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HomeMy WebLinkAbout0008 NORTHPORT LANE - Health — isTT j. i x LO AT10 SEWAGEP ERMI NO. •1 +0 VILLAGE y ii x/I INSTA LLER's NAME D. CDR S 0 UILDER ��OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �- �.� �� -.,-,i"'� �� _._�� � �� ( � -;� `"�i G \� � �'� �1 -� � �I � �� ' I � x� � '� �� Z � _ VO o w �' .., ` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH to �22 Appliration for Disposal Works Tonstrurttun Prrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at _ .......�:�`. . ....'................ -- =. - ........ .._.............. ........... Locatio Add s s or�I�ott No '------------- -- l!��S! •...tom ...v 1 .... Owner /, - ....................................Address .......... a ...... � .................................... ........lop ...•---------------------•-•- Installer Address Type of Building Size Lot___�Y�,r ....Sq. feet V Dwelling—No. of Bedrooms.......3.................... .Expansion Attic ( ) Garbage Grinder ( ) a p,, Other—Type of Building -10fjez -ef.......... No. of persons........4................ Showers (/ ) — Cafeteria ( ) a' Other fixtures .----•-----•-------------------•----•--••-•... W Design Flow............. .........................gallons per person per day. Total daily flow.............23�0.....................gallons. WSeptic Tank—Liquid capacityA ...gallons' Length.... ........ Width..., Diameter................ Depth................ x Disposal Trench—No,..................... Width.................... Total Length.................... Total leaching area.... =_7....sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by... `+r..!JA<?!.... ........................ Date...... _c ---------- ,� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.._! �...... (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----•-----------------------------------------•-------------•-----.-...........--------•-------------------....---------------- ..... -------------- •--- -.-- 0 Description of Soil-•-----------•...........................................................•...--•-----------------------------.......------------------...-----------------.._.._..--•--- V .............................•-•---••••----••...............••-•-•-••-•-••-•••••--•......--------•---•.....-••.......-•-...••---•••••-----•••--•-•.......•--•-•-•-•••-•-------•--......•-`-......_...... W .-••-•--•---------------------------------•---------------------------------------------••----•---•----•------•--------------------••-•---••--------••----••••-••-•••-•-•••............---•----------•- U Nature 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 TITTLE 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. Signed...... .. Da e Application Approved By............ - A............................ - Date Application Disapproved for the Mowing reasons:-------•--------------------•---••-•---•------------------=-----•-------------------------------•----......... --•--•---••-•----------------•----------......_.....-------------•-------....---...-----•-------•--••-•----•---••--•--•-••••-••••••----•-•••-•---••*--•••••---•----- •--------- ----------•----•- Date Permit No........!3 7 ...............-------------- Issued..... �. �7 . Date — - ." 1-No.......... ....7......7q, ......... Kx THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................0F... . ............................................... *-&'A -firation for Disposal Works Tomitrurtion Wrmit Application is hereby made for a Permit to Construct or Repair an Individual Sew"agie-Aiisposal System at: /.0 7- xt- ............................................... n..... res Locafton­',A...d..d. .... or1011N� . ............. ...... Address ................................... ................................................................................................. Installer Address Type of Building Size Lot-----Z_�:P6_k----Sq. feet Dwelling—No. of Bedrooms_..............................._.__..___.Expansion Attic Garbage Grinder Other—Type of Building No. of persons........4............... Showers Cafeteria Otherfixtures ........................................................................................................................................................ Design Flow......_.....................................gallons per person per day. Total daily flow...........,Fr?....................gallons. 9 Septic Tank—Liquid capacity.&:�e..gallons Length.__..`....... Width._..f ........ Diameter................ Depth.._............. Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area......41,'�Lz...sq. ft. Seepage Pit No..................... Diameter._.................. Depth below inlet.................... Total leaching area..................sq. f t. Z Other Distribution box Dosing tank Percolation Test Results Performed by....... ...!.!...<:_... ...................................... Date.......... ... .... ...... ...... Test Pit No. I................minutes per inch Depth of Test Pit.__._._._........... Depth to ground water.._. .......... fi Test Pit No. 2................minutes per inch .Depth of Test Pit..._............_._. Depth to ground water..____.................. P4 ............................................................................................................................................................. 0 Description of Soil........................................................................................................................................................................ U ......................................................................................................................................................................................................... ...................................................................................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable........................ ...................................................................... ........................................................................................................................................................................................................ Agreement:, The tiridersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with MTM the provisions of I I I Ll, 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. Signed.. .. ........................... 9 _,�4 Dat ApplicationApproved BY------------- . .......(..................................................................... ........................................ Application Disapproved for the f�owing reasons:............................................................................................Date.............. ....................................................................................................................................................................-------4............................ Date PermitNo.......... -------------------------- Issued...................................................... I Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................OF..... . ........ ........................................... Quatifiratr of Tompliaurr THI 1, TO (FIERIT.I.F.Y, That the Individual Sewage Disposal System constructed or Repaired b, ................................................................................................................................. �*Installer at........ . ........ ......................................................... ................6� 4..... -----------6� has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.......3.*V_±......7q....... dated.........&.,- .................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ��> 2 ....................... ......DATE............ --- Inspector----- 1 - W_4 THE COMMONWEALTr',6iim,ASo�,q-H,P!�-ETTS BOARD OF HEALTH ................... ...... �1 0A.e.K.- N� 3-37 OF'-= .......... . ........................ 0 - al FEE........................ granted ........ .... ............................ ............M... .......... B Rorkii/Tonstr Permission is hereby gra .......... ........................................................ to Construct epair an individual Sew a Disposal System at No...... A --------------------------**--------------------.........*........ as shown on; Street ........ Dated_.____._4.- 14 . 7 el the application for Disposal Works Construction Permit No. ............................. .......................... ............... ......... ------------- Board f Health DATE................................... ........................................... 1,V:,� FORM 1255 HOBBS & WARREN, INC., PUBLISHERS V 4 � F r 1 ' I tv`•-� / �/l.,.d \V.�v a tii�+l\•.r ��r��,�.1/J.^�/:S(+�lT�� .tif � --- - -- - _.. ��.`vey •4"C G �• iLG IUV ill 1� luv ' ` 1 Gv47 t C, ! iiaw =-`✓ = 4�f4- 100 © ., P IS T a o x J f' O C { `�- ,• o C C r ' ` Ajre7- •sra SCAc E ' LE�9CNING PiT ' -3 1 arR c ��i�y F�oy✓: 'SU G PD / L.a T 2.5 \ T a e-no X t I O to--L 45�-7 � &rc hp t�c�r 17-4&G, 04 Id rj 14 45 i 1 50 bra Ajr_s .`�'s f3a ,PE+�+c• dtA'tE� M � t4 -�'�.�r.s" : �•�~._,�.r�r..t ._.._��%'f�T`G'' ��,a�°. ( �_.J • � �. L C Ca C i'J i;7 a tssr/`v c:"�' �t::. }�.:�4� i .r��- :'�,,.:► �'i �P ���► 1� ,yM of'ocr ` 45+-.5 pExt ST L .U. 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