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HomeMy WebLinkAbout0066 CAP'N CARLETON'S RD - Health LIO(o 7 LO, CATION � = 0. V ,LLADE �-- INSTA LL. R'S NAME & ADDRESS �/�.�b B U I'L D E R OR OWNER ZZ2 OAI-7J'0/cl DATE PERMIT ISSUED DATE COMPLIANCE ISSUED���,�� i 1 o� s I -r • No.--•-.... �...� F�s...............`:........_ LTH THE AO HEALTH OF rs OAR® ApplirFation for Disposal Vorkfi Tontitrurtion Vantit Application is hereby made for a Permit to Construct (Zr Repair ( ) an Individual Sewage Disposal System at: / -••- -•.... -- ......-•------- Location-Address �' or Lot No. �z -------•-•--•-- _.....�2�--------��-�,��Ye.,j.... ......--••.................. ROwner Address fW1 •--------------••-•- � *" ......'............................................... ____......__.....---------....___----•----•-Address............................._____..._.._.. Installer Type of Building Size Lot.. _ _Sq. feet J Dwelling 1 No. of Bedrooms.... ___________________________Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons____________________________ Showers — Cafeteria a Other fixtures ---------------------•--------•- allons e e day. Total daily flow__..__..___ gallons. W Design Flow----��---•----------------------•---g P �pr P� Y• Y �-=-----•�-•---•-----� W Septic Tank-L Liquid capacit},49!G.0--gallons Length._4--..____ Width....... Diameter________________ Depth.... Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area............. q. ft, Seepage Pit No...../........... Diameter./��.._._. Depth below inlet._6.::..... Total leaching areal:_°`...sq. ft. Z Other Distribution box K Dosing tank ( ) Percolation Test Resul Performed by.�-nc-v �....__� � 6� -•............:...... ............ DateAwai 6--� ---•--•-----... , Test Pit No. 1 .._._minutes per inch Depth of Test Pit___________________ Depth to grouer:____.____..___.._____ . a Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ N' - •------------------------••---•---...-- - ---•----•---......__....-----------...•-•---••---......................................................... ° P .� Descrl tion of Soil..._.._..- / � ` --------- .-------/ 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 iIT?is 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss oar o Ie Siged ---•-----•----......_•-.....---- Date. Application Approved By.....-- �`f/l�L Date Application Disapproved for the folloz&ing.:reasons:.. _---=-----------------------'• • ------•• --• -- -•-----••-•-----••---•••-••-•---••••----.........- ' ---•=•-•-----------••--•-------------=-=----•---=-•---------......_....._.........---•----•-----•---•-••---------------...•----------•••••••------•------•-•••--•-•-•-••-----•------•--•-•••-••......_._ Date Permit No..................................: Issued.... �_— .. Date No........-� -•- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliraa#ion for Dispnsaal Works Tnnitratrtinn Prrutit Application is hereby made for a Permit to Construct ( 44 o Repair ( } an Individual Sewage Disposal System at: .. ......... 1 C' , -��C .a ` 0; Vie ?c•r- .... ^^--•--.....� !:_....................... --•-•r---------.... ....... .s------- r Lot No. Location-Address G—�J4 �d� �f o •.......................... -------------------------------------------------------- Address..... jr CTs ./ -- Owner • ,` a. Installer Address Type of Building ` Size Lot_..," :- -�a Sq. feet U Dwelling-L No. of Bedrooms........... ............................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria Other-,fixtures ................................... lA«•> ................................. -----s----------------------------------- ------ -•- W Design Flow....., rd ..................gallons pe _j errssonZper day. Total daily flow......__ ..-.F Cam........_.gallons. WSeptic Tank-4 Liquid capacity, ? .gallons Length-_- Width......._ . Diameter................ Depth... r..... x Disposal Trench—No..................... Width-................... Total Length.................... Total leaching area..._.._.__._....`f,., ft. - Depth below inlet•- �. .... Total leaching area.,sl j�sq. ft. Seepage Pit No.._..�°_..._...... Diameter..ZQ. Z Other Distribution box (;7())_ Dosing tank '-' Percolation Test Res Performed by-A.;;.2. ^ ....._ .'�..--'�..... �`a'��{'� ... Date..... _^_'' -......_.. a Test Pit No. 1 ••---minutes per inch Depth of Test Pit-------------------- Depth to groudd wat r..................... (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R; N. ....------•-----------------------•--------.........--ti-------••-.................•.........'-•••--......................................................... 0 Description of Soil......... -----.t ' �? ►' �> a ' -------� G• r`'` �-.• -� - - ... . -....--- - 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 TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss b a 1 Sign1% .-----•. ... ...... . ........................................... .......................... I ...