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HomeMy WebLinkAbout0031 CARRIE LEE'S WAY - Health (2) 31 C¢rrit Cet's IA41MM Ali S M E A KEEPING YOU ORGANIZED No. 12134 2-153LGN SUSINABFORESTRY � MIN.RECYCLED INITIATIVE CONTENT 10% CertitedRbersouming POST-CONSUMER® www.sfip.gramwg S"1190 MADE IN USA GET ORGANIZED AT SMM.COgI c: No..-A.........��... d Fxs.. ..' :............ { THE COMMONWEALTH OF MASSACHUSETTS `r BOARD OF HEALTH ...5.7. � . ...................................... App iration for Disposal-Works Tomitrnrtinn ramit Application is hereby made for a Permit to Construct �<) or Repair ( ) an Individual Sewage Disposal Systnat / v.... . . :. ... . .. .......... ................._.v ...... .... � v L L c ion-Address (�/ or 1 No. A� p ........ . . ..:. .. Owner A d s .. a .................................. ..... Installer Address Q Type of Building � Size Lot 2.0 1.31....Sq. f t U Dwelling—No. of Bedrooms_-_.. ...............................Expansion Attic C`4 Garbage Grinder f p., Other—Type of Building ............................ No, of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures --•-•-------------------- -- ---------- ----------- - Design Flow........... -_._.' ...................gallons per person per day. Total daily, flow.._..._.,..._._._..___.._................_gallons. WSeptic Tank—Llquld capacity. gallons Length.f C.... Width___ _________ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width_.__v.....:_._._.. Total Length.................... Total leaching area....................sq. ft. rSeepage Pit No.......1----------- Diameter-__--_ _.._..... Depth below inlet.....[............ Total leaching area.-1?1_ ... ft. Z Other Distribution box Dosing tank (;V10 ,p� '�' Percolation Test Results Performed by,)=, .�dl A.�-y.....�-_.e---7------------------- Date__.._ �a�1_� __..__..._. Test Pit No. 1...... -____mmutes per inch Depth of Test Pit........6........ Depth to ground water........................ G� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --- -------------- :....... ?... O Description of Soil....... - .�?'� .......=_�---ram'!.................................................... x W ------•----•----•------------•------------------•-•-•------•--•--•----•---•-•------•--•----•-••-----•--•-•------------------------------------------•-------•--------------•--•----•-----------•--•••-- UNature 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 TITITZ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be n issued b the oar f health. Signed ' � ... ....... .................. ........................ Date Application Approved By....---. -------- �� ......._... �� - .: Date Application Disapproved for the following reasons:.......................... --------------------------------•-•------------......__.._.....-•----------------------•--•--------•-•--------......-------••---•-•---•-----•---------•--•--------------•-------•-••-------•----------- 2 ..�� Date PermitNo...............--•--------------------------------------- Issued..-• ---71--•-----------------••-----._......------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF ALTH _ �U v ... OF................. ... �r�ifirtt�le n� f�nnt��i�a�tr.� T TO RTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by ..`.. { c ------------------• --------...- Installer at.. �-- /�... ;�, •--- -_----_-----•-_-- has been installed in accordance with the provisions of T r Zi-The State SanitaryCode as described in the application for Disposal Works Construction Permit No.0...���--------------•. dated ...��._ls�.' _:_..._._._....__.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUEI) AS A GUARANTEE THAT THE SYSTEM WIL FUNCTION SATISFACTORY. DATE............ F 7 Inspector..�,� No....:.......... _t°:._ r Fss...,, ..r `..... a x THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE TH 1..Q.d0..)-.7.............OF... Appliratiun for Biupaauai Warks Tonstrnr#iun Vamit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal Syst at: .......ke.e...........1- a Is I,�" lion-Address (�Jl- or Inc -•- S -- c�- • -••- .............. ---_.. ..._... ................................. ......._... owner k Ad Vs-- .t .......