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HomeMy WebLinkAbout0154 OLD KINGS ROAD - Health r 77 - LOCATION SEWAGE PEIINIT NO. VILLAGE G ® -fuf f I N S T A LLER'S N.A III E i ADDRESS � U��L 0 E N OR OWNER lf4 DATE_ PERMIT ISSUED DATE C0MPLIA-NCE ISSUED 'o IPA . eft Ou No. 1:..6 ._ �a.� _ .a Fps....................di THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...........................................0 F.......................................................................................... ApplirFatiou for Uiipuiial Mirkii Tonstrurtiou rmuff Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ... � : ' - . ........k .. � -� . ... .......----••----•--•--••. --....-•-•_•-_ •......_ -•--••-------•••--•---•.................•- Location-Address �Q r'�A or o .. ...... ......------ Owner �,,,, P ress a ....... ............ . ••......�.1.1a --._................ ... r..sts.....�.j....'' S Z� ..................... Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of B,edrooms..............3..........................Expansion Attic (fot Garbage Grinder (463 kL pa, Other—Type of Building ........P.W4,......... No. of persons............................ Showers ( ) — Cafeteria (0041t W Other fixtures --------••••••• ............•••_••......•.... ..........gallons per person per day. Total daily flow.............. :3®....................gallons. Design Flow.......56.............................g P P P Y• Y �- WSeptic Tank—Liquid capacityi ---gallons Length................ Width................ Diameter--------.------- Depth................ x Disposal Trench—No..................... Width........... Total Length..........1......... Total leaching area.....,..__. .._....sq. ft. Seepage Pit No------1------------- Diameter.......kP....... Depth below inlet................ Total leaching area. q. ft. Z Other Distribution box ( ) Dosing tank ( ) ` `-' Percolation Test Results Performed -(,�:�° _e`!�y) Date........................................ a ,.� 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......--................ a -------•-••• •••• ....... ,....... -------------------- O Description of Soil.....Q....�'O `�.... - �`� a'� 4� t fir``� .................. -..- x V •••••••_•••••••---••---••••_••_........-••--•-••••-__•_•_••........................••____-_••-•-----•••_•-•-•--•---••••--••••-••-••--•-••_--•••••-_•-----••••-•-_•_•_--•........_••••_-_......-•--..•••- W ••-•-••---••-------•----•------------------•----••----••-•----••••••••••••••••••••••_•_••-••-•---•-•---••------•••••••---•-•••••----•_•••••••-•-•--•••---••••-•••--•-•-_---••--_--.....•••__••_-•-_-•-•- V . Nature of Repairs or Alterations—Answer when applicable............................................................................................... -------------------•------------------•----_-_------------•---_----•-------------------------------------------•-••-----_-------_-_---- ........................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with '''T m s _ , the provisions of �y. .,,�. 5 of the State Sanitary de The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be j sued by�, l�o he h. Signed - ------ ......•-•-•_......--• Z1Z,>1)pp'lication Approved By....... . ..�-_-----_.... --------------------------- //�. . . ^— Da Date Application Disapproved for the following reasons:................................................................................................................ ........................•_•••••••_•-••••••-_•--....••-•••-••_-_•-••••••--_•-••-•_•-•-_•_•••••.......•_•--•••_••••_•••••••_-••••••_•_••••••••--••••_•---•------•--•••--•••••-••••-------•-•-•••__-_•.--- Date PermitNo...................................................--••• Issued_....................................................... Date NoY 5.1.4r2. sad ...-----•- - � �� •�" � FEE.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliraatilan fur -KlispoiW Works Toustrnrtiun ,Trani# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ..._..... .. ---- � Location-Address or o ......................M`�.... ._. �"........................................................ �... ............. �+� .4.+�� Owner �!yM "----- eS�,,. nstaller Address d Type of Building Size Lot............................Sq. feet v Dwelling—No. of Bedrooms______________ ..........................Expansion Attic ( I Garbage Grinder (yid�+ Other—Type of Building p,, yp g ........hP.4^R,_........ No. of persons____________________________ Showers ( ) — Cafeteria (VO4.L Other.,Axtures .-•------•--------------------------------------------•-...•-----•-•••--••-••-•••-••-•----•••-•--•-••........•••...:.-•---•---..._......---•-------- W Design Flow.......`��+`.•.S..............................gallons per person per day. Total daily flow............I-14....................gallons. 1x Septic Tank—Liquid capacity .._gallons Length................ Width.;.............. Diameter----------_..... Depth................ W Y: .. x Disposal Trench No..................... Width.fir............. Total Length.._..,E..I.___.... Total leaching area___.._.____ .......sq. ft. Seepage Pit No......I............. Diameter.........._....... Depth below inlet... !........._... Total leaching area.+_ .....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed Date..... aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ .......( 04 O Description of Soil s [� �.;, $ . Sa'. P ...I `w_ .w �,• _ x ------------------•--- t, --------------- -------------------------- ------- ----------------------------------- ............ ----------------------------- •-------------------- 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 TTTLI� p 5 of the State Sanitary de— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be sued by he h h. Signed--- •-- .............. .......... ,.. Da PPlication Approved By.. _ .., !- ���_ ... ......... Date Application Disapproved for the following reasons---------------------------•----------------------------------------------------------------•-•--------••.------ ..........•-•••-••-•.............•-----•-•••---•-----..._......-•---------------....._....---•••••........-•----------••-•------•--•--•••-•-•-••-•-•----•---------------...------.... ----------•- Date PermitNo........-................................................ Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................................OF..................................................................................... (9rdif iratr of rtt mpliFam �, THIS IS TO CERTIFY, at tlxe Individu ewage D's stl System constructed ( ) or Repaired ( ) b ............................................................ {{� oat. �._ �r� ` 1 at !`.ot....... `J ` Installer y has been installed in accordance with the provisions of TITLE j f The State Sanitary Code as described in the application for Disposal Works Construction Permit No.__AF�"` ...._...._-�............. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...........................................................�i�41 bE Inspector--------------- ----- --------------- .................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................................OF...................................... ........................ _ No... .....' .. .: .. EE...............6........ Rsposatl Works TaanstrWion r ani# Permission is ereby granted••--- -- -- --- ••••.... ,. ........ ... ...... .........•�-- .ZV4............................. ......................... to Construct ( or Repair ( ) ap Indivi u 1 Sewage sp sal System atNo.... ..---- + .. � _-...,�`........... O C.va ------------------------------------------------------------------------- Street PP P t No.. Dated f................. .......... ...... ass own on the application or Disposal Works Construction Permi �- - l f r,� Bo Health DATE .... ....... . ...........•--- t FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS :-i 23, E i �o6K� lrag� � 1°6x"gym ,11 rZ JO 19 \ PFZ o - v5t � �O�i(7 ' ►�' c lax `- ° ! 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