THE SYSTEM WILL FUNCTIO� ANTIS ACTORY. Inspector.�..DATE...................................... J _ ----------_______-•---•-•--------•----------••-•-- THE COMMONWEALTH OF MASSACHUSETTS BOAR F HEALTH ev� S . .....OF..... . .......05��._b.L J�a N ................. FEE .... ••••••..... ispolia1 go k5 � nntrn�ton rrmirt Permission is rYgranted----a- - � .------- � .......... to Construct or Re aiF ivictual . , Sewage Disposal System `` ••-••-_ Street as shown on the application for Disposal Works Conitructi ermtt No..................... Dated.......................................... / •-----•-•..............................••.. Boa of Health DATE___.1��-�'�-.----�-�-------- FORM 1255 HOBBS & WARREN. INC.. 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