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HomeMy WebLinkAbout0065 BOSUN'S WAY - Health s 65_Bosun's Way A-046-129 �� LO ,,AT 10 SEWAGE PE IT W. VILLAGE �J IN.STA LL R'S NAME & ADDRESS U I*L D OR N ER tA A DATE OERMIT ISSUED DAT E COMPLIANCE ISSUED S_1 r- 7� � L 0 N i i ll No....... 4`6.1..--- . Fps..,...... THE COMMONWEALTH OF MASSACH,JSF^-. BOAR® OF HEALTH /U.r .�7..... ......._0F........ � .. ...._. S� Appliration for Disposal Works Toustrurtinn Frrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: �') ' s Location Address' ............................. .... . . o°L...... ......................... a ..5��� d!� jAr%sTrs /) Owner �rlesss •--•------ -'ice •---"•-----•................•-----=--::a_............ ... ...... .. •-•^^' .. .: 4!..c.................------....--...... J Installer Address of U TypeDwelling Building ngNo. of Bedrooms......... ............................Expansion Attic/��.�I Size Lot Garbage Grinderq pa, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q, Other fixtures -•----•----------------------------------------- -- ------------------------....--------- W Design Flow_._.._.. ... ____________________gallons per person per day. Total daily flow....._......................_........I.....gallons. 14 WSeptic Tank—Liquid*capacityl�?©.gallons Lengthg'.x...... Width._.._-..... Diameter................ Depth.___ x Disposal Trench—No. ............:....... Width__J_...__._.__.___-_ Total Length___.._._..__._7..._ Total leaching area/11011 ft. ut Seepage Pit No.....Y------------ Diameter... .__......... Depth below inlet............... Total leaching area.G.� ./....sq. ft. Z Other Distribution box (�) Dosing tanpk ~' Percolation Test Results Performed by.____.. .i... ......../:�__ k.................. Date........, d� 7�_... W -- ,4 Test Pit No. 1...OF--------minutes per inch Depth of Test it.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ a .... -----------------•-- -- / -----------••- O Description of Soil................ ' v�� 3� -----• ... ---.. ...... -- -- - - --- ---- 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 THIM 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance hibeissued b oard of health. Signe .�_®. 'Date Application Approved BY ......--- .... •--•-----•••......---••-•-•---...--•-- = ^7r�.....------ Date Application Disapproved for the following reasons: -----------------------•----------•---- ...................................... ..............•----..........> :------•-••-----•-----.•...--------•----------•---........-------••---•-•--•-••--•-•-••-••••--•-------••••----•-••--••..................-••-•-•. -•-•••----------- t Date .ice...... . Perin No;.-'.___1.a:L_..--••------••-----••-••-•--•----•-.. Issued_ • ram,,.° ._ Date `� No...... /i---- F�s..'...........`.....� THE COMMONWEALTH OF MASSACH!USFAS BOARD OF HEA -TH Ajilifiraa#ilan for Disposal Marko Tungtrurtinn rrmW., ,,. :v�. Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at - lowl .Locati dd-dresr .... ! e-d- '?.r .. �� �, a/" �•- Via. --- f......_.... ... ..... r + rf/I..................................... ►-a I� Owner �g +' ess cn Installer Address r � m7.." U 91 Type of Building Size Lot___________________________Sq. fee �., Dwelling—No. of Bedrooms___.........................................Expansion Attic Garbage Grinder ( aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures •---- ----------••--••--•---•--•----••-••--•-------•••-•-•----•-----•----•-•----•----------•--- W Design Flow......... ........ gallons per person day. Total daily. flow.;_.......'j° .........:.................g llops. d81�_ allons Len th ....:.�__-._. Width__. ____.. Diameter Depth W Septic Tank—Liquid"capacity g g p :.-_-- x Disposal Trench—No. r........... Wid -.,,........._...... Total Length........ t._ Total leaching area ft. r Seepage Pit No...._./------------ Diameter--- Depth below inlet_...__ ...... Total leaching area. ../�::_sq. ft. Z Other Distribution box ( ) Dosing tank Percolation Test Results Performed by....... �__:.__; '�L'Vit /"tDate �✓ f? � ••----•-----;t.---------•----... ----...- - ,� Test Pit No. L-_ .......minutes per inch Depth of Test .................... Depth to ground water......::............._.. Test Pit No. 2.:..............minutes per inch Depth of Test Pit.................... Depth to ground water........................ Description of Soil.............. t4.r:.... �� `'' . ' V ------------ •------ ------------------ ••----.------------------------------------------------------------------------------------------W 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation,until a Certificate of Compliance has be n issued byt di board of health. Application Approved By......... ate' Date Application Disapproved for the following-reasons----------------------------••--•----•--•----•-----------------•---------------------------------.....--••-.-_... ........ ... .... ...•-•••----•.....---•-••---•-••-•-•-•-----•-•-•---••----•-•--•••---••••••-•-•---•--------•-----••--....-•-----•------•---...-------•------••--••------- Date Permit No........ "__`� �.._...... - Issued_.... ..- --_- -` •----------- Date R Ada .pP _ THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH �. .............. ........0F....... j�/ ................................................... ;r..r Trrtifirab of Tl mplianrr THIS S TO CU�971FY, That the Individual Sewage Disposal System constructed ( <or Repaired ( ) by..�,. . " ..... ... ----------------------------- --- --------- •-----•----.."} .......i � ------------------------------------------ Installer f) has been installed in accordance with the provisions 5 of The State Sanitary Code as described in the application for,Di, Construction Permit No.. _ _ ;_,�.'1....._..__. dated___,._ "' .--. -_'.. ...... . THE ISSUANCE OF THIS CERTIFICATE SHALL OT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISEA RY. ...--•-•-•----- Inspector....---••------•---- DATE......•--•-•....-•-•--���-•-:= == THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' 7 Dispnott nrkii (1-111ntrnr#ilatt rrntit Permission is hereby ranted,..... ...r........ to Constru or Repair r ) an Individu Sevcra a isposal System at Street • `� as shown on the application for Disposal;Works Construc ion Per 't No.................... Dated.._�f:.._� - � j ------------••-----•-•---•-••-•----.--- - DATE-------=-- -•----------•-----------•-•-•-----•-•---•--••--••--••--•.....--••--•. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS .... 7�3:IA � 3iZ�y��'ha lJ✓L�1fDk �.. ..I ;?s','9a+t..l '.".,;'�. � •�� �, - �� m ctro , h I P�E.DFzdarn .`r. - — — I � 41 : r - �e 7IN h. mm. a � i\—zx�df�f{_ ..... 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