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HomeMy WebLinkAbout0168 MOORING DRIVE - Health f • N ..(...... .. ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF !-i AL H ................OF.... .. ......:..............------ ........................................ Appliratiun for Uiiipuual Works Toustrnrtiun Famit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at ... •--�- - N . ..................... �: . . ... oti dre ss. ---------------- ------- �. rZa � ss // -------------- ........TP 1.................. ....... ................ ..................................................... Installer Address Q Type of Building Size Lot. A0100._..Sq. feet U Dwelling—No. of Bedrooms......... ._ ...................Expansion Atic ( ) Garbage Grinder ( ) U p., Other—Type of Building ............................ No. of persons........... ........... Showers ( ) — Cafeteria ( ) Q' Other fixtures ___________________________________ W Design Flow............. m�r............ .gallons per person per d�y. Total da}1 ��ow..._.....3J©...................gallons. WSeptic Tank—Liquid capacity/._.____.gallons Length. ._..`r _.. Width__00...�_---_ Diameter________________ Depth................ x Disposal Trench—No. .................... Width.................... Total Length............. Total leaching area....................sq. ft. Seepage Pit No....../----------- Diameter...... Depth below inlet....;?V....... Total leaching area ,�.sq. ft. Z Other Distribution box (/) Dosing t ( ) '~ Percolation Test Results Performed b _ .......... 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 __. •--••---------•-------------------•-•-••--•---..........._..._.....-------------•---.....------............................................................. 0 Description of Soi ...........f..................... -- -- ----------- -----------•----- -----------� ---/ -- -- --------- UW .................. 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 TL 1'U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' ?uedby t oar bf health. Sie ------------•-•.. .....................•--------- -•---------....-----............ i � Date Application Approved BY----• -� -- -- -- ----------- -- Z e --•------------------ -•--�-_�-��- --�-�-----•--- Date Application Disapproved for the following reasons---------------------------------•---•-------------------------------------------------------------------••-••••- ---------•-----------•---------------•--...------------------....------......•--------------------------.._......_...--...-----------------------------------------------------------------------•--..._. Date y_)..� , PermitNo...................-•---••---•-------------------------- Issued ----- -------- ------.... Date N7Q .... .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH AVVI rdian for Eliquosaal Works Tontrnrtion Permit Application,is hereby made fo a Permit to Construct (X�) or Repair ( ) 'an Individual Sewage Disposal System at !`.._--.. .�� f�-' .... .... _ 1,... .../r' 1 Location Address /r No. � � — .... / ._....... .. ............... .... fft! ...... ........ ......... . Owner ss a -• .✓,... �............,. -.......;..... /r ... -•........................................... Installer Address Type of Building Size Lot_ rO---------------- _Sq. feet U Dwelling—No. of Bedrooms._______::?......................:.......Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building _____________ No. of persons _________._._ Showers — Cafeteria 0.1 YP g --------•------ P ( ) ( ) a' Other fixtures ____________________________ W Design Flow............. ................gallons per person per dray. Total daily flow___________?_;��.____.______._.__.::gallons. WSeptic Tank—Liquid capacity/ Length_t'__f�____ 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,!r!.._'`�_....sq. ft. Other Distribution box (/ ) Dosing t .nk ( ) z Percolation Test Results ' .�'' .Performed by - !' `-" ? 7/t-a2--•--..__. 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_0�. �+ ..................................... `.............................................................--•••----•--••--••----••---•_..._}--••-•-•-...----_•••. >` O Descrlptlon x ofrSoilr..... .;....... - -••--•-••- •- , i Y �.1 _..-'..__. . ?...... . ----= `.. �.. f U v -- J -•-- -•-�y U Nature lf,Repairs or Alterations—Answer when applicable............................................................................................... _____________________________________________________________________________________________________________________________�f___________________________________._._..______-________-_______________- Agreement The undersigned agre s to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT'I.% 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 bf health. Si e _ i#,1fi- .................................................. 1f Date Application Approved BY f -�� .......... ....Z�kf--- f........ Date Application Disapproved for the following reasons:------•---------------•--------•----•----------------------•-------------------...---•••-•••-••-•-._...--•-_..._ Date PermitNo..................................................... ": Issued_............................. t` y„ Date THE COtNINONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...... .'.:.... ..R2 ..: .....................................................d Tntifirble of TontViiFaurr THIS IS TO CER FF/That the'Individual Sewage Disposal System constructed ) or Repaired ( ) y..... ._. ...... ..................... 1 Installer at-"--;-='.= y....... ......... ........:....................•-....._..-------•----•----- ...1;------------ ------------------------------------------- -----------------•----------•---------------------------- has been installed in,a.,cordance with the provisions of T 5. f T e 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 WILL FUNCTION SATISFACTORY ,, DATE ,s. R, t x t w Inspector taraM 3 x :i:`Y�•-'�'� ..r�`��� .+,� ,.t+ 4 �- :l.� .I�:��x,x,wrs• -� _ �,;.'. -< �. � n ,•�,. x�„.� �xr. ;" r ' ip r, } THE COMMONWEALTH OF MASSAC'HUSETTS BOARD OF HEALTH ....- 3,0 No..:...................... FEE....................... i fro t1 orko Tonstriulion Pgrutit Permission is herebyranted _..�`=� .---..�u� �.-------��1 g f to Construct ( or Repair ( ),an Individual Sewage Disposal System ] f at No.-••_. ..._..__. �- =` #'r" --------------------- --...---........ qj - - ---- ... as shown on the application for Disposal Works Const>:{iction Per No._ _ ted..... .._'`.7I.