- ------.Date y .. ,-Application Approved B -.... --- •----...... .-f�'��.. .....-•----•-----••. Application Disapproved for the following reasons:............. •-----------•--------...---•---•---•---••--•--- -------------------'•-••--•-'- ._.........•---------------'-•••---"--------......•------•-----'--••-•••-•••-----------•-----------------•••-••--•----------••---•---••---•--••-----•••--•------••-----...-••--••••--••--•----...------ Date PermitNo.........................................................•............................ Issued-..................................... ................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........} ... ........OF................. . . ..... ......... ..............................._......... Ur#ifiraatr du`na aanrr THIS IS TO CERTIFY, That thef Individual Sewage Disposal System constructed ( ` .Repaired ( ) b . . ........................................................... .............................................-... ---------••. ............ ....................•-•--•----.-•--••---.__.---•••--'--------•------.._....-•-----"-----•-•----........_____........-----......_ Installer. at.�.. ._ .. - has Been nstalle"d in ac ordance wit the provisioC-(; - F ��r} a described in the application for Disposal Works Construction Permit No. . 1r. ... . ................... dated.... ... .___ -------------- THE•ISSUANCE OF THIS CERTIFICATE SHAL 07 E C TRUEU S A E�B A NT&T14AT THE SYSTEM 'WILL_FUNCTION SA ISFACTORY. DATE. "'= ..:.:1 .__.....:�_ . ...... ==--:.. Inspector... :._._..... -----•----•----------•---. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r .........nk/- k, ........ � . FEE... �,,.p.dl..... Bignusaal Works Tnns#rn.rivan Vamit 5' Permission is hereby granted;_----_..�- w,, � ...... to Construct ( ) or Repair (h ) a -- vAA ewage Disposal System •'n/Ind�v1 • ..... -j$ 1` a ✓r as shown on t e ap ication for Disposal Works Con truction Permit o..................... Dated_..___:._._..__.._... _............ r ...........................;,: DATE............. °_:. =.7:- ......... Y C y FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS IW #�66 Cd�3s V_ 3a ,f L0CATIO > �fl SEWAILPERMIT NO. VJLLAGE INSTA LER'S NAPE D ADDRESS u T BUILDER OR OWNER _ DATE PERMIT ISSUED �� �G^ S? f _ DAT E COMPLIANCE ISSUED 1 Q "9// I� 0 'PV THE COMMONWEALTH.OF MASSACHUSETTS BOAR® OF HEALTH ...........................................OF..........................................-----.................... ApplirFation for Btopas al Workii Tongtrnrti orn Vanfit Application is hereby made for a Permit to .Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ...... ........__..- _....---•-- - - ....... - . -`-�-`-�......--. ......................................... oc�Ji n-Address or Lot No. mil/Li Cf! !!� .._.... -----•................. ........... ...........................................•-••---•------.......................... Owner/ess W / ..?.c��.� a / ............... ---------------- -------------.......,4.........----........--------------------------........----- Installer Address UType of Building Size Lot............. ..-®'®..Sq. feet Dwelling—No. of Bedrooms._.... ---------Expansion Attic ( ) Garbage Grinder ( ) a'4 Other—T e of Building !'9^� `N of persons............................ Showers ( ) YP g -----------�--------- ( ) — Cafeteria dOther fixtures .................•..................................................................................................................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capacity�®e!�.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........................................ ,.� 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 ---•-------------------------------------------------------------------------------------------------------------------------------•-.............••....•--- ODescription of Soil................................................................•-•-------••--------•--------------------------.------------------•----•----------------•-•....._.•----- W V .........-•----•••-----••..................•---..._........-----._..........--•-------•...................----------•-••-•....-•---•-----•--•-------•--•-----••-------....••---••---...._......--••------ W -----•-----•-------------------------•--------- •----------------•----•-•------•----------...----•--------------------------•----------•--•---•------•--•----------•-. U Nat re of Repairs or A terations—Answer when applicable---____ ��' .. X�'s'_'. 'l%OC :. .?----:---!v Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITLZ 5 of the State Sanitary Code— The undersigned fur r agrees not to place the system in operation until a Certificate of Compliance has been ' sued by the board of th. Sig ........... ... . . ... 7. . .......................... .... .