HomeMy WebLinkAbout0088 WINTERGREEN CIRCLE - Health �&--otr7
No......................... R ..a....
i THE COMMONWEALTH OF MASSACHUS�_,UT, §,'ACT TO APPROVAL OF
BOARD OF H E A LCT-'NISrABLE CONSERVATION
Apphratiao n for ]Niip iial Works Tonti#rurtion Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair (V�an Individual Sewage Disposal
System at:
...........................
ovation-Address or Lot No.
/. 7P1! G ...........................
O r rAddress
W ....---••••_----- �-� fir _ cl_/l '-------------------------------- ----e:• 1 f 9.._ � ? ....��° s__ �+
.1 staller Address 7 Q
CT��s
Q Type of Building Size Lot----_.. ________ ___9tr—feet
U Dwelling—No. of Bedrooms------------- ______________Expansion Attic ( ) Garbage Grinder (I,<
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures ------------------------------------------------------ ----------------------------•------------------------------------- -----------------------
W Design Flow______________________________________ __gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity/ ,06-?-gallons Length_.1'0—_6__ Width-5---,8---- Diameter-_------------ Depth.-_-
x Disposal Trench—No- ____________________ Width.................... Total Length.................... Total leaching area.......-------------sq. ft.
3 Seepage Pit Noz__E:XA5_f, Diameter-__-___--16_ --. Depth below inlet----lr_.___-..__._ Total leaching area-.gvt'?--------sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by---------•-----------------------•-----••------------------•------------- Date------------ ---------------------------
a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
r4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------
------------------------------------------------------------------------------------•--------------....................................--------- ---------
O Description of Soil----- -e--. _ -------� 1,-6----f f--- /1'eaC.ce::r".-_..5,4
x
V -•------------•-----------•---•--------••-------------------•--------•-•----•--•--••----------------•---•--------------•----------------•-------••-----------••-•---•------•------------•--------------
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 Article XI 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.
Sigd ••-------•••••----- ................................
Date
pplication Approved By..... �,�,
---------------------
Date
Application Disapproved for the following reasons------------------=- ---- -
Date
PermitNo......................................................... Issued........................................................
Date
Z
No.C". 7,;7-..
THE COMMONWEALTH OF MASSACHUSETTS ,� ,,_
BOARD OF HEALTH
a
,. ApplirFation for UWVasal nrko Cnnnitrnrtinn: r1prulit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
........ I/---------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------
Location-Address or Lot No.
•---------------------------•-•-----•--------------------------------......------...-------------- ----------------------------------------...-----•--------•---•-----...............................
Owner Address
W
Installer Address
UType of Building Size Lot----------------------------Sq. feet
Dwelling—No. of Bedrooms.............-------------------------------Expansion Attic ( ) "4 Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons-.----------_------_---- Showers ( ) — Cafeteria ( )
dOther fixtures --------------------------------------------------------•-•------------••----•-•--........----•--•---••---------------------------------••-----------
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 Test Pit................---- Depth to ground water------------------------
rZA Test Pit No. 2................minutes per inch Depth of Test Pit--.................. Depth to ground water------------------------
,X P' ------------------------------------------------------ --------------------------------------------.........................................................
0 Description of Soil..............................................................=------------------------------------------------------------•-------------------------------------------
x
U
Wf-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
x
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 Article XI 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.
Sig ---------------- ---- --=------------
Date `
Application Approved By....... - ... . . •y� ------------
Date
Application Disapproved for the following reasons----------------------------------------- --------------------.................................................
--------••--••----•------------------•---------------------••-----------.....-•-•--.
Date
PermitNo-------------------------------------------------------- Issued--------................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
.,,�. BOARD OF HEALTH
J.... ............OF.......
........................
�rdif r atr Of Taamptiaatta
THIS S O "ER -IFY,. t t ndividual Sewage Disposal System constructed ( ) or Repaired V..<
r
nInstaller
has been installed`in accordance with the provisions of Apd'c-115,XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permif`=No.(f'v_...7 a............... dated.__: _"__ _ .-._s ...............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM W L FUNCTION SATISFACTORY.
V ��./
DATE------ �...............•---�-• Inspector
THE COMMONWEALTH OF MASSACHUSETTS
t
BOARD OF HEALTH
Nig ............/ 4�/Y�....._.OF..........- `........ FE---------------
�t��aa��t � r rttaa rrmt�
Permission is hereby granted...... -•-•• -- - - -------
to Construct ) or epa'r (�) an I d' idual Sewage D�i"sposal System
-� 11 A . 11
Street
as shown on the application for Disposal Works Construction Pe
- G .
No Dated. H
__ 2._" __ `. ............
Boar i
DATE--------`-=--- � --------------------------------------- .
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
it
LO CAT IO SEWAGE PERMIT NO.
s- _
VILLAGE
INS LL R'S N E i ADDRESS
OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED .- �` -"� "l
u �
M r ��� �v
Y-✓ `
,��'� ��
.�,.
u/ F.P. 292 ;
t
'CAI c f ��izttttmiftti:�iltl cr " Nv ry .
Department of 1'uUl et ion of Fire Prevention 4
APPLICATION FOR PI-f-oirr 17 .[MO _ ANp TRq p VOTO/APPROVED TANK YARD;,M.�a�;i.
3 12/22/ 19 88
IOrtil � Xi:
�..7•
C.82 S.40 M.G.L.
To: HF,�,D OF FIRE D PnRTMENT
l tiarnstab e DIG SAFE N U,M 8
J -
�,h . .� 88501871
is #2 500 Gallon
Start DoteV. _12/22/88 y
G In accordance with the provision; of Chapter 148. G.L. as provided in + ,
Section 38A Application is hereby made by
�Co Inc a
ame of erson, I rm or orpora ton) ifi
335 West Main Street, Northboro, MA� ,>,�.�
9 - Afire s s �"� �,�`;� r `
For permission to remove and transport underground steel storage tanks) from z
zg
r 5�45iew Avenue Osterville — Kaneb a
I tree a rd�7 ess clay or OWn
FDID# 01920 _ to approved Tani; Yard!; 03501
State clear] ' '
• Y type of7�-
Inert gas used in
steel storage tank
x
ype o inertgas used-
Name
' of Person, F rrn,
1 corporation d1;p0;inc) tankSyr) }
J.T.Grant
Date issued - x�c ZuSx 12/22/ 19 88 By: ���_
Date of expiration 19 paid/due (gnat re o Kant
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