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HomeMy WebLinkAbout0129 SANTUIT ROAD - Health S �- � LOCATION SEWAGE PERMIT NO. go VILLAGE INSTALLER'S NAME AND ADDRESS olu� BUILDER OR OWNER Jo �tnr 1�,Q.v J.a DATE PERMIT ISSUED /© � DATE COMPLIANCE ISSUED /ems i �. •3 . . v No.g�.-•-•5-9----- z.4 Flea.. E THE COMMONWEALTH OF MASSACHUSETTS y BOARD OF HEALTH 1N0 _....... .OF..... I t y9.t-4,C--------------------------- Applirativan -for Difipviial Marks Cnowitraartioaa Vrrmft Application is hereby made for a Permit to Construct ( 'J) or Repair ( ) an Individual Sewage Disposal System at: Zq ................� r--- �t' �C Location CAddress ' or Lot -o. A Fl.._L Y�tdNQpP,T Cz._-L..1.9 = _1_ _� _t!!!If1, Owner Address a am�------------------------------------- ~f 4_t __Irk z ( Installer Address Q Type of Building Size Lot_.z-® ®_ ---Sq. feet U Dwelling—No. of Bedrooms_________-ar-------------- ----------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons__________________,..______ Showers ( ) — Cafeteria ( ) a Other fixtures ---------------------------------------------- W Design Flow....... _________________________gallons per person per day. Total daily flow___________q-600-------------------gallons. WSeptic Tank—Liquid capacitv«S®-gallons Length_®.e'.® Width_.J5___.._0_.. Diameter________________ Depth.s. 42 x Disposal Trench—No- ____________________ Width _____ �-------P�_.___- Total.Length--------- ®F�Total leaching area__.__._________sq. ft. PD Seepage Pit No_____ ___________ Diameter..`d_"_®---_. Depth below inlet___............. Total leachingy area. Z Other Distribution box Dosing tank Percolation Test Results y Performed b .____. - t -lcl Via,_ - Date__._ftAl_ t l - a Y . --- --•-• - ,� Test Pit No. 1...Z-:......minutes per inch Depth of Test Pit_)_ �Y__ _o_ Depth to ground water.A)_0T_E 10.(WT'Lr2eA GL Test Pit No. 2......Z-.....minutes per inch Depth of Test Pit.1__L_�"_9.... Depth to ground water__._._�-_____.___---- (� -- --- . ---- O Description f Soil- 0 -p ¢ �'°'� `�6vl --i x ----------------------•-.....---••-------- �� , W ------------------------------------------------- --------------------------------------------------------------- ------------------------------------------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable------------------------------------------------------------- -------__________________________ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with fl the provisions of,., 'i+j_ of the State E1 r_Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued y the board of health. Date Application Approved BY----- r C6 ----- � /Vle $�••---- Application Disapproved for the following reasons_________________________________________________________________________________________________________________ --...:-•-•-----------------------------•--------------------------------------------------------------------•----•-----------•-----------•-••------------•---••------------------------••----...----•--• Date Permit No.---- Issued--------- ................................... —j, _ -- ��-j� C. -�(_ �� I I - - ---- lJ--j 1 " at----------- --------------- ------ ------------------- ------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _........OF... ,. ' .... Appliratiou -for iopuottl Workii Totuitrurtion Vrrnift Application is hereby made for a Permit to Construct ( ✓) or Repair ( ) an Individual Sewage Disposal System at ................................1 F 1 hJ ,ss p ' t>�. _....._ 1N.1>SQ aZ ,�..1 0` Lot o N C_44 e.M p„ Owner 'address AN.a Installer Address d Type of Building Size Lof!_:Z 4_Q_O C3_ Sq. feet U Dwelling—No. of Bedrooms------------ --............................Expansion Attic ( ) Garbage Grinder ( ) Gam, Other—Type of Building ---------------------------- No. of persons------- .................... Showers ( ) — Cafeteria ( ) PLI Other fixtures ------------------------------- -- IV w Design Flow.-_._. � -. ._-.._- gallons per person per day. Total dilly flow.___.. ^ -_.--.--_....... .gallons. . 94 Septic Tank—Liquid capacity I�AQgallons Length-!O--0- Wldtli . Diameter- ____ - ------ Disposal Trench—No------------------ Width-----...��...--.-- Total Length.........-.-.------ T01fotal leaching are a--------------------sq. ft. Seepage Pit No.....�----------- Diameter..I�•"'.Q---- Depth below inlet--- ..`:�.... Total leaching , 1 Z Other Distribution box ( Dosing tank ( ) aPercolation Test Results Performed by. ... �� .._.0 �_�. � '`� ......... �............ Datet Test Pit No. I....Z _._minutes per inch Depth of "lest Pit �'-_r--�.q,. Depth to ground water.J.J-C?Jr__E.tj_eotw eeP f=, Test Pit No. 2------ -r_....minutes per inch Depth of Test Pit:.. . .... Depth to ground`water........................ O °+,, ,, ---------------- -------- ,� -- De crI tion f Soil - o a "' �-Qb e i Ul+yL x �----- .. --------- --- --- -------- ------------- w UNature of Repairs or Alterations—Answer'when applicable................................................................................................ ----------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------- ........... Agreement The undersigned agrees to install the aforedescri'bed 'Individual Sewage Disposal System in accordance with the provisions oft Sof the State Y'1Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of,health. tied -----------------=---------------------------------------------- -------------------------------- / Date ....------1�;_ Application Approved BY. E57ar� �. t� ..._.............. •f��� �i Application Disapproved for the following reasons:................................................................................................................ .................. •-•-••--------------•----------------------..-....--•-•----------•---------------•-------------------_:...-..-....-..._._....--•--•-----------------------....-..---------------- -- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH P-ws�....................OF.. ........................................ (9rrtifirate of ToutVIiatire THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed �or Repaired ( ) by--------,lL,t „�,--------- ----------------------------- ------ _ Installer :.. at-----------------tt rf:.. ..�.. ► "i-------� i.�---------------------- 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---8D.-...59-11.............. dated........................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE -:...--•-....---•---- Inspector------------=-----------------------------------------------------................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .F. .......... .. ............OF..... No._g U....�9. FEE G. ......... BinVo,itt1 Norkii Tlomitrurtion Prrutit Permissionis ereby granted---� s i-�..... . ---------------•---------------•------------------------------------ .................. to Construct ( or Repair ( ) an Individual Sewage Disposal System atNo............9,7.....3-2----------- a•-e. .--•-------------- as shown on the application for Disposal-Works Constructio mit No--------------------- Dated------------------------------------------ ------------------------------- iy DATE------..11 �a? ............................^.... Board o n FORM 1255 HOBBS & WARREN- INC., PUBLISHERS THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) M A- ' F 7��-C&' L DATA ,r 125 Y � 3 1 d'ntl' Z-0' zo ScPrr� TArJK_ tj 1 ! E jc i l r A-(b O{4JJ 7 ��IJ }t��' (� Tr. `4 1v�,.O. e>a E' V`UL V�i t/\_.� FT.��'r.�S 4��^� IJ'•i i N �r td� � p c sT•.Bq� v 4o�U �9rS 390 ©o GFr. DRAM. l250 C . G.oNc• E.�AcN��ty PsT Ca;c. - Q pea► .. 4 - . 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