HomeMy WebLinkAbout0050 VERMEER COURT - Health SCE Vo-rr m(::e.r Co
LOCATION SEWAGE PERMIT NO.
VILLAGE
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INSTAL ER'S NAME ADDRESS
9
BUILDER OR OWNS
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DATE PERMIT ISSU D
DATE , ' COMPLIANCE ISSUED Y��
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........T .......................................
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
Car.........3...2.................. ------ ...5'/........
Lot
Owner Address
Type of Building Size Lot.... 7._�(.O...Sq. feet
Dwelling—No. of Bedrooms................. ------- Expansion Attic (/M& Garbage Grinder (Aeb
Z Other Distribution box Dosing tank ( )
Percolation Test Results Performed by..................... ..
Test Pit No. I...4:-�53---minutes per inch Depth of Test Pit ....... Dept to ground wat0.....ova
Test Pit No. 2....�t -minutes per inch Depth of Test Pit.......
� ........................................................... -'__--.----.—'-_'-_—_''---.--'----____--
Agrconeoc:
The undersigned agrees to install the aforedescribed. Individual Sewage Disposal System in accordance with
He provisions of TL III lE4 5 of He 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. -. '2
| -------'''---------'-------'-----'''''-''-'--------'-------------------------'---'----------'-'--'-----
ate
Permit |
Date |
~~~~--'-------'----'--
No
- FEs, .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
7 i, .....-.....oF......-...001tflWle.......................................
Appliration for Dhipviial Works Tonfitrortion amit
Application is hereby made for a Permit to Construct 11(�) or Repair ( an Individual Sewage Disposal
System at.......................... L E............ ...2..................�f...�"��h9�:t!
Location_Address or Lot No.
' ,C• ..... _ ._.._....... �t.. _ ..��: .......... ..:,t-Z'.-�...........................
0 (� t3 `
_Owner 7 Address
W ._..._.._...•••••••--•....__---•....--•••_.._ 7 r. ........ b ............................................hddress •--••-•-----
�r
Type of Building Size Lot____ __ 2._ 0._Sq. feet
Dwelling—Nc. of Bedrooms.................4-'-----------------------Expansion Attic (/2�)Ly Garbage Grinder (49:t:;
'4 e of Building No. ersons____________________________ Showers
(1.1 Other—Type g --------•----•-----------... of P ( ) Cafeteria ( )
Q' Other fixtures --------------------------•••-• -
Design Flow.........................: gallons per person per day. Total daily flow................. ';r__ __}......_.___gallons.
WSeptic Tank—Ligaid capaciity.___________gallons Length................ Width................ Diameter._- ___.___. Dept h................
x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No_____________ ______ Diameter.................... Depth below inlet_._____.........._.. Total leaching area.................
ft.
z Other Distribution box Dosing tank
Percolation Test Results Performed by_________________________�-/.__�� 21 _______6�! Date...............
a Test Pit No. I.__�y-s.5__.minutes per inch Depth of Test Pit________``.. Depth to ground water...... �� c
GL, Test Pit No. 2....�. $-�__nlinutesper inch Depth of Test Pit..................... Depth to ground water______________________
----•--------------------------•----•---•--•--•-•-•-------...__......----------....-•••••-•--•--••-----......................................................
ODescription of Soil...........................................................................................-------------------•---•--------.....---•---------._._...._.._......._---
x
U ........................................................-.....................--••------------------•-------------•---......-•-•---•------------•-------•---._..._...__........_=.....................
VNature 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 TITLL 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 ...............,heaalth.
igned
Application Approved(B.`y' ---" •• '-----•---------------••-•---•••-•••------•----•-•---_-••-- _ •�'
.
Date ...
Application Disapproved forq..e following reasons:..............................................................................................................
........._-•-••-••-••••._...--•-••---••-••-•••--••-•-••------••••-•••••••--••••---•-.........•------...---••••••-•-•--•-•-••-----•-••---•-••--•-....--•-•••••••••••-•-•. ._._...._••-•..................
Date
PermitNo......................................................... Issued_........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...G�G�rd'►-r-...OF................f,( ,� t: .:.............._...._...........
Trrtifiratr of Tompliatta
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (1-1-f or Repaired ( )
�--�- A ��
by--------------------------------------------
1 � :---------- </f ;e ...--•--------------------------------------------
,- ---•-_ 7 Installer ; -.. --_
at......................................................... /............................. j----2--------.•... -" ___.
has been installed in accordance with the provisions of TI�TF' 5 of The State Sanitary Cas. scribed in the
application for Disposal Works Construction Permit No._1I....��'_ �'��" '___._____ dated_ - __�______________________
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRIAED AS A GUARANTEE THAT THE
SYSTEM WIL F 1ICTION SATISFACTORY.
/ ��
DATE.......- ... ...................................................... Inspector.. ...............................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........... ......OF..................� ..................................
FEE... ..................
�i��o�ttl ork� �ott�tr�tion rruti��
Permission is hereby granted................................... -----•- ...............................................
to Construct (-4) or Repair ( ) an Individual Sewage
e g Disposal System = —•ar J',
atNo................................................ ' !./..... v ._ . '.... G� =
Street
as shown on the application for Disposal Works Construction Permit No__________________ __fit .__ Q �f.....................
r f
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...................................... ___._
-•• Eo�d of Health
DATE......................................................9..?-'�3__��
FORM 1255 A. M. SULKIN, INC., BOSTON
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EXISTING SPOT ELEVATION 04-- �- - CERTIFIED• PLOT PLAN
EXISTING CONTOUR -- O - -" �E��tN OF
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DATE AGENT �` svR� SCALES =¢0 DATES 3
LOREDGE ENGINEERING Ca IN
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EGISTEREd REGISTERED jog NO. BUILDING SHOWN ON. THIS PLAN
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