HomeMy WebLinkAbout4390 FALMOUTH ROAD/RTE 28 - Health 4390 FALMOUTH ROAD/RTE 28
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LOCL,TIOM SEW&C,E PERMIT UO.
IMSTQLLER- 5 U&ME �,�c .DDRESS
TO`i" l7 SR z - - -
BUILDER 5 1.1 &MF— 4&, ADDRESS
DIaTE PERMIT ISSUED 7.� — — —
D NTE COMPLI &&ICE ISSUED : — — —
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD O,1T HEALTH
_...... .OF.......... �.
Appliratinn -fear Disposal Works Tomitrnrtinn Vrrutit
Application is hereby made for a Permit to Construct ( ) or Repair (4-<an Individual Sewage Disposal
System at:
.........•---�3ga--•-� ..X•-- .Sir., N..... ....... •................................................................................................
L lion-Address r Lo No.
Owner re
STsrhs �i
Installer Address
U Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
d Other fixtures ------------------------------------------------------------•-----
----------------------------------------------------------------------------------
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacitv.-......_._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......................... ----------....
Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water.-.._--..-.-------..--..
fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_.---_-----_--._-----
G
------------- -- • ... ------........-
x Description of Soil-------- --------
' ------ --- ----------------------------
k. . = J
.._.. ---. -. --�-------- ----------- ---------
x h �J -- � ow erc�i ao�
V Nature of Repairs or Alterations—Answer when applicable._.___1____f- _�.._�v�v
----.....--•--------- ----------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article \I of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be 'ssu d by the board of health.
Sig ------ -•••-•...... --•--..
Date
Application Approved By---- - L '--------------------- .... 1 7�---------
Date
Application Disapproved for the following reasons:--•--•----------------------------------------------•-•-•-----.....---•----------......---.....----••-•••--.....
--------------------------------------------------------------•-----------------------------------------------••-•--•-----------••-•-------•---•-•-•-----------......----------...------•---.......-•---
Date
PermitNo........................................................ Issued........................................................
Date .
,
No... '
THE COMMONWEALTH OF MASSACHUSE- TS
BOARD OF HEALTH
]
2f'
l '1. ............OF.......... .. ........
�Y
x�
ApVtiratiun -fear EliiiVviial 10orko CL�Yt trYtrtt>QYt PY'Yltit
Application is hereby made for a Permit to Construct ( ) or Repair (—'I'-an Individual Sewage Disposal
System at:
/-i 3 qo ,fir 27 5"'-Jw 't �,/�s S
----------------------------------------------------------------------•---••---•--•-•-------•----- -••--•.....-•--•----•------•••---•••--•----•-•-•---•-•----•-•-•---•----•-•----•--•---.........•--
L atio Address r Lot No.
-------------------------- ------------...------------------................. -•---........-•-......... --------------•••-.
w Oner Ad ress)
w Jotih �, �N,; G1/•r�...�,r sT i��,...>r;
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms.............................. .. _Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons_.-_-_--__.-_-____-___-_-_ Showers ( ) — Cafeteria ( )
Other fixtures -------------------------•---------------------
w Design Flow............................................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. it.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by------ -----------------•--•............................................................ Date---- ------------------- ------------
.� Test Pit No. 1----------------minutes per inch Depth of lest Pit-------------------- Depth to ground water........................
fX, Test Pit No. 2................minutes per inch Depth of Test Pit.-_--_-.---_.__-_-_- Depth to ground water--.-_.________-_-__.._.
a ----- ------------- ........................V....................r.. .--.....•--•---•-••----• ............... ....................
O Description of Soil_______. . _ --_.._____.___..._-
f-.
--
�..
x ------------------------------- ------------- ------------- ----------------�_.�t " ---- ------- ----------
U Nature of Repairs or Alterations—Answer when applicable.-..../. _� ��.. !i r�'. pw PG c! �?�,o�..............
.------ ---- Y, Py yT,-- L
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 b issu d by the board of health.
Sigrle........ ---------- ------------� -•-•............
Date
Application Approved By.....�f�./� GE��j S�-/ ;----..7,/...........
Date
Application Disapproved for the following reasons-------------------------//....------------------------------------........-----.......-•-•.......................--
---------------------------------------------------------------------------------•---•------------------------------------------------------------------------------------------------------------------
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD...................... O� HEALTH
...'c*...... ...OF.........../....1�� ..............
TI.Prtifiratr of IT.Ompliaurr
THIS IS TO CERTIFY, That th Individual Sewage Disposal System constructed ( ) or Repaired (✓)'"
b Tod /t,
Y ------------- -----•------.....----------------------------•----------------------------------------...-•••-----•-•-
��. � �� � •� Installer
at -------- •-----•--------`-•--- -------------------``-----•-----------•----------•--------.----.------------•-•---•--•----•------------•----------•---
----._...--•-••--•-----•-------
has been installed in accordance with the provisions of :Article XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No..................:...................... dated------------------------------
.----------.--.-.-
THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WI FUNCTION SATISFACTORY. ((�� ,
DATE----�' �' -------- --------------------------- Inspector.-_P.. .......................................................
THE COMMONWEALTH OF MASSACHUSETTS
} BOARD Of HEALTH
N ......................... FEE,;,_-.,------........
Bi-spasal WarkiiC nYt�tritrti�Yt Prmit
Permission is hereby granted............... o 4 h 19 �/1...------------------------------------------.....-------------------------------•--------
to Construe] (� ) or Repair ) an Individual Sewage Disposal System
.......................................--••------ ....--••----•-•--•-----• ----------------------- ------------------------------------------------------------
Street
as shown on the application for Disposal Works Construction Perm
ti No.,.-_._„_._.. %.... Dated_ - - - :'___J ___--------
DATE. =---- �----------------------------------
Board of Health
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS