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HomeMy WebLinkAbout0042 OAK LANE - Health 42 OAK WMIERVILLE A = 142 029 001 i i ��� J. No................_... F�s�........................ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..........................................OF.......................................................................................... Appliratiun for Biopuiia1 Works Tunitrur#'tun Famit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: l� /�w/Z 61.7T�/v/ ///y Ile ss ............................ .............y�.......... .... �s� �y .._._: ... .F ......... Location-Address / or Lot No. CEYAll.........................•- ...................................... •......_. ._. .....---•---------•-•••••............- Owner Address 7 OS/r-iP�i_//r Installer Address Type.of Building/ Size Lot............................Sq. f U Dwelling—No. of Bedrooms....__________________________________---Expansion Attic (11/1) Garbage Grinder Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ________________ ________________ _ W DesignFlow_____________�,I ..___...__.__4-gallons per person per day. Total daily flow.__....__._._____ -- ----- g P P P Y• Y ��-�-----------------gallons. WSeptic Tank I Liquid capacity gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—Nq_____________________ Width.................... Total Length......._y.... .__. Total leaching area....................sq. ft. Seepage Pit No-------1'/_........... Diameter.....(f1_S_ ___ Depth below inlet..__.fA__......... Total leaching area.v.2.0Z....sq. ft. Z Other Distribution box ( ) Dosing to ) `-' Percolation Test Results Per b _ . -.----- _ Y----= d�1-4 Date....................................... aTest Pit No. I.... ._minutes per inch Depth of est Pit____________________ Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 ----------- 0 _ b 2 — Description of Soil..... • 7 - 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 the provisions of TLT'i 1� 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. Sid_-- --- ---•----•--•-•---------------------•-••-----------••---••-•--•--- ................................ / Date Application Approved BY -----------• ------------- -----G l) l 1-7�� Date Application Disapproved for the following reasons---------------------------------- •------------------------•-------------•--•----------•-------•......._--•--- -•-----------------------------•-••---------------------------....--••---••••---•-------•-----------...•----------------•-----------•--•---••-��•--•��- -7g----••---------••---•- Date Permit No. Issued ............................................... Date �z �sAF -- — No............... . Fx � .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ .. ..................OF...................---.................---------..........------.......................... ::'Appfiration for Dispoii al lgorkii Tomtrurtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at A /1 ...QFA ........................ - -...-•--•---_.... ..................................... ,t. cation Address or Lot No. + -----------f-•--_. ._.... .. . -•-•_.... ..... •................. .................................................. 77:, .. ...._. �py Owner f Address ........t'•F �'"1 `:t...........................�.. .............i1,V"r° . Installer Address Type of Building Size Lot............................Sq. feed" �-, Dwelling—No. of Bedrooms......../................................Expansion Attic ( ') Garbage Grinder Other—T e of Building ............... No. of persons-........................... Showers a' � - ---------------------------------------------P ( ) — Cafeteria ( ) Otherfixture ....-•----------------------------------------------------------•------------•-----............---- Design x Flow. ......... ..: .. __._ .gallons per person per day. Total daily flow.................J1.4...................... lons.WSe tic Tank 1Li uid ca acit_Yz/ gallons Length................ Width................ Diameter---------------- Depth... ......_ Disposal Trench—N .................... Width.................... f Total Length......_._. ........ Total leaching area.................... ff. Seepage Pit No....--- ----- Diameter..:...l�b_.5w._. Depth below inlet.... ......... Total leaching.area..a�_��..sq.'ft. Z1­4 Other Distribution box ( ) Dosing to ) Percolation Test Results Performed'by..... ____ �__._. .6.it t:4....... Date....-I..... Q Test Pit No. .... _ ..minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water:........................ --- ...-•-- ..I O Description of Soil .2 -••-•-------1` ---e �- ----- ....... -------•---------=•-•----------------------- x U W ----------••- ................................. U Nature of Repairs or Alterations—Answer when applicable............................................................ ........................ •------------------•--------------•------...-•-------------------------------...--•----•--........