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HomeMy WebLinkAbout0090 TRACEY ROAD - Health (2) _ !� f - -- J �, _ 1 a c lofn, 4" .. �ov� I i i SMEAD vrrc,!N/; vnu No. 1Q31A 7-153L MAD IN USA --T nprANI?- A AT S.A EAn.n011 L0CATI N SEWAGE, PERMIT NO. VILLAGE i IWSTA LLER'S NAME ADDRESS � . 0 U I L D E R OR OWNER = ` w DATE PERMIT ISSUED ,t DATE C-OMPLIANCE ISSUED �..a. -.� % � „ � �� ,� ��_ s` �;,:R ` t y.. w•. i 4T � Y �. _ e+r+ �� Id �a � li O 9 �e � �. � � � ti .. � 3 a. No-CD_._ j..,.;? t M. - F�s. .........._THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH vw ,J - Appliration for Disposal Works Tonstrnrtiun Wrmff Application is hereby made for"a Permit to Construct O or Repair ( ) an Individual Sewage Disposal System at:. --- 'on-Address or Lot No. Ow ,Elddress . a •-----�.-•-• •. .-•--------------------'� .__.�....---------..... . ....... . ................_............_......._..... Installer Address Type of Building Size Lot............................Sq. f t �. Dwelling—No. of Bedrooms..........-3.............................Expansion Attic ( ) Garbage Grinder (A/io ' 04 Other—Type of Building ............................ No. of persons.......6L.............. Showers ( ) — Cafeteria ( ) ad Other fixtures ..._•--•------------------ - - W Design Flow...............✓�__5.................__ gallons per.person per day. Total daily flow...........��3 ....................gallons. WSeptic Tank—Liquid capaci •gallons Length...e.`....: Width......4....... Diameter................ Depth... ........ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........I........... Diameter.....L A%: �_ Depth below inlet......6.r........ Total leaching area.�r�'� .,�.. t.6!'D Z Other Distribution box IX) Dosing tank ( ) ~' Percolation Test Results Performed by .............. Date...... ........ .a Test Pit No. 1....e_.Z...minutes per inch Depth of Test Pit_./ ."..... Depth to ground ground water!V0T. ." 44 Test Pit No. 2...C_z...minutes per inch Depth of Test Pit__/j4"_.__. Depth toy ground water. 4q+� eV ...........................................................................................•----•--.......-----•------......................_....-----.-----• O Description of Soil-------------------•`5le �J" ---------------------------•----------•----.....-----------...------........---------................ U .................................................................•.....---------------------...---------...------------............--------•-----...---------•-•--------................-----........... W U Nature of Repairs or Alterations—Answer when.applicable__ �C... .."��.l T[.----• 2 rAi s•_ t\Y�v_?"P►t......................rJ �---- TcNG _o F.T OT Rhto Agreement:01r tt4N7_T14- -t'tf--E' L-Oc-Atto&j uF- —rHC L.5AC4 ptt 2nC Vft �y'p.F- Prvl0L-,,, :0c The undersigned agrees to install the aforedescribed Individual Sewage Disposal System lttt9clordance"wit7 � the provisions of TLITIZ !5 of the State San%so ur signed further agrees not to place the system in operation until a Certifica f.Compliance hh b and of health. . DApplication Approved BY ............ ........•.. --------� t Date Application Disapproved for the following reasons:----•--------------------------------------•------------•--••----------.......,•-------•---•----....-----........ ..................................................•-••-•---------•-------------...----......-•----------.-----------•--•----------------•••-•-••==:.-----------••-•------•-----....--- Date PermitNo.------- ..-.fZ................. Issued........................................................ Date AN No THE COMMONWEALTH OF MASSACHUSETTS ` BOARD OF HEALTH �. . .,..... ......OF.. Avolirafion for Dispn.4ttl Works (Pons .rnr#iun rrrmi# Application is hereby�iade for a-Pe rinit to Construct-( i):or. Repair ( . ) an Individual Sewage Disposal System at:##•-� p ................_l_,�RKe-'- � .�-�v............................71 . f � �f --... :._. ............. ••.I.............. .. .................. ............. Location•Address or Lot No. W �-fir}Yam/ ' O�iC y� Q�✓�. Address........................................................ Installer U i Address U Type of Building f Size Lot............................Sq. feet a Dwelling-;.No.k of Bedrooms?_.`.....•-�.................:_._...:....Expansion Attic ( ) Garbage Grinder (N)� 04 Other-Type "of'Building .......................!