--•----•........................... 4. ..7i t 3! -5--__ .... Installer Address d Type of Building Size Lot ..�.......... ....` 9Sq- f t U Dwelling—No. of Bedrooms.__.3_________________________________Expansion Attic �/9 Garbage Grinder Other—T e of Building No. of ersons____________________________ Showers a YP g ---------------------------- persons ( ) — Cafeteria (----)- Otherfixtures --------------•----------------•---•---•-------------------••••-•-••--•--------•-••-•••-•--••--•--V WDesign Flow..........S. v' ________))________._gallons per person�er dAy. Total d ily flow_____________ _ _____________________ �ons. WSeptic Tank—Liquid capac tyld�®.gallons Length_Q-,'�_______ Width._. _._._._._ Diameter________________ Depth__.__..__. x Disposal Trench—No_.........__________ Width . Total Length........ ...�...... Total leaching area....................sq. ft. Seepage Pit No......,�............ Diameter_.__.1 ......... Depth below inlet____a ........ Total leaching area°'�q�.......sq. ft. Z Other Distribution box (/) Dosing to (f o / / '-' Percolation Test Results Performed by._ o!!!. `__! Y_.._�' __,___________________ Date_._._? Z! 7e a • ---------... Test Pit No. 1.....L�.....minutes pe ;inch Depth of Test Pit_______b- Depth to ground water________________________ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ...... .._..:.. .._._.. O Description of Soil.......................... 9--. S 7"a. �� 5 �'�-�.._.. - x W --------------------------=------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------- 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 TITL is 5 of the State Sanitary Code=The undersigned further agrees not to place the system in operation until a Certificate of Compliance has4bn issued b theyboar f health. Signed. ........ .- %� "Date APPlicationAPProved By.. --•---• .- --- -- --------------------------------------------------- ••- Application Disapproved for t rea WS:.........._ Date•' Permit No............................... ------ -•-•-•.. Issued-------•••----- ` Date r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 OF. ................/.. . ...................................... .................... f�rr#ifiratr u rr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( er Repaired ( ) by.... --•----_ .......--•------------•--•-•---------------------- --------= ••-...... ----__...... .....--. ............... Installer � r r at '�.� ••-------- -------- j'' - 4 V i has fee inall�d.3n a c the oon�s�f T ` The St tary,;p ode as described in the appli do for sposa or ks Construe ion ermit No.- y',t' dated a �................ /;-•- THE ISSUANCE OF THIS CERTIFICATE SHALL T BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM.'-,WILL FUNCTION SATISFACTORY. DATE::--•------•--•..................•'=--------.....__......•-•--=..._........._. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS ~,BOARD O HEALTH ' to�.............0F..................... � ' r No. _r��>._ - FEE........................ to ............. aarbi Tunu#rttrtiun unlit Permission is hereby granted Lai- - - - -r--•---•-----•--•------•----------------------•------•----_..---•-----_==__-___----______ to Construct )�Repair ) an Individua ewage isposal Syst at No. - C'/ __l----6"oyf ••-- -• ------ .._ - r ............. as shown on the application for Disposal Works Construction Per o.. Dated �'�` '- `- . ...------- ----•-•---•----_----- j Boa',-MfA DATE............. _.r................................. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS 1 / .3 Y /7/P6077 077 Fla7 /��d WIZ4 / YoVcd 44 ,Zo, L9,3,9 fY�� / o s 4 .t�� h �'IL •C o A10 9 4 d �a�e cYis/a /4- /'Z L o 14.Q ss. 4 /v vt /PaIVMENTAL Coves, T/ 7-,4 ,E �. oti4/ yzt� .4 A1,q A, Y-u e s 0 ,0/0 /03 % I'e /»e o» 45cvee 7/ to 2-0G X1041 ram, zz A/v `vu >r © ttleile; G T 6 cat` 4(re .y/ 7-r7.1 n L � �f �+ , s �,t . O.f OF Mrs `� bps 3 FRAME a FRAfIR ?CIF/C E C4NER'/ :; COMrEAT a C ! t G L,(� 9 No.6573���Q � � No. 6232 Q 10 ` gO �QPSTEP���� ♦Q/STf-lk � L 9�t Tl C�/vrer. f��C MASS. OW NW vy FRANK COMERY 5 TROITIM S'T- HYANN IS. MAS& =1 RV_G13T%PW DOG-l"MPt-a LAND suwvL-foR SCALE .1 1 N zZ0 FT. 71'z/78