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HomeMy WebLinkAbout0100 CARLISLE DRIVE - Health I aa. /1� ! � � -7 C_ � too LOCATION SEWAGE PERMIT NO. V14LAGE INSTA LLER'S NAME 6 ADDRESS �� �'��L�i�►,�7" bob. OlateS7-a8S DILLS °04(.s-8 2 T zoo BUILDER OR OWNER DATE PERMIT ISSUED 3 _ ) 3 - DATE COMPLIANCE ISSUED. L� � �� �, - � �1 i Y� V, No.- --- ---- Flss.............................. THE COMMONWEALTH OF MASSACHUSETTS COW0 EOARD OF HEALTH ........... . ..--......OF..... �+.A Ti(17.('.&.--------..................------------ Appliration for Disposal Works Toast utinn Prratit Application is hereby made for a Permit to Construct ,( or Repair/( ) an Individual Sewage Disposal System at: ................__..__....An.k- �c:4...... l ---.......... ......................-•------------ ........................................ Location r4ddress - or Lot No. ._.......... __ k�1; � .-.....k C _.l sly ? .._..._ .. ............ ........ ne �.. Address ....�� .:......•---•......... .- --. -- --------------------- ...... _a Ina Ier Address S f dType of. lding Size Lot._.. `_...__ . ._.. q. U Dwelling—No. of Bedrooms............... ..........................Expansion Attic ( ) Garbage Grinder ( � PL4Other—T e of Building ... Nq,. of persons............................ Showers — Cafeteria Otherfixtures ................................................------••-•---------------------•------ -•--•-•••----•--------......---•---•----...--••........_..... .12 W Design Flow..................�_�-•-�_.................gallons per person per day. Total daily flow...................07 ..............gallons. WSeptic Tank—Liquid capacity.tC allons Length_._." : Width..X:"(& Diameter................ Depth_3_:"�_.. x Disposal Trench—No..................... Width.................... Total Length.............a..... Total leaching area....................sq. ft. Seepage Pit No.........A---------- iameter._._.....CP. ...... Depth below inlet.......t_,_......... Total leaching area..� ..sq. ft. Z Other Distribution box ( Dosing tank ( ) B9 p ��p� , O ¢¢ 4 Percolation Test Results Performed by. -e...f,.._.dj's_'_H°�E7s.1P .tRAbate.._._i._..._125_��t�_..__.. 4 Test Pit No. 1_.__. _-_minutes per inch Depth of Test Pit.....!:It�...... Depth to ground water.....:..........•.._.... (s, Test Pit No. 2______ ._minutes per inch Depth of Test Pit...... ...... Depth to ground water------:.�........ ... ................ ....................... O Description of Soil..... l.c - l .. ............................••- x 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 iII= 5 of the State Sanitary Code— The undersigned further agrees not to place the system I in operation until a Certificate of Compliance has been issued by the board of health. Signe ---•---...... *----- ------------------------- I----------------- Date Application Approved BY `� E �.7710.2 ..... Date Application Disapproved for the following reasons:------•-------------•-••._.________.__-_.-.._____---------------------------.__...--------.._...------........_ ------------------------------------•-••••--•4••-•-`••--•••-------- Date PermitNo......................................................... Issued...................................................... Date f / Nd.......... FEB THE COMMONWEALTH OF MASSACHUSETTS' BOARD, OF HEALTH ,' ... .OF...... A .h ` ... ................... fi Allp iratiaan for Disposal, urks' ', Tunstrnrtinn jhrmit Application is hereby'made'for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ...... -----__._ 11st :.....`HIV '. ` ..................................... ` ..................................... Location pAddress r or Lot No. '- ......•---..... IRO A4,0 :f:MQS.......... ........ .------•--•---•--.._.... I........------.............. ...:. ner Address W ................ -1 ..... . ......... ................. -- - I staller Address � � Type of ding'' Size Lot__-- f!-64 .Sq. f �, Dwelling—No. of Bedrooms.. .......... ........................Expansion Attic ( ) Garbage Grinder (` , aP4, Other—T e of Building .._._.._ No. of persons............................ Showers, YP g -------- ---------------------------- ( ) - Cafeteria d Other fix1 res . ---.•---•.......- -- Design Flow...................I�..... . .......----gallons per person per daX. Total ably flow-...... ._ .............gallons. Septic Tank—Liquid capacity_� allons Length.... _'!.4's. Width._..:..''4f _ Diameter________________Depth. "It .::: Disposal Trench—No.................... Width_.. .._... Total Length............ Totaljleaching area_...................sq. ft. Seepage Pit No.......... Diameter..........�W........ Depth below inlet....... :....... Total leaching area.. .sq. ft. Other Distribution box ( Dosing tank ( ) Z 'a Percolation Test Results Performed by.... ,... ... yi `. !4 . ate.: . __ " ' --' _.__.. Test Pit No. 1.....?.....minutes per inch Depth of 'Test Pit � Depth to ground water, .......:.......... Test Pit No. 2....... Minutes per inch Depth of Test Pit......1 ;.._... Depth to ground water....... *°`"•..._.._... ----- - ... f -. . O Description of So....................: �.4a --•---.._._. *-. - ..... ` , W UNature 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 TITLE 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. Signe �, .. -. ............................ _..................... ... k Date Application Approved By, ' . ' = ��� �,.r '.. �•_ -ite . Date. --- Application Disapproved for the following reasons:_._.__..... 4""° -•------•-----•---------- .............................................•--•-......---------•------•-••-- Date ; Permit No._--•----•----..---- .-- Issued_..............•---------- ...__.._.. ...- •------^ Date'.............................. .. THE COMMONWEALTH OF MASSACHUSETTS , �t BOARD F HEALT - Zlf7� ' . ......O F.... ! tZ.�. .................... Tntifiratr of Taampliaurae THI IS O CE TIFY, That th Individual Sewage Disposal System constructed (' o Repaired ( ) by........... ...._ .__. .... ...... .................................. A -----f.. I a! .. V C r { c has been installed in accordance with the provisions of T 5 of The State; Sanitary Code as described in the".- applicationX F for Disposal Works Construction.Permit.N _ .._:� .....:... ......: dated. ...._.. r THE ISSUANCE OF THIS CERTIFICATE SHALL N®T BE CON RUE®:AS A UARANTEE THAT THE ✓/ : . SYSTEM WILL FUNCTION 'SATISFACTORY DATE..- 3 °2 7 Inspector... _ ------`�--..................................... •. •---.... .... THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEAL. H No: ................. .........0F..... :�,- ............................ FEE........... ^ " . wri �raat1. a ptrivn anti# ' Permission is hereby granted__' _. %7 to Cs... tr ct ( or/�epair ,: ,) n Ind' I° ual Sege Dis sal System No. x... -, ----------- ' r Street s ,p as shown on the application for Disposal ti��orks Construction e mrt ! _____ Dated .__._._.._. � . ................................. DATE DATE----- _ = , FORM"12$5 ,HOBBS & WARREN. INC PUBLISHERS y ;� r - - C-q Y � , - j ?Mtt/A.L.L. 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