_...._ No." of persons.......-_9................. Showers ( ) - Cafeteria ( ) 04 Other fixtures ................................ :. ' ?+ = = �'• ` - ............................................................. W Design Flow..... ` ...... .._....gallons per person per day. Total daily flow..................�3__�?....................gallons. W Disposal o:. Septic Tank-Liquid capaci Fth ..gallo`s Length...c�_`.:_.. WidtL r___ Diameter................ Depth-.. ........ x Dil Trench-N .............r.. Width-_ ±...._.. Total Length...-'--- ------ Total leaching area....................sq. ft. 3 Seepage Pit No........>........... Diameter..... d:.a_�` Depth below inlet.....l�_`...... Total leaching area. 2. "'/'_.'�i....:sq_ft.G P V Z Other Distribution box X) Dosing tank ( ) y - F" Percolation Test Results Performed by _ _... -i?. 1_._. __`--�............. Date......0-.-Z.:-...7.9__-_.... 4 Test Pit i\lo. 1---.t..Z-.__minutes per inch Depth of Test Pit./4q "..... Depth to ground water_66T ..fF?_-" W Test Pit No. 2... ...minutes per inch Depth of Test Pit.j.4,t.4-`....._ Depth to ground watenq�qgt 9? P- a -- ................ ------------ ----------------------------------------- O Description of Soil........... ... 5�`-=...... `�f l .........-•-----•------------ \. .. ---- ......--•-=---------------•---------- -......--••-•---------•----------------._...------.-----•-------------.-_----------•-- ...--•-•---•---------........----------------------------...----------------------------------------------------••-------------•--------------------••----------------------------•--••-•---•-----•--- U Nature of Repairs or Alterations-Answer when applicable.__ 42C....0 � ......... Agreement:C�i— N C t�Z T)fi _7_,+ LO c fF C+o I J J r! t( 11 L �S/l C 4( ,:l t �� V_-1 l l_/ The undersigned agrees to install the aforedescribed Individual Sewage Disposal Sys in'eecor&anceew1`t�f-, the provisions of TIT1E 5 of the State Sani~fa'ry Code-,The undersigned fr rd:er agrees not to place the system in operation until a Certifica 'f Compliance has'bee issue4 b�lthe board of health. ' . . 11 — at Application Approved BY if. _ P:..V(J(...... ....... .... � �1� Date Application Disapproved for the following reasons:................................................................................................................ -•-------• -•--•..................•---------•-•-•-•---...--•---------........-----------•-••-•-•------•------------•-•-----••--------••--•-------•---------------------•----••••..•••-- Date PermitNo.... - .. ............................ Issued.....t..............................................-- Date k THE COMMONWEALTH OF MASSACHUSETTS tiU ` BOARD OF HEALTH ............ . .........................OF..................................................................................... �`"�� `• � �rr�i�irtttl� of f�nm�rlttnr�e THIS IS TO CERTIFY, That theYItidividual Sewage Disposal System constructed (Y)or Repaired ( ) by ?'1. - f' -------------�.....-----••-------•-------.---------•---• ------- r � - Installer --I—------ ..........................--..................... has been/installed in accordance with the rovisions of TIT11 5 of The State Sanitary Coe as described'in the application for Disposal Works Construction Permit ............... dated .._t_ - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A G AR NTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY ' DATE ........ Inspector - --_---_-_.- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTHT �1 ( 2 f b,- 1 of IVS,31eL-C _:.' : , r, .r.............................................•-•-•............... No..........•.............. FEE-- . .......-- 14sp Iforkii Tonsirnr#ion "Vrrmit Permission is ereby granted____T 'J._.. dtfv..__._.._......_ . to Construct (L) or Repair ( ) an Individual Sewage Disposal System at No........L.a: .....!_)............rt R l (� ,c,:�� -•------• r ..................................................... gyp» Street / as shown on the application for Disposal Works Construction Permit � e) ,Dated.._�,�Z �3C............... y ------- -- -------------•--•-----•---------- Board of I{calll�i- DATE.................. --------------------•------------ l_ - - -- - ,� TQI� c � �,pU,tiJ •' , Dry?• y{!µl 1 '`, 1 �4. 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