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Home My WebLink About0255 INDEPENDENCE DRIVE - Health ,ASS I nd2�e��e iww�eno�ean�ws�ia�w ��S 1'f 117fl00ld!Q N EMI N•I Alp 9 Mott Ut open • woo,pvom mice oan VOCS K*ON ®1 V 3 W S I Z9Z-80£ — au SW i 0 ............._............._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .........O F.......................................................................................... 'XIlpfiration for Dhipaiiaf Works Toutitrnr#iun Vamit Application is he�rreby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at• 2J '.'1. ..... "� 4'!4��.e!�Ce_. ter..--••-------..........................� ..... Location-A dress or Lot No. 4*!!o' .. n! L®/ /✓ �Ceara....... .1 . ................. Address Installer Address QType of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms___ ______________________________________Expansion Attic ( ) Garbagedr�( ) Other—T e of Building ^� No. o ersons....._.. _:..�._.___. Showers — a ete is a —Type g P ( ) d Other fixtures ........... AF .f W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. R; Septic Tank—Liquid capacity/001,0.gallons Length................ Width................ Diameter................ Depth................ W 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 ( ) '~ Percolation Test Results Performed by........................................................ Date..., _-.__174.AYj6 J----•--------•-- `�a Test Pit No. I...4�c_....__minutes per inch Depth of Test Pit... Depth to ground water �r o✓N eReV Test Pit No. 2................minutes per inch Depth of Test Pit..............._.... Depth to ground water........................ a ----•---•-•-----------------•-•---•-------•--•--....._.....---•....-----•------•-•-••-•••-•--•-•-......---..._............................._.......•--....-- 0 Description of Soil.................................................................................................................................................................. .. x W ----------------------------------------------------------------------------- --------------------------------------- = U Nature of Repairs or Alterations—Answer when applicable.......__= ,44-r._-Q.-'-................................................ --------•-------------------•---•---..........--•-•----------............._....----........._........---........--------------------•-----...--•--------------------•------------------................. Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of:IT:LE 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 health. Sig -------- -----•-------••----•----------....-•----------------........-----....._. .......................... Date Application Approved B 7 .......... PP PP y-_--•- L-�• ......L .. Xa-— Date Application Disapproved for the following reasons:-------•---------------------------------•-----------------•-•----------------------......----................. ....................••-•-.------...........--•-----------•--•---........--•------------.............--•--...------------------ --------------.....L------->--------------------- .................. te Permit No............................ Issued ---` ....._ Da . ............. Date i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH :. Appliration for RspoiiFal Works Tonstrnrtion Famit Application is hereby made for a Permit to'Construct ( ) or Repair ( ) an Individual Sewage Disposal System: {� ......... _ . .et r7�.: i _ ............... ..A� �Q ......... -•----_-------- •-- Location-A dress �*,f .,r-C: a ! "--- ......�N t't '�!'c e:mac�-----•- Owner Address Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms,,...................................Expansion Attic ( ) Garbage_ Other -_.,g e oft'guildin +�!' . ._ p / ""`._..... Showers ( ) — afete is C-.Z y"'"" Other fixtures .._._...._.,' ... +.5► ..Anw_x... W Design-' Flow............................................gallons per person per day. Total daily flow..........................................._gal Ions. 1:4 Septic Tank—Liquid capacity/0.0d.gallons Length................ Width................ Diameter................ Depth................ W 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... .