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Home My WebLink About0140 CAMMETT WAY - Health M Irl (DO ' I 001 L0CAT-10N t - SE.WACE PERMIT NO. / �/tl 7;4VC.111� . , ! VILLAGE �4.%- '1 I'NS,TA L L E '.S NA E i ADDRESS ' , -. tom`fr 101 OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED -' �� ` � �� .-> ��°'� • - J No....... �'.74 S THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ........ .....:..._. ........------.....OF...............---.........------......--------.......................................... Appfiration for Dhipvii al Works Tomitrnrtiun rumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ......... ...__ ...._......... .... . Loca n-A ress or Lot No. J !^^ ._... ^ .. ^A ----__ ._Tr. er Ta rW' � ---..•--••••••-•--...................•--•••.........••--•-•--•--. •--... __ ----...-•- Installer Address Type of Buildin Size Lot............................ feet V Dwelling No. of Bedrooms____________________________________________Expansion Attic ( ) Garbage Grinder ( ) Other—Type e of Building _______________ No. of ersons_______._._____._.__._______ Showers — Cafeteria a YP g -----------=- P ( ) ( ) fs, Other 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_-_____--_____________-. Test Pit No. 2................minutes per inch Depth of Test Pit............_....... Depth to ground water_--_________________.--- - -----------------------------------•---- ................................................................................................................... O Description of Soil.... .�. H-`1_------ x V ....-------•--•-------------•---------------------------------•-._._.......----•--••----------._.._._.......-••-------------------------•---_---. W -------------------------- .......................................................................................... ...A-•-------•------- •• ---_- -----_.U Nature of R p irs or Alt ratio —Answ r when a plicable_. _ : Ir eemenl The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T.iT L4 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has*bDeeni, d b the board ofiealth. Signed-• - :-----------•-----_----__--•- °2 ! [ ----------------- Date Application Approved By.._.._..- =---` f� ................................... ....................--a--.............. Date Application Disapproved for the following.reasons:........................................................................................'..................... ...........................•----------•------•---------------------------.....-----------...-•-------------•--•---------•----.-.-----------------------------------------------------------------.._..-- Date PermitNo............................•--•-•----••-•---------••--. Issued....................................................... Date .� FEa..No.... f,: � A '...._.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............. ...........................OF.........................................._.................... ..................... Appltration for Disposal 10orkii Tunitrt ion truth Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ............... ..�.-,,C"... �y................................. Locaf n-Ad ress or Lot No. .. ............................ .... . ;�� A ------------ .y....._ aw f. P... ............... ---•-• ---....................... Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Otherfixtures -----------•----•------------------------------------.-....-----------------------------"--------•-••---------•----•---------......_.__.........----- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 0� Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ .....................-----............. .................................................................................................................. D Description of Soil..... ........:................ U -•----••-••-----•--••-•••----•--•-••--•-••••--------•----•-•-•-•-•--------•--------•••.........-•-•-----...--•---•--•------------------•-----•--•------.....-••-•---•-•...---•------•-•-•••------------- �l ...................................................................................................................... ... .. ............... V Nature of Re a,.rs or Alte ation Answ-q when plicable.. ___:. Agreement. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TTL . 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beerU i �1edbDYAhyb=,th. ;Z Signed............-•••--•••------•---------•..................•-•---............-•-•---•-- Date Application Approved By......... ... ... '----•---•--•---•-•----•--------------- -------------------- ---•-------------- Date Application Disapproved for the following reasons--------------------------------------------------------------•-----------------•------------------......._....- •-•--•--•------------------•----------•••-•-------------•......---------------•-•--...--••-•---•...........••---•----•-..._..•----•-•-------•----•---------•-----....................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ��.,....,,`.............OF........,. .., ........................................... (9rdifirat e of f�uut fiunrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by----------------------�-��........Z=_�------------.......----•.....------...............------------------..........-----------------------......_..._....--•---•--------------- Installer at1.l�e ---------•---------------------------------------- has been installed in accordance with the provisions of TLITIZ 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No------ l____ .2. ......... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED S A GUARANTEE THAT THE SYSTEM 1�A114 F CTION SATISFACTORY. DATE_�_G 3 __________________________•----___--______-_____ Inspector..... • _ __- ------- --- -----__-__-•----____---••---•------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -. O F..... ....................................... FEE No. .......... ....... �i��o��tf ork� dun �rttr�iun rrmi� Permission is hereby granted......... ........ ' to Construct (' ) or Repair ( `) an Individual Sewage Disposal System atNo.........................I`- ► ' ......... ............... '------. Street as shown on the application for Disposal Works Construction Permit No..................... Datp&......................................... / and of Health ....................................... DATE........................-2� ,'° " l-------------------------------- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS