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Home My WebLink About0426 OLD POST ROAD (CT & MM) - Health (2) S 742W1d�P'ostR'oad UjA�}: a� fol / D T WN OF B NSTABL9 ub L A CA ID SEWAGE # VILLAGEC47\0 \ ASSESSOR'S MAP & LOT r INSTALLER'S NAME PHONE NOS . � 0 SEPTIC TANK CAPACITY �?o LEACHING FACILITY:(type) NO. OF BEDROOMS PRIVATE WELL O PUBLIC WATER BUILDER OR OWNER�t DATE PERMIT ISSUED: DATE '^OLIPLIANCE ISSUED: VARIANCE GR,' NTED: Yes No -79 - b Ir 0 7, No..... Ficz........ THE COMMONWEALTH OF MASSACHUSETTS t S CG�� BOARD OF HEALTH -- ----------- �O F.......................................................................................... 'Appr tiotWit xiliWvviial Workii T a omitrurtion Vmit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal t m em at: ..C .V ...1P.P. .1 C47.4h.7.... ..........................................ZY.............................................. location-Address 0.4 0, L't. .1 .......... ....o . ... 157,.. ..A 4.... Owner Address ......... ......... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms....4/----------------------------------Expansion Attic Garbage Grinder ( Other—Type of Building eA.Pr.RA1._ No. of persons.4------------------------ Showers (;k) — Cafeteria ( Otherfixtures .................................................................................................................................................. Design Flow..YV ............................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. f t. Seepage Pit No_____________________ Diameter............_....... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 14 Percolation Test Results Performed by....................................."--------------I..................... Date.-------------------------------------- 1.4 Test Pit No. I................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 *...*---------------------------------------------------------------*....*"".*'*--------------"'"-------------------------------------------------' 0 Description of Soil........................................................................................................................................................................ --------------------------------------------*------------------------------------**---------------------------------------------------------------------------------------------------------- ..................................................................................................................................................................................................... U Nature of Repairs or Alterapons—Answer when applicable----------------------------------------------------------------------------------------------- a 0P.4....1P1+A./V..........................................................................4.............................................. ...................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of IT11S 4-1 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ... ben issued b the Signed_ .... .- .. . . . ................... ...-'-- ate Application Approved By................. .. C . _. ... ........................... .......... ....... Date , Application Disapproved for the following reasons:.............................................................................................................. ......................................................................................................................................................................................................... Date PermitNo......... _5 ........................ Issued....................................................... Date No.................. . .. Fm3...................._..---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ------. .....".................."......OF..."................------------.......------------. ApplirFatiun for Disposal Works Lun��rttr�iun rratti� Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: ..7?`.� .._r )4,41 .. 1 .•.................. ........................................../.1---............................................... _ocation-Address Lt _ _ Owner Address W Installer Address Type of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms.__`/...................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building No. of persons.l________________________ Showers O — Cafeteria ( ) Otherfixtures ---------------------------------------------•--------•---•-•---•----••---•-•-•-•-•-•------------•--................................................ Design Flow__/r .5�.............................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 ( ) a Percolation Test Results Performed by.......................................................................... Date........................................ ,.a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water______________________-. LL, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water__-_____________________ P4 ..................................................-.......................................................................................................... 0 Description of Soil....................................................................................................................................................................... x U •--••---•-•-•-•--••--•--------------•-----------•---•-••-•--------•---•-------•--•-...-------•-•-••--•----•-------------•----••-•----•--•---•-•---------•---••--•------•---...---------------•---------- w VNature of Repairs or Alterations—Answer when applicable............................................................................................... "/-� /P /mil Agreement: The undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance with the provisions of TTT .a"" p 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 Application Approved By............... ______ - - _ -. I s `� e ae -� Date Application Disapproved for the following reasons:.............................................................................................................. .................•-•-------...•••--•-•-•--------------••---•-------•---••.....•------....._..---_...._...._._...__....__...---•••-----•------------•----•----•--•--•----•-•-•----•-----•••--•••..._------ Date PermitNo---------- ............................................. Issued....................................................... L.`-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH crtwnrF...............................i............... Oy.....; .........-. QTrrtifiratr of ToutpliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (>c ) or Repaired ( ) by.................................................................................................................................................................................................... Installer has been installed in accordance with the provisions of TIT E 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No______________?f_2. .__.7_jf_.____ PP P dated..................-............................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..................... •---- -•---•••--•••------- Inspector............. - a---......----------•--.._._......_........-••••-••- v THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ ....................................•.... No.... f. FEE_ .............. - Disposal Works Tono#rttrtion rrutit Permissionis hereby granted.............................................................................................................................................. to Construct (>Q or Repair ( ) an Individual Sewage Disposal System, 1 •• at No------------- = t` .--='=------.... t { .t. = ---.....j,..e� _': _ .,-----•---••-•--•---•-----•-••-----------•--•----•-•------•-•--•---•----••---•--- �------------------ Street tr _7 as shown on the application for Disposal Works Construction Permit No.:�/•:__ _ ____ Dated.......................................... DATE............... .�.�r�!_•"•:-��--�.----•---------•--------........... sl... ofPe.1th FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS gown O� (^o4,iwood Ce*--teiiy $73.9 pit to be , pumped avid p,Cled •CarcdPPJr.� 2-6 'x 61 pit i •Ca . \ 402 D_,i .('o t atea ._.. . 40 , uitide 0.79 8 S6d : ' . 1500 a� a . New 4 a T to >rt �1•v ?. 5/05 O Cd t o " I s/o 4 . 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