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HomeMy WebLinkAbout0576 OLD STAGE ROAD - Health (2) a 0 n 79 `� THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF. HEALTke- ...-......_..Town-..-....O F...........3axn s-table---------------------------------------------- i App iration for Disposal Works Tonstrnrtiun Vrrinit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: j'J(p Sold....S-tage___Rd,.-,-..C.enteruill.e_,....II2h32. ...................•--- Location-Address or Lot No. Ei-chard_..Thomas..............:....._.....------------•-----........_.... -5 6--Old. 'Stage... 632 Owner Address A...&...R...Cees paal.'.SexYj_c e-----=---------------------------- 128...Dishaps...Terrac e.,._.Hy_anni.s.,.... 2 6O1 Installer Address dType of Building Size Lot.......:....................Sq. feet Dwelling—.No: of.Bedrooms.______:__3...............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building _______________ No. of persons....55_..................... Showers — Cafeteria dOther fixtures.-----=-------- ................................................................................................................................... Design Flow..............................................:gallons per person per day. Total daily flow......_.....................................gallons. WSeptic'Tank—Liquid capacity............gallons. Length................ Width................. Diameter................ Depth................ x Disposal Trench—No..................... Widths................... 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 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......................... CL' Description of Soil......Sanfl _& Grave . _. (� ................................................................: .....•---------... ..._....----....--------•------ ---------------------__.....------•----.....-•-•-----.....--•-••-•-•----------- U aatnu;e:f Repairs or Alterations—Answer when, a pplicable.___Iri8t111.a.tlOri Of a 1 000 S2 tfC P.. -----------------------------•---....------------------•----------..__:..--.-.-.-•:::_.._.---------------•---------------------------------------------------------•-------------------------------_--•-- Agreement The undersigned agrees to install the ,aforedescrib'ed-Individual Sewage Disposal System in accordance with iT the provisions of ? E 5 of the State Sanitary V Code= The undersigned further agrees not to place the system in operation until a Certificate of Compliance has.beeennissued b e boarr h 1'th. .� �:-....�°.-_[ -..o_,�� (s/,!w"'--- �3 _ -�-7_9_------•-- r 5i V79 Application Approved BY ! _��.-•r------------------------------•. ------------------------------------•--- • Date s Application Disapproved for the following reasons_______ _________________________________________ ............................................................ - ------•-•-•--------------------------------------------------------------------------------------------------------------------- --------•-------...................................................... Date PermitNo..........79—. ------------------------------------------ Issued_.........5.1---?174..---•----------=--------- Date 7 No 'T + Fizz . ...... xP THE COMMONWEALTH OF MASSACHUSETTS BOARD .............. ......Town------..OF...........Barnstab e----------_-___-_------------------------------------------------- Applir�atiun fur Dispos al urks� Tonstrurtion .eruti� Apphcatip is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal £.: St', f elate- .11e ...026-n_ ______----- ----- ----------------- • ------ ....... ty J i s Location-Address, or Lot No.. E �? 0�.� �.�a_ 2y'�2 i dd. y r Owner Address # �e------------------------•-------- �� : ?, Q?? .: ' i : ..By AM tines,• Q2601 Installer. Address Type ofBu>ldirg Size Lot__,_ ...Sq. feet D d11>' ' 'W of•Bedrooms.______.__3................ .fir__=___.__Expansion Attic ( ) Garbage Gririder ( ) of Building , a '!" .""""Other .- yp g _______________________'... No. of persons_ � .__________.__. Showers ( ) Cafeteria '!". Other'fixtures .........--•- Desl ni Flow : ................gallons per person per day. Total Bail flow gallons. W �; S� k • WSeptic �'2', k I iquid capacity............gallons Length________________ Width._ .._.....__ Diaxieter..._.. Depth ____.___._._. x Dispos9;wTreaeh No .................. Width.................... Total Length.................... Total leaching,area__ `:_:._...sq. ft. .�t...xitN r4(wup.� ..A Seepage:To .__-:___.__.. Diameter.................... Depth below inlet.................... Total leaching.area___ ::.....sq. ft. Other 2,s61utton^box ( ,: ) Dosing tank Percolationf Test Results Performed by......................... ........_..__.._......_...........__...... Date............-:-- Test Pit,:'No 1 ... ._._._minutes per inch Depth of Test Pit.................... Depth to ground water......................__. err , f=, Test Prt �'0 2_______________minutes per inch Depth of Test Pit.................... Depth to ground water---:................... ----------- _....__...............__.. _ ............. O � , Descri n a€ Sorl �1�nd... .....zKyAl.........--• ------ U ;--------------------------------------------------------------------------•------------------..._......-•_..... ....... .....-------•--•-- UWc ... .......'....................... ............•......._------.......................•...... ..._._ ... NyTatur/per_of,Repairs or:Alterations—Answer when applicable._._ a�•atioM 0 0007;7 wept c . .................. Agreer eflt k ,x ----------------------- ----_.. _... •,•••--- •. . ? .` ... Thtindersiged'"agrees'to install the aforedescribed Individual Sewage Disposal System in`accordance with the provi�rons=o-,t TT"'-L 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation urttil'a'Certificate of Compliance has been issued b e boar h th. r ,k ip6e oor3� a Apphca'ot Approved By c �- ---- 40 ,A:te Appllcatton,D> approved for the following reasons: ------7-------------------------------------------------- .P.ermit.No..-----•--7.©�— � � J ......... Issued_ . R v Date . 5 a THE COMMONWEALTH OF MASSACHUSETTS "r BOARD OF- HEALTH 'C?W2Y OF. EIX'17$�ib�e M ............................... .. ..... ......... x tC rtifirate of (goutpliFantr THIS I,S,TO,CERTIFY, That the Ind vldual Sewage Disposal System constructed ( ) or Repaired ( X) by Set-Vr -.-=-J?. ._.3a shntS.. -------------- iNr Installer ' ------------- has bee'n,:^installed m accordance with the of TITLE— ` of hf�State Sanitary Cede as described in the application for Disposal Works Construction Permit No._.._x_� da.ted_....__.__ l �7 _^_______________ THEt�ISSOIANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE TI AT THE SYSTEEA WI ILL FUNCTION SATISFACTORY f T ' ....__....(.....-•----------- ----------- Inspector..---... ------•----....... .......--•-- THE COMMONWEALTH OF MASSACHUSETTS,, BOARD OF HEALTH bel k.7' - f•'Wn.......OF.............Ur.n4 •*icab.lp............................ NO ` c ... ,. FEE :: .�J.. n.. Disposal Works Tonstrnr#ion Vrrmit Pernissi i.hereby granted----- ---C-a-c- - .d �!"8 �-r ry l�SQ. '��`. ��: 3 18 to Cons-act' or:.Repair (X) an Individual Sewage Disposal System } at No..': f �� :' ";!?... . .y... :ei' tjainri .t:}° 3 C. Riclax t_• 19 * ............. Street as shown,onrthe application for Disposal Works Construction Per No. _ r'g�'�___ Dated.__._ � .....�/?­............. 4.... Board of He lth DATE. ,M1 FORM 12gqqtttC s� HOBBS-&-WARREN. INC.,^PUBLISHEt'$ '"� L 0 CAT ION SEWAGE PERMIT NO• VILLAGE I N S T A LLER'S NAME & ADDRESS t U I L D E R- OR WN ER DATE PERMIT ISSUED DATE C 0 N P L I A N C E ISSUED . :I Sre nN P� f �