-----•------------------------------------------------------------... <.. Agreement: The undersigned agrees to install the aforedescribed Individual,6,gwage Disposal System in accordance with the provisions of TIT11 5 of the State Sanitary Code—T116 uQersigned'kfurther agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health:` Sid--- -------- - ..........................................................---------- Da Application Approved BY .. .---- .. -- -- .. -•- � r- Date Application Disapproved for the following reasons________________________________ �-_..__.______.___.....__----_----_--------------------------------•••••--- ---------------------•---........-------...-----...._....--••-----------------------...-•----. ----------•-------- Date Permit No........................ ................•-•-•---------•-• Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSITS>,; BOARD OF HEALTH .........-f .......OF...... .>. ..... ............................................... .. +w Trrtifiratr of Tootplianrr T IS IS CERTI That the Individual Sewage Disposal System constructed ( or Repaired ( ) b Y -------------------------•------------ � } Ins r at.--- .._.._. 41 . ..... has been installed in accordance with the provisions o T 'Tl 5 o T e to Sanitary Cooe as describedthe application for Disposal Works Construction Permit No._' -- '•-- ----- dated-.----14 ��"' ill THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.'" DATE...:...............................•--•-----•--•----__•-•.......--•-•-•--_..... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD Qf7 HEALTH 0. .....OF....... . ....... ..��� --No ..... _ FEE ...._--•-•.......... . t ottl �o #r ion rrnti� Permissi an ireby granted... to Consi- �( ) or Repair "anlduaI Se ge es os System{1 atNo.. aA& -•---------------------------------------------- Street as shown on the.application for Disposal �t�orks Construction Per t o.. e ._f_ ..._.J_ ._.__...... -- / / Board of ;t. ' DATE r. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS Y. . CAP 1r7 G % . USA l OC)CU 6QL. ,� � {Pcu;.c,.L r✓IT - �C�a�. t©coo G� . '� ;<-=� -- ir'7-meu/Q.t_t._ AV-E-A = tSU S.F. ToT,�L T�ESIGtJ = •425 la.P.D. .oe--.a 0 GEf�G�t_�Ttc �1 l�T E CIQ Z Mt1 W 02 LESS. 471 T Tor Pw o a -Mon oo.o--ram o. -1, ' � �PPe I o0o Iwv. l -Box 9 5 SEvr►c �c IWV TA►tK , oao q5 ,Nv. I►N. s. GAt . qSi 9q-3 Pi T .'���r wiru •� I, /o CC;Ttl=1ED P�-O'T" F'L./S4J PQv F`t L L o cA T I o" P5T 2l/i s,c Sc.nLk; ( IL 4D /A rr.r<.- ��f''�i'V� p^t,._ t�,t�.l 2►��_��Z.i=►.1�� I GGtzTIh `f TEAT T{AG L>WL .t..t..,0(. 5llorc/►.1 4-1i_I'( T>►�1 [�+tilf'L`(S WiTIA T4-1i:: 51DELI►_1E: G tiJo E='Tl: Ac►C I~'CC�rJ���NtruT� �F T►�.�= r� PL 131s.)(T(I42. C) ;W�f-�'.�:.���►.��" �/UC:���-.�' t .y,a; : CsFt=,r-_T°, �,I.10e:�ua �tNlat_t Cn.e`-1'T 1. TL) i�r._1'�=i�MI%4C O'Y' l-►N`=`-' F2eT--XA.4Q �jO , r r O® THE COMMONWEALTH OF MASSACHUSETTS z. BOAR ®F HEALT OF.-.. .............. ' Appliratinn lar Uhip vial Workii Tutu5trnrtion Vrruift Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System `�'' p , 4001 ..... _u.. .....4...... ..........,..... /` . . ...... Location• re , .�.... ••-----•................................••or Lot No...-----------------------•----...---•---- y Owner � Address ......•. •--'---- ------•------•---------------•---•-----•----•-•---•-•---•----------------•--•------•----------- � n ler Address Q Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. 'of Bedrooms----.3------- _---__-Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons.--___--.___----_--.------- Showers ( ) — Cafeteria ( ) P4 Other fixtures ---------- ------------------- -- - - Q ------..----•-- W Design Flow.............................................�.. gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width................ Diameter-----........... Depth.---_-_--_--- 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 ( ) aPercolation Test Results Performed by------------------------------------ -------------------------------------- Date---------------------------------------- Test Pit No. 1................minutes per inch Depth of "Pest Pit-.-__-_--__----__-. Depth to ground water..---.-----..--.----_-. 44 ,Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water--_------------------- 9 --------•--------------- -------------------------------------•-••---......._......................•...................................................... 0 Description of Soil-------------------------------------- --------------------------------------------------------...........................x W ------ -- - ------------- --- ----- - ---------------- ----------- - U Nat f Repairs or Alterations t�nsw r en applicable... ®4... G-. ---------- . --......Gt'-,12 A eement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be sued by the board of heal Signed- 'proved Date ApplicationAp BY----------- ------ 11---- •-•-•--•--•--•--•---------------------------------•-----•--•--------- Date Application Disapproved for the following reasons:---.....---•..................•---••----•--•--.............._..-•---------------............-----•......-•------ -------------•---------•--------•---•----------------------------.•-------------------•---•-•------•-------------------•-------•--------•----------------•----••-----------------•---------•-----.----- Date Permit No.--. ......(75)....... Issued-............... Z0-h..1.9:' .... ate ------------- 1Z11-rs) _ y ,l THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT OF_*46 . . ....................... Appliration -for Uhgpmal Workii Cnotwlrurtion Vrrmit ,Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal Syst at: t. 0�--- �_�-�.- ._ :�------------- }may Location-Ac rT�ress or Lot No. '-- .,r!'r •!�. - ---'-•-- ♦J-- ...... W Owner Address tf .... -• .........................•.. -----••---•........._..----•-•---••-•---'-----•----------••--- ,. ter Address d Type of Building "Size Lot............................Sq. feet Dwelling—No. of Bedrooms.---_.J...................................Expansion Attic ( ) Garbage Grinder ( ) Other a —Type of Building ___________________________ No' of persons-.-------------------------- Showers ( �'�) — Cafeteria ( ) dOther fixtures ........................................... : ::._..,-----------------------------------•------ -------------------------------------------------- W Design Flow-------------- ...�.__.._.........._ ___gallons per person per day. Total daily flow_____------.--.-_.-_________-_-_--.-.-_-_gallons. Gt; Septic Tank—Liquid capacity___'__.;,,,,gailons Length................ Width................ Dilmeter:_7:...:-,____. Depth------------- Disposal Trench—No- --------------------`'width.............?___- Total Length------------------.. Totaheaching area--------"__.--------sq. ft. Seepage Pit No-------_------_---- Diameter___............._.... Depth below inlet.................... Total leaching area........ ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by- -------=---------------------------------------------- -----------' Date.---------- -----------------------_- Test Pit No. 1----------------minutes per inch ``Depth.,of kT, est Pit..."`. ........... Depth to ground water-----------..__.__-__.:. fs, Test Pit No. 2-----------------minutes per inch Depthf'of e-st,-Pit _____..-____._.- Depth to ground water------------------------ a' --- a:> Description of Soil ---- ------------------------- ----•--• .--- . ------ s, s-- :--------------------------------------.------------------- ------- i ._________________________________________________________________________________________________________________••-..--._________.-___---_.-___-______--.-------______--__---_-----____ _ --____--.-. �.W ----------------_---------------------------------------------------------_.-"_.:.-__-_-_--_____-____-______... ______ _ ..... ----- ..._....___.._______....... __ ---------------- V Natur f Repairs or Alterations 1�nsw r hen applicable. PV-n.. .. ._'"'_ Q.Q_- °.__ ,,, ______________ !' -- - --- - - -- - ---------- ---------�-- --- -- A eement: , The•undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be sued by the board of ea h .• Signed T r� .ir. .-- --- Date ApplicationApproved BY---------- ................................................................................. - * Date Application Disapproved for the following reasons---------------------------------------•---------..._.......-------'......-••--....--••-----•---•-'-...----••... Dat T'orT/ [ �I Mr ls _ "., i e 7 I� ! %�e Cl Permit No... Issued --- ---------------------------- - Date , T1-1E,COMMONW"E•ALTH OF_,MA$SACHUSETTS Q GCS f�alu , - A• ., . a.- •.:,� .•,,.-. BOARD. OF HEALTH .........................................:O F............................................................................... ,. C.rrtif iratr of omp' lianrr THIS IS E IIFY, That the Individual Sewage Disposal System constructed,,(`s^) :or Repaired (�y) by CLSS,Aaaes Installer has`been installed in accordance with provisions of :Article ll l'Ptet, itarvI&de as"described in the application"for Disposal Works Construction Permit No.::__._ _- _. �' �S ,f tilted- - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. - d�. ?5" DATE --------•'•• t _... .. r = Inspector cto THE COMMONWEALTH OF MASSACHUSETTS ]( "BOARD 0O 14E' ALTH (75) `. .f..z_ F -t;- k S No.............- FEE............ .... Rnpwial Works Tnnstrurtion rrrmit Permission is hereby granted............/�_4----•.._....C�SSOoo�.S ` ............................ to Construct ( ) or Repair (x ) an Individual Sewage Disposal System at No----------------V d%-- C... -ALR [Ai ` GSs • ---- ¢ t-------------- yrstreet 17 C7j) 7s' as shown on the application for Disposal Works Constructtoti Permit No... --. Dated_._.- .................. Ass.......' a.. s. " Board of DATE FORM 1255 HOBBS & WARREN..ANC., PUBLISHERS - I . LOCATION 1 "��. SEWAGE PERMIT NO. V--lLLA$f INSTA LLER'S NAME A. ADDRESS WC1 \'A-.(, K tT' v 0 BUILDER OR OWNER `DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 7 '�d«k ;i .. }� - �.��� • � k I vT n 1�\ / t � (/�\ 7'_ � .. Y v �. � .. V � ' - , � `\\� ..a 5 `� y �.. `�\\ ` � - ..� \\ • .. �"3 S �. .. `. � r � ' 1 4 �. � � r i` LOCATION : Z- OA-K - (4.5EWiiC E PERMIT UO. i _ IWSTALLER 5 U&& AE AD RES _ 6 C��Sa�oLs — lZGPArr2 �U.ILDER_5_tJ.AI./lE__�_AD_DR.E SS_ __. ._ pL1,TE._PER►v�1T_ 1SSU..ED_-.���Zrr����-_-._ - D 47E. COMPLI_&KICE .LSSUEQ : _ �"Y I5 __ . �w