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HomeMy WebLinkAbout0014 WALLEY COURT - Health /y Wad/e t (,opr4 , 141ann i r No........ _.�a-» Fus.... ..................... THE COMMONWEALTH.OF MASSACHUSETTS BOARD OF HEALTH �}. OF......... . ... '. ' ............................. Appliration for Dispuotal Workg Tomitrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( <an Individual Sewage Disposal ��W System�a/t: . . .. .6 2 .. ..............................•. .... . ...... o atio A dr ss. or Lot No. ... ... ._ .... . ... - -----•-....... ..........-•................................. ............................................... Owner Address W Installer Address Type of Buildi. Size Lot............................Sq. feet �. Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 'w Other—T e of Building No. of persons____________________________ Showers — Cafeteria Q' Other fixtures ._---•-•--•--••-••--•---• -•-•- W Design Flow............................................gallons per person per day. Total daily flow____._._..._.___..._._.____..___________.__.gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ 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.....................,__. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ...............................................•----•----•---••••-•••--••-••••-•- -............. Description of Soil......--••-•--- '�' .:=--••-•--•-Z - G( ...................................................... x -----•-------------------•--- --- U Nature of Repairs or Alterati s-Ans r when a licable_ .. ...... --G- - Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITU 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. Sig .......... ... .•••-••...........................••-••-••-•••-•---•-•••••-----__••••• •--••-•--••••-•-.. ........ Application Approved By•__--- C f - 1'2 Date Application Disapproved for the following reasons:----• ....... -•--•--•-••- ...................... -•-••-•-•----••-•-•-•--•------•••-----•- ----------------------------•-----------...--•---------•--••-•---•------•••.....•------....---- Date PermitNo......................................................... Issued. r .- ..._......_.... Date i .J'tt..d t?... FEs. ..��.... THE COMMONWEALTH OF MASSACHUSETTS n !> BOAR® O; 1 EAI-TH ApplirFation for Disposal Works Tonstrnrtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( '-(an Individual Sewage Disposal System at: j .... . .y. f .... � .. .. ........................ ......................................_-- ,� d , ess or Lot No. • ..........--...................................................................................... ..._ Owner Address W ............... Installer Address Q Type of Buildi Size Lot............................Sq. feet U Dwelling—No. of Bedrooms-----------------------------------------...Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria a Other fixtures ---------------------------•---- - W Design Flow: :___-.S.................................................................gallons per person per day. Total daily flow............................................gallons. WSeptic"Tank—Liquid capacity............gallons Length..............:. Width................ Diameter---------------- 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........................................ ,4 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ d O Description of Soil-` -�--................--•--..---- -• - x ..V......... a� ' U .................................................................`....i..............._.. _... ._.__.•. _.___ - .........................................................................•____--_-__. ___ U = <Nature of Repairs or Alteratl Ans r when ap licable_. _ __ 7`/._ c - � A "eement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE; .5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificaate of Compliance has been issued by the board of health. Sig .............Za................................................................... Date Application Approved BY v!' �. ,.f------------- Y .2 Date Application Disapproved for the following reasons---------------•---. •••-• --------------•----•----............................................................ Date PermitNo....=-................................................. Issued__'-..jQ.-----------•----...-•--•-------•---..... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � !f .........O F. ....... ... .... ........ ..................... TrrfifirFaft� of TontpliFanrr THIS,I,S,,TO IRTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired Install r , has been installed in accordan with the provisions of Ti 5 of /T,he tate Sanitary Code as describe i the application for Disposal Works Construction Permit No y...... dated__..V'--__/ ...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS GUAR LTEE.THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE._...__ '..-'`Z-- .....•----•----•--•-------------••----------.. Inspector...-- , -• `•---•.----•- .._...... .�:_....._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH . No......................... FEE.....V... .. Disposal Works onotrudion Dprrmit ' Permissionis hereby r a �i•.�------------....................................................d..............................-`.... to Construct ( � ) o1r/Repair ( �ay� di dual 47age Dis osal S min at No"{� - /!t x ... ......... ... . . --... --- `.'.._. --------------------------- as ....... Street­ treet shown on the application for Disposal Works Construction Per i-Nio.._.... Dated.._ oe, . _ . .:_ . _........ Board���U of Hea th DATE..--•---•................. ............................................. FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS ' la -CATION�,Q �� SEWAG �/ , jjjRMIT N0. jq �. V LLAGE 7a�Qyt � i4 )d � INSTAL ER'S NAME & ADDRESS -rc Coo f T 7 7 � — /36 �. B U I'L D E R OR OWNER ns- �- ,P e v'a a_V DATE PERMIT ISSUED � �� DATE COMPLIANCE ISSUEDr—Z�',_�� ��� G c `'�1 �� �'1 �� Q -. � � �� 4�. No.. % Fm�...... ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... ... ..................OF...................................... . . ..............-..........-------------- Appliratiun -for 'iupuual Worko Cnunutrnrtiun Vrrufil Application is hereby`made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at Location-Address or Lot No. ,�- -�ms--------------------------------•--------------------------------------•------------------- Owner Address . . ------------M� ------------------------------- --•---------------------------.------------ Installer Address d Type of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) PL4 Other—Type of Building ............................ No. of persons----........................ Showers ( ) — Cafeteria ( ) a Other fixtures ------------------------------ W Design Flow............................................gallons per pet-son per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length________________ Width................ Diameter---------------- 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 ( ) aPercolation Test Results Performed by.......................................................................... Date__-_______-.---.-_.--------------------. a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-..--_----.-_..__----... (� Test Pit No. 2................minutes per inch Depth of Test- Pit.................... Depth to ground water._._.....___---___-_---- a ---•• -----------------------------------•-•-•-•-------•---•----------•---------•-----•-•••---•-----......................................................... 0 Description of Soil-----------------------------------------------•------•------------------------------------------------------------------ ---------------- --------- ------------------ U ---------- ;�...--r ..�o Q --- W -------------------------0- -�e .1� `•� /---------------------------------------------- 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 bee ss by b he lth. Signed _ •-••- ---------••- - ------------ -------------•---•-•-•--•-------•--- -' - - -�� Date ApplicationApproved By-------------------------------------------------------------------------------------------------- Date Application Disapproved for the following reasons-------------------••--...._._.-.....------------------------------•--••-----••--------------...•--...----------- ••--------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------- Date PermitNo......................................................... Issued........................................................ Date No.._..lir...... Fizic ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... ..............OF...................................... ------__­__...................... Appliration -for 43hipmal Morks Tomitrurtion Vrrufll k AppX li6ation is hereby'made for, a Permit to Construct or Repair an Individual Sewage "Disposal System at,: .4, .................er......... ..............A444,.y........ ............................................................................... Location-Address or Lot No. .................... . ........................................................................................... Owner Address4o.... ................... Installer Address Type of Building Size Lot-------------------- Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder Other—Type of Building ---------------------------- No. of persons..._.............:':........_ Showers Cafeteria P4 Other fixtures -----_----------- -------------------------------------­­---------------------------------------------------------- .............................. Design Flow..........---------------------------------gallons per person per day. Total daily flow....................................... ---gallons. 9 Septic Tunk—Liquid capacity--------7 ---gallons Length............... Width..-_--- --- Diameter._. .--..-..---__ Depth..-.---.-_.-._. x Disposal Trench=No................... Width----__--_-_-_----_-- Total Length--_--_--_--__-__--- Total leaching area-------------- -----sq. f t. Seepage Pit No---------------------- Diameter------------------ Dep'fh­b`eI bi �V"inlet..................... Total leaching area--_--------------sq. f I. Other Distribution box .......b -Dosing tank Percolation Test Results Performed by......------;------------------------------------------------------------ Date--------------------------------------- a Test Pit No. J...---------------minutes per inch Depth of Test �lt----- .............. Depth to -round water..-.---------.---.------ 44 Test Pit No. 2................minutes per inch Depth of Test Pit-.-------______-__-- Depth to ground water-_.-.--.-__-_-..--_---- .-------------------•--------------•---•---- Descriptionof Soil-----------------------------............................----------------------------------------------------------------------------------------------------------------- .................. ----------------------------------- ............ ....................... -------------- U ------------------- --------------------- - ... .... 7 ........... --------------­---------------- --41------- --------------------------------------- Z X 06 U Nature of Repairs or Alterations—Answer when applicable.---.-:-----------------------------------------------------------------------_----------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I--------- 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 bee I 1s s by Ae bi��,o hyalth. SignedV_...... ---------------------------------------------------------- ------------- ApplicationApproved By------.-------------------------------------------------------------------------------I-------------- ---------------------------------------- Date Application Disapproved for the following reasons:---------------------------------------------------------------------------------------------------------------- .................................................................................................................j� I ----------------------------------------------- ---------------------------- Date Permit No......................................................... Issued--------------------- ,. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.................................................................................... (9rdifira"tr of QVIUMV11-tturr THIS IS TO CERTIFY, That the IAdividual-Sewage Disposal System constructed or Repaired A") - &_ , / ................................................................................................... A-f by-----_----_ at...9.4 r.....A,4........4V# VAF - -----Installer------------------------------------------------------------ ............................................. _7e_ ith-- - - --the provisions of Article XI of The State Sanitary Code as described in the has been installed in accordantit application for Disposal Works Construction Permit No................. ....................... dated..---.-._--_-..---.----_-.-_- _____-----------. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION� ATI FACTORY. DATE................ ... . .... .. ... ........ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................. ......OF...... ..."Ae.............. .................................. ej(I No.-------- ............. EEE... R-tipwial lVark,i ClInmitrurtion Vrrmit Permission is hereby granted........ ------------------------....................................... ---------------- ................................ to Construct or Repair 0 an Individual Sewage Disposal System atNo...........40.r..*.......IV....... dlV............ ------- -------------------------------------------------------------- Street I 2,ermit No as show,.rfon the application f6rZisposal Works ..... Dated__._ .......... A _0 ............................................... T d of H ealt ........... DATE -- ----- ....................... Me" • FORM 1255, 906_6S­,& PUBLISHERS 9 4 v� 'L 0 C.A T ION SEWAGE PERMIT N0. 14 alaL.L,--. C - � (� -9-0 VILLAGE ,Q� Q.� INSTALLER'S NAME i ADDRESS,, Ayc � +r IUILDER Olt OWN ER / DATE PERMIT ISSUED �✓ � o� �Q DAT E COMPLIANCE ISSUED <lA �'A