�.....a 1----- Q.a; - - - --C e Application Approved B .. •-------- ----- •-•-•- S� ..f ---- ate Application Disa rove r t e following reasons:-----•--------•---------------------------------------••------•-----------------•---------------._...-•---•---•- .......................... -•-..... ----•---------•••---•------.....----•--•-••-....----•----.......••-•-•--••-•--•--•------------•••---...---------•--....-•---------------- Date PermitNo................... .........................._.._...... Issued....................................................... ��J Date No�f--- Q --- F�$. .._. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...........................--------------..O F.......................................--------------------............................... Appiirtttion for Diipostti Workii Towitrurtion rrnti# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systemat: / `..............__--- .......... .- •---------------•---.---•-- -•...... •--•••......-----........_......-••------- -•-•-•-----•--......................---... v �'� Address or-Lot No. �`......� .. o. �`+ ------------------------------------ -------- -- --- ------ ---------------------------------------------------- Installer Address , ��® d Type of Building Size Lot.... -.__1............Sq. feet U Dwelling—No. of Bedrooms-•....----- jtL/-. --------Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ' `N of persons............................ Showers — Cafeteria Q' Other fixtures ----•-......•-•---------•-•••--- . W Design Flow............................................gallons per person pe day. Total d ily flow............................................gallons. WSeptic Tank—Liquid ca.pacity�d 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 ( ) 1.4 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (z, Test Pit No. 2................minutes per inch Depth of Test Pit.......:.:_....._... Depth to ground water........................ ---------------------------------------- -------------- •................ ------•-•-•- 0 Description of Soil---------------------•--•--•----------•--•----•--------------------•---•-----...--••--•-------------------------------------------------------------------..........._.. W -------------- ----------------------- ----------------------------------------------------------------- ------------ r- U Nat re of Repairs or A to arions—Answer when applicable___.__._ .� .t/G... /' ej�d.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIE 5 of the State Sanitary Code— The undersigned fur Fr agrees not to place the system in operation until a Certificate of Compliance has been sued by the board of e lth. �- .._.. l 4l �m Si . !/ ••--•I •- . ...... *.4 114P > Application Approved --•- ••---•-- --•-• •--••-•--•--. ....................... ...... --•• •-- .............. Date Application Disapproved f r t e following reasons:................................................................................................................. . ........................... ------- ... ............................................................ Date Permit No...................... .. f .. Issued-.................. ....._.._... �•�� Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HgA ,%" �.. .............................................................. �.- Qlrrtifirtttr of Tontpiiatta TH9 IS TO C TIFY T, the Individual Sewage Disposal System constructed ( ) or Repaired (4-y - by-- .F�O�s,�e i ,•� �rl� .c ...... .. :.... ...........•-••---................--------------...........-•-•------....--------- ...... at - -------------------------- has / - Install 4` C •---•------ -- �. d. t c .......1...__......._ '-------::......-�-•-.-----_.._..........---._....__....__.._..-----------------•---_...........--------------- been installe&in accordance with the provisions of TI T L�'. 5 of The State Sanitary Cows�escJibed in the application for Disposal Works Construction Permit No. .�.._:y�i iq�................... dated.-'�--___._`�,' - :..!__......_._............ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................. - ...................... Inspector-.-.,,. '........................................................................ THE COMMONWEALTH OF"MASSACHUSETTS BOAR,, OF HE pp�� � 1✓' `` z..........:..............0Fp' ...�................ r''� No.P...r:.... E�, FEE........................ Permission is hereby granted�--r----=-------------------------- y to Cons u ( Rep ' (✓) a dwi a Sewa sal System r - at No.. ��i .: - 1. { ----Street as shown on the application for Disposal Works Construction Permit NoV.'1'0,?_.. Dated.. ......0....... ............... y_._-.--- < •�1 DATE................................. -! f ................. %:Board of Health FORM 1255 HOBBS & WARREN, INC., PUBLISHERS L0 CAT ION 1, ��s- SE/IA PERARITi' 0. VILLAGE ij% SY LL Ut S J/}riA ` Z 3 ADDRESS f � t a V I L D C .1r OR o,, I ISSUED .. / ? 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