HomeMy WebLinkAbout0516 BAXTERS NECK ROAD - Health r
Glo I��f�ku�Sil �
l
I �
j
p'
I
i
I
i
i
I
rJ M E A
No.2-153LY
i
UPC 12934
emead.com • Made in USA
4 R�11��G�7mR��
K
�i111flYdF�Rs01IfCLW
111111 usosfow=Lwa
' RI . T
LOCATION ,Lp' — /® fAjrlit /U9CIL SEWAGE # - 6
VILLAGE ® IV-*QtSTdN,S AWS ASSESSOR'S MAP & LOT O 3",& -dl®
INSTALLER'S NAME & PHONE NO. CONS7-, co, --m�
I
.SEPTIC TANK CAPACITY d2, 000
• —T o
LEACHING FACILITY:(type)FtptJ Ed;dgs (Size) 5 -
NO. OF BEDROOMS PRIVATE WEL OR PUBLIC WATER
BUILDER OR OWNER OViJOO iZkA,.-rLr
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No �/ J
i
w
M ��
..+��
J ,�
V � � �,r �
� ,�l
���
� r
O i�
No.......:-..�C� Fxs.... .............
THE COMMONWEALTH OF MASSACHUSETTS
t
BOAR® OF HEALTH
............. nX- ------------OF.....I. fl l L ....................................
ApplirFation for Dhitimi ai Marks Cfnndrnrtinn Prrutit
Application is hereby made for a Permit to Construct (YQ or Repair ( ) an Individual Sewage Disposal
system t
........... ..._.... . ... ....-....._.... ---------.. _ .............
//+�` Locatio ddress `�� t o. T}�
. Fr.�!M. ._.. 1� ..... sf' .L• _...I...�o sS ... .✓. � `r^!:� V ......Q----'- -1_V ...... ..5:5.:� _3
........._.
Owner Address
e
a ..........................`i --..... -•----••-•----•••---••--•--•-•----••------------ ----•--•••----------------...........•--------•-------•------•--•-•-----------....................
I staller Address 2 (l�P-Fk/L►it7
dType of Building Size Lot4.�7_9W.._....Sq. feet
U Dwelling—No. of Bedrooms..........J�.................... _Expansion Attic A0 Garbage Grinder q65
Other—T e of Building No. of persons............................ Showers — Cafeteria
GaOther fixtures -----•-------------------------•----•----------------....-----•----------- ------------------•----•-----------------•---------------------••---.------
W Design Flow......... J+` .........gallons per person per day. Total daily flow.......... 2 ...............gallons.
R: Septic Tank—Liquid capacity_._ ...__._gallons Length.l(_'1`..._._ Diameter__._______ De pth.s5!'_ r/
Disposal Trench—No. ...... ............ Width.....��______-- Total Length-----AA. _...... Total leaching area_'.------sq. ft.
3 Seepage Pit No-_----------------- Diameter.................... Dept 1 below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box N96 Dosin ank
'~ Percolation Test Results Performed by.. _.......___f_..M 4.G_�kI.................... Date.3-ZA"�__....____.
aTest Pit No. I...4 ___minutes per inch Depth of Test Pit---- Q........_ Depth to ground water_.77-77—....
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
O Description of Soil..... -.�._L �_. 5�?. L --- .- i� �-�P-5A. Q- - - -- - - ..
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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Comph nce has been issued by the board of health.
Signed ....- .................................................. I.....--
Da
Application Approved By . ...... '�' - /C
Dace
Application Disapproved for the following reasons:
................................................................................................................................................................................................................ ................Da...........----.....
Permit No. -9.1-.10-7-------------------------------------- Issued ------3...- .........��.....�.......--...............
Daze
�Z
-; 5 <y
No. ............... _...._......
THE COMMONWEALTH OF MASSACHUSETTS
-�- BOARD OF HEALTH
..........c'�a..A f\e ....---.....oF.... ,��!�:�4� L .'-----------------------------------
Appliration for Raposal Works Tonstrnrtinn ramit
Application is hereby made for a Permit to Construct (X� or Repair ( ) an Individual Sewage Disposal
System .t
120
..... ........... .--------- . -•--... .AA
. ............
_ Locatio ddress °}A"/� y� r� .y �tL N�o s ,
Lr JOS.(Gw ��,.....:..`."�*�� i Mrr... +�S. A�..3.. APw;.��
'- !...
Owner Address
W
Installer Address , t.�.I�L A+-_X%"2
Type of Building Size Lot 3.'. ��.......Sq. feet
Dwelling—No. of Bedrooms___._....� ..............................Expansion Attic ( Garbage Grinder ('s`65
PL, Other—T e of Building No. of persons............................ Showers — Cafeteria
Q' Other fixtures ..................................
W Design Flow.........� ,?....,_gallons per person per day. Total daily flow.........._. `_' .K...............gallons. j
WSeptic Tank—Liquid capacity..gallons Length_.:: ,_.... Width.G. " .... Diameter_ . Depth_ :.'�._.
x Disposal Trench—No.......�:............ Width......(P......... Total Length.....` ....... Total leaching area.=. ------sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box (�qs Dosing—jank ( )
Percolation Test Results Performed by_ o x tee 'kC. ............. Date_._. . . .......................................
aTest Pit No. 1___A:7�---minutes per inch Depth of Test Pit-__--..0.._...._... Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P+' ----"-""""""-----------"-""-- •r...•...•- - -•-----------------------------------.----------•---..-----
0 Description of Soil--'-". .. Ck' vL ^t r� '7t C.......�.' `` fl_
x
U -------------------------------------------------------
--"•---------------------
.-----------
.------------------
'-------------------------------------------------------------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 Environmental 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.