___........ Board of Health + , DATE----� . -----•-------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS LOCATION SEWAGE PERMIT NO• VILLAGE INS3A LLER,S NI/ME, i ADDRESS a U I DER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED � , , : t �..� � � � \�' � O �� --; � k.` LOCATION SEWAGE PERMIT NO. 0 VILLAGE I N S T A LLER'S NAME i ADDRESS �tz-;me y;,�ee f f'or,, /IL c BUILDER OR NEB DATE PERMIT ISSUED DATE COMPLIANCE ISSUED z " r i 1 / i 70 J' TO ,J jl I I�� 1; THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALT .-l.� J+�.......OF........ ........................ Apli iration for DhipmFal Warks Tontitrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: �ocatio - dd ess or Lot No. ................................................. ........•---- i._.2 ---........__......._...................------ �- Owner Address a --- �5�_d .12��c . . . -------------------------------------------------------------------------------------------------- Installer Address d 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 Q' Other fixtures ...............•••-••--••-..--.. . - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No. .................... Width.................... Total Length.....................Total leaching area....................sq. ft. x 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 Test Pit.................... Depth to ground water.----.-----.----..-----. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water----.................... ODescription of Soil-----.... 1* _ . ..................•------•----------•------•--•-------------------------------...---...........--- x W --- ------------ - ----•---------)---------------------------------•--------.--•- UNature of Repairs or Alterations—Answer when applicable-------..-,7)4-V440 9-a—L�1t.•.•-------------•.--••-•--•.-----•. -•----------------------------------------------•-•--------------------------------...............----------.........------------------------------.------........................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 1- 5 of the State Sanitary Code—The undersigned further agrees t to place the system in operation until a Certificate of Compliance has been issued by the boar of lth. Signed..... - -- - - ••---- ---- •- Date Application Approved By................. ----`.....-.... . --- .........R ZI!0A.--------- Date Application Disapproved for the following reasons-..............=................................................................................................. -----------------------------------••-------•---------------......-•---......--------------•---......-----•••-••••--••••••-••••-•----••---••----•-•••-•-•......-••-••......-••••----••-................ Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS -- - BOAR® OF HEALTH, ApplirFation for Disposal Works Tonotrnrttnn "rrmit Application is hereby made for a Permit to Construct ( ) or Repair (t-)- an Individual Sewage Disposal System at: { t Locatio•-n�-Address • i p or Lot No. ...................... `�{.. �.p...1 r !. •. ......._..... ........... ..............�._.Las:��. ._ ......... fy Owner v J fi t Address ,� A �' /r a.,,, f A 6. Installer Address d Type of Building Size Lot............................Sq. feet ; U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) ' Other—Type T e of Building ............... No. of ersons......................_._... Showers — Cafeteria a YP g ------------- P ( ) ( ) Pa 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. 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........................ O Description of Soil............ j .. .'`:'.. ..................:...•------------------------------•----•-----------------•-•-•----•-------._........--•--- 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 TITI:x 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 hearlth Signe ......-- . ..... 41 Date. �APPlication Approved By-•-----------•- ............. ' .-- .. ;. Date Application Disapproved for.the following reasons-------------------------------------------------------------------------------------------------------•......._ •--------------------------------------------------------------------•--......_......--------------------•-••---........--•----••---•---••----•--------•---------•-----••----••------------•--......... Date PermitNo--------------------------------------------------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH i - J ........#(.....:.........................OF..... ........ ..................... LT&rrtif iratr of TnntpliFattrr THIS IS TO CERTIFY, That the Individual Sewage-Disposal System constructed ( ) or Repaired Y r} d Installer at ' e"> , � rip / t d r�, , r+"rt : 1 _..�..-- `-•---.... ----•---= --•------ --------- --------- --------------•------------------------------------------- --------- -----••-------------- has been installed in accordance with the provisions of TIT1., 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.... ........... d< ed.............:.................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST E S A GUARANTEE THAT THE SYSTEM WILL U CTION SATISFACTORY. DATE.........�lf. .. ..................................•----_.... Inspector---_-•. --------------------------•-•--------------••..------......------- THE COMMONWEALTH OF MASSACHUSETTS BOARD ®F HEALTH ... .. ..........O F....:y,,� .e .:.a._ r „f'. ,.a. 1.................... ......................................,,. FEE.:: .... Disposal Works Tonstrurtion frrmit Permission is hereby granted " ` n_ ---•- .. :..-.. --......h' .................................... to Construct,( ,) or Repair ( ) an Individual Sewage Disposal System !r at NO. f f.: " t t�t°l r.. rt r1 '" —'Y ' "-= --------------------------- — � .d.<........ °' Street as shown on the application for Disposal Works Construction Permit No............:...... Dated........................................... DATE_ l„� $'g.--•------------------•__-_-_- / Board of Health FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS Y Ar :�f!P_���',_��_� t F�asH v•p.oL•F •�� - F"IMCSM GGf'DE �irrA;M G�TAD� - - -- --- - - c► 4fx Tit INK = r t� o✓E�c /,P-7' Tor o vArto. L- cQ✓ : _C?7fo I �,.•i�JJ1..�.v!;1,'y�Y J,h'�`!!/.`7`T,�,,fiJ.�*T� :��.�f���t��.�� '- - - _ �D [..a. G w6 _ `'fG- � 13 'ILI Low BA1 a D !.g T" t3 t�5►- IPE,HE� Co.v�. tiG•2+� , I� ,, G�w�rVltiCFn+ i J ® 6 C c I J .S APTI C 7AJV h( + . AND S rAa[i ` y ` j ECgr. 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