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HomeMy WebLinkAbout0179 WEST WIND CIRCLE - Health r-M �� �A� �"dc,, G 1 �� � lofi /63 � a;at't76 I M i i IN IS M EAD KEEPING YOU ORGANIZED NO.103U 2-153L MADE IN USA GET ORGANIZED AT SMEAD.COM Nop_.4-� .. ti_. Y-- Fi B.. ............... may/ THE COMMONWEALTH OF MASSACHUSETTS o BOARD OF HEA TH ...OF.... yv Appltratton for Disposal Works Tongtrnrttnn ibrutit Application is hereby made for a Permit to Construct +or Repair ( ) an Individual Sewage Disposal System at: ocation- dress � Lot No. .............r �:r ..__ � .� 1/'1 1.---TM...............------. Own r ddres a •................. . .. Installer Address �A /�� Type of Building Size Lot..... ..... . .......Sq. feet U Dwelling—No. of Bedrooms_._..._....,___________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ..fly No, of persons...........6............. Showers ) — Cafeteria ( ) Other fixtures ------------------------------------------------- ^ -------- W Design Flow................S. ......_._........gallons per person peVdj. Total daily�iow......_ .________..............gallpns.�,� WSeptic Tank—Liquid capacityl-Q�gallons Length._10_4 j... Width..... _...._ Diameter................ Depth_.46_..J_. x Disposal Trench—No..................... Width-.....p............ Total Length............... Total leaching area....................sq. ft. Seepage Pit No_------I---------- Diameter-------4......... Depth below inlet.......K......... Total leaching area../,,/,47sq. ft. Z Other Distribution box ( ) Dosing tank ) '-' Percolation Test Results Performed by...,t—&'V✓..Z24V lS. I.Aljj Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit-__-_. ��Depth to ground water.,.(9.;._. r�� Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground wate ..._._.....� ll� -------•-• ------------- --- ------------- ;; ;�. O Description of Soil------------------- 1:�..D 1 ;;r ff ._._....___.______..___.___.._.______._____.__._._-__............._.. 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 TIT1L 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha been issued by the board healt Sl a .... Application Approved ... ....... - - •- ---------------•----------- Date Application Disapproved f o t ollowing reasons----------------------------------------------------------------------------------------•--••----------•--....._ ................................................ ----•-•-••••....----•-----------------•...•-•---------....••-••---•-••--•-------------------------•-•••-•----------------------•-------------------•--- Date PermitNo......................................................... Issued....................................................... Date t ! _ Fps.:?No� :.���.. P�,_ �7 �,, ...::..............._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT ApplirFation for Disposal Morks C onstrurtion Frrutit Application is hereby made for a Permit to Construct (' '") or Repair ( ) an Individual Sewage Disposal System at �f y� /^Location/-Addres/s�. / r /t o. ......... .!!_.4„..Y......tr V r 4'!..a._ _ .. '�1�, '.... ............... t� Roe,`�9� ' ...._............... Ownerddr ................. .. ==�-1� .`c�.171l�. t.:P.d.. ............ '�" . ? _: ...----....---- Installer Address `/ Type of Building Size Lot..._.__._..------------------Sq. feet Dwelling—No. of Bedrooms.......... ' . ._;.......................Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Building No. of persons J ) — Cafeteria ( ) P ---------•---- Showers Other fixtures ------------------------------- -----•-••-•-•-•...... �y W Design Flow................ 1....._....._.._.._gallons per person pet dam. Total daily/flow____ .-S,>_•-_----..............gallonsy> WSeptic Tank—Liquid capacity/�_6.gallons Length_1, .. i " "Width.... ._..... Diameter................ Depth.6__3_. x Disposal Trench—No..................... Width..... Total,Length.............. Total leaching area....................sq. ft. Seepage Pit No........ ...........: Diameter.....: _.: ....f Depth bel"ow inlet_......_....... Total leaching area. ._�_sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed Date_..................................... ,.a Test Pit No. 1 ...............minutes per inch. Depth of Test Pit...1_ _. 1 Depth to ground water.4-6n,_.�_ tl (�..r+ 44 Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water......................... a.... DDescription of Soil------------------- . .......... ----•-•-• --•----•--•--•--.-•--------•.-- --•-•--------•- x U -------------------------------------•---....._......----••-••-•-......•----- w -------------------------------------------------------------- -------------------•-•••---•-••-••••---••---•-••-----------•-•--•-••-••--.......----••--------------••-••-•••--=--••-••-•---------..... V 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 TITLP; 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:�� netfe....... �-J Ji -•--- -- _...._ . Application Approved-By> (.... t-• 74-r-' Date -.... a.te.............. Application Disapproved f th f ollowing reasons:......................................................................:......................................... �1 Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a Trrtifiratle of TompliFaatrr THIS IS TO CERTIFY, That the Ir}tlividual Sewage Disposal Syrgem constructed ( or Repaired ( ) Installer ��r ' ._.. .fir -sueE . ----------- has been installed in accordance with the provisions of TLE Pr' 'p X. 5�of T}e State Sanitary Code sc�I�ed m the application for Disposal Works Construction Permit No..... . ._.'..1r................. dated..• ��' THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON)5TRIBE,® AS A GUARANTEE THAT THE SYSTEM WILL FLR4CTION SATISFACTORY. v DATE.................�. . .� ......................................... Inspector------.....-- '_... -----D_ v THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTHPei No:..,r...:., X-./•-- FEE........................ Disposal- orks,(Ionstrurti�tt r-rutit Permission is hereby granted..... -C ...... :1/ 1`�°?fit "ti� ......................................................... to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No.. _._ ��.._ _.... ,== ."-' tart- ' 1 _........ .'1*44Z:'�'1....... Street k a' as shown on the appl' do for Disposal Works Construction Permit No.f............ Date(1.......................................... / ................. __ _- :......_ f ... if Board of Healt t DATE._...7... --�� ..................................... i FORM 1255 A. M. 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'�� PEQCGuAI TcX '� RAYMOND Q.EQU/CEI� - GB3�.t 'cii9Titac� �7" ;`� 4Na 215ii� p _� J I t_- i_ i I.,1 j } LE,'*f11/NG 4 r ZXAe Al/•VG o.Yo✓/o�D f�t3�.����- `�j PROPO-SED LEACHING PIT �� .6.PPL1ca.t.1~I-' : �t.[�+► iEL[t' t' .4Qr z5v/ E#4GJ NEE2l NG INC. J1oo °1� Ex NAKIs1on1 gliOf• ?1i �# . C•FA.LJC 14iG"K/^y • p Ui S1rJEfa UES�G:►.1 _ - . Q.� zra�I: f' 1. Fi�.�w� tF1� oz RAYMOND iia.19375 SCALE: i,sWE. 9h 11ECT '�Ic• war AS NO TED ,' it i 1 OF 1 5V,Wlt P— ,PPLIC-4,71 OtJ Ito, _. c 1>+,� DRAWH sr: CHKO sr: w ev: PLAN KD. 0 i •