Signed ------------------------
-
---------------------------------------
Application Approved By ..-: :...... _:.::.......:._
Dace "
Application Disapproved for the following reasons: ................ ........... .... . ............... . .....--.------...............-- ....................
. .... .... .................................may....---.......�...4--{�/-- -- -- ------........ .......................---....--......------....-- .......................................... =....................................
✓ ,V 1 . C..O Dare
Permit No. .. ............... . ... Issued ---- - ---------- --- I -----
Dare
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..............................................+ of --�Ae-M�---W-0....
Certifira e of Tontylianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed O or Repaired ( )
by ---------------------------- -- ---- ..... ---- ..----------- .. ------... ... .- ---.........
at .......................... . ........ ..........: - ---- --- -- 1_.- -Q --
has been installed in accordance with the provisions of TITLE f The State Environmental Code as described in
the application for Disposal Works Construction Permit No. _6A-_-..1.0.�.............. dated .....S.-'-Z_-1-91------------..
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE /... .�. ---- -------------------------------- -- Inspector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
'4 01 — �J�........ ...........OF...�^�^^�.. �sl. *...................... L
No.........................7 _ FE
Uiiipoiia1 Workii Tlntrnrtuan �ernti
Permission is hereby granted.................................................................................r------------------------------------
to Construct ( s) epair ( ) an jndividual Se rage Dispos ys em
at No........................ �14\1*, ` _ 1
.......
q)
Street
as shown on the application for Disposal Works Construction Permit No._23......U __ Dated..3 ..............
•"'•--•---"-"---------------------"-•••------•---'----------------............................----'""-"-
Board of Health
DATE................................................................................
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS '
_ T,«..i„am.•a-•f• -rw.+rn� .w.a+5'+' snk'.:' h�ri' > srf>a ' ' '. •
:. ••+r.,w.A....arnx•• a.aax++are5uewe:!r�mw..,..+.+,e. nr.«rn •,....r �.+e^rmsw»*.-•.e..m+:..*nv,na*+mwmmaa�r�avuu:r.-arw+• vum + .. wrtiwp'
v
:
1 IS
O`=� o 3
•
c
\,
1 _
R � 7 TXtCx W•7 i,
�At-Ak.. ZOO /o 157GO 11 6C'Ir�rt7
C�, y, • ' ;` - ,,` \ /�'',• e usE to �1_ow v�r IFosS6 es. W, tTR 4 STQ�'.9'� oN 51 DGs
r 1
C� i - . 44 k 1 to = 76-A sf: �
'-- " n
.� -.,:! • !
- OOL
i� 704
�.Y to Ir 2�
Islan
e,
St Marys cx ✓
o `.o Pt
Island
I� Isabella , d I Gd 4 i I O U T Fs et C.
u �1 „ b Q tV l5
' it c ,
off Public `p ��` 5, .,,`.
/ . ° 161-7 1 69 ro
- '
O G cr 1 4 '� cbt It qe
eta 1
o `y
I
v.S AP 79 7 -1t> o _�
,
�I Zvi , � - "' � t►•�t�'o� �ESou`d�_.� ��,�S�s tom'-e ,
ti Li1t> ,
�'���?�a%i� � �
t ieM 1f3Or—ZS
_ p, r4 �-� ,.�a"'' " �'" C,o M M t Ski a►•:�, j
!
\ r. -- . C—�i t C -NE. -'`fib1' OGEE f` ou"'Cam. 5 VJTw)
�>�,�.4U�.ATt o1.� 1 r5T z�,Q�.,c_-��!/�TtQ��J '�Cc��,aS, � .��---_ G
C,E IXT ; J--D u N N►� C Ny E 1 C
� I ;
.---
I ,
,
v
,
WJLl 11 C C�._cte
' �,..,..-•-•--r......,_ e ram. f - ,
Lid, �u _ c
t
M , :
' rx
A-T T (4 1 •
ALL pP-OX, TO '5 I - a e
71
di
Y
F" •
10,2 TA a.x K^ r' nrF'� ' C ' ,.3 G OF "!., 7� -1 G�,/ Kf -Pc l m L�.f Cov G L
9.7 9.5
ER
_ a SUL[IVAN ` 'I+j CEIS \/ L�Cx ��
-No. 29733
VA pt•,t f.l ors ', boasr w _ x-r 2.. �( ►.� C... M plc t� $ 1�`�1
'�Ir•'� '+ .r ,..r,.-- „rnn f^+y .NKr WON :.-. 1 i
u
x
__. .
r caJ 0IZ-VI L,t m
0 t :i t�'o' .:�-: c ,9 , \��g`� P�10 Gt-' ON Q.C-SC>L2�E2EAS
7 n_vt LL
v. r:.. -. as i,,a.da-K YN n:R .'. -K^i+✓ .-.aµ..em. M. .1,..; +N.AxRen.,.;F:. ...x..r.v.a`kn•e;:fix"•NX.Y'tMiMYFb>,rt,irr.:>.Y '$"T54s'wIMP: .!:tT^R .. - '. .' 'r,•1!er+w:fmYa' :
,.. >mrl.rm*-.».—r.,z.,>,;-z.+w wrsm•.e'.< wafiaws _-. qs. Z ,ar.::.r+t......_.. !' fa k.rN"r; v+r .. . i _.,
i