&--4 e!�4r..!,$W�* Test Pit No. 1..,o.........minutes per inch ,Depth of Test Pit Depth to ground water/ A 1 (14 Test Pit No. 2................minutes per inch Depth of Test Pit.... ............... Depth to ground watee....................... Q+' -'...................................•--=-'----.......----...........•--.........,.....•.................................................------•-- O Description of Soil............................................-.................................................... --------•--'------•-'-"-------------••'-'•-•-•-•..........---•'---- x V ..................... --•---•'••-•-•---.....-••-••-•.........•••'--•'-----•--••-•-•-•••---•••••••--•-.....----'-•----•-•--•'--••--•---•-•--•---••---•--•-••...•-•-••'••-.......---........----..._...... UW •-•-•••--•'--•----....•------------•----•-------•-------'•..................•---•-.••---•---•••......--------•'-- Nature of Repairs or Alterations—Answer when applicable---------- ----G-�l '"`..._._........._............_....._...........-_... ........................................................................................................................................................................................................ -•--------------------'---'-•----------•-----'-------'------------...---------------'-•••---........-----•.....•---•••----------•-----•-'-•_._...-'••'••-•---•-•••'--'-'--•-'•----•--....._.....•-----'- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 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 of health. Sig -d--..... ............................................................... Da Application Approved-By........ _.._ Date Application Disapproved for the following reasons:................................. . ............................... -- _ Da te Permit No.............................. ,......................... Issued.-...... r Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH OF ,a Trrfif iratr of,f ompliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (�r Repaired ( ) by -`` .-•-•••._-- ---. - - - --- --- • ----- staller .._---•4- .. �� +........-- - - - r - -�-Cat . .----�J�� '!.�--------------- has been installed In accordance with the provisions of T of The State Samtary Code as described m the application.for Disposal Works Constr.._;uction Permit No....:_..... �/.............. dated_.. Q..... f" A................ THE„ISSUANCE,.OF,,THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............... = E.-....... . ....... r ----.----- Inspector 14,,f/�: THE COMMONWEALTH OF MASSACHUSETTS r / BOARD F HEALTH �P ......... ............... :. ::... . .... FEE " Bispaoa1 nr�� Haan uan rntif Permission is hereby granted. . w e D posal Sy as shown on the application for Disposal Works Construction it Date dd l .......................... / Board o ealth ---.. ......................................... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS a r - r x NJ A e .1 .0 y ra - T F__c) .. Z G x T t.�.t A�� i y Fw L�+ I. 7, t� V is .P F. rL S c h1 S - o �� 0 5 t P ; - T A i. 1� a` r a � GIZQtifi; t� ;.. 35Z-> iq. FT, IN ' rT = LIV. G2. ( t. a :._M 717. i "r T. D LIT L t_T !E `I. !0 2.+2 4 �. c Y r .z T ,, 10a . � t, v , � J � . 0 3.0 x 27 "� tv1b - + GE -- 7 Gfii S /p �.;' rr : 0 Ntt7 c � V. 6 02E�4661�14 T "SArd � 0 71 wATEPZ __ - , . 75K 7• --- 540 :'A4LLON " ct7 I 5 U9• 10 :�.A , .0N 0ij ;T EL IV. 41 •°JZ ti 5 'PT . c N TA itC. 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Ga 6. yD 3It7 7� QY G.a, �'0 {I ` FoC; �}(1 ?; s Tsr TiilA VA ? Ncl i - ��G. A J, ? 4.� ry � c i fj NLt1 i�ik k — 'CIS F 0UZ vaIS " ! :, ? atwDIl<(.1 ks; L41wkLD r ys P 1 51 N 114 1 'ANJA '' ih P '. AN , Cosh � � u � Du a�TA ' � S :� jz0or 7A `'tN P � rS `� p ' Al _ S t �Ea c y�� hh -- 1 •, r> r., .ti r r - ► . Y » S t i E t 7 N(.} g . IOR*gy�16, rta y.J i i� : i .+.` . ► `. 1� t . • i g U: R^sTHAM, ��G y A 3 r ? MABB. ,Z.•3 t t•�n ". "� i !�i v� ? � i � TZ Y- T � � L •. v � ¢4 Sit 'ji '� DATE: 5 r.P Ti"t.. F1t t? ! , I ? ARCHITECTS NOTE — ALL DIMENSIONS MUST RE DRAWN BY: G. R V. j# svg 160 BASSETT LANE VERIFIED BY CONTRACTOR AT BU+LQ(N4 t,�— BY: J, i rah.!._ HYANNIS, MASS. O2601 C D