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HomeMy WebLinkAbout0181 CHIPPINGSTONE ROAD - Health Oo2a- ®78r �11 I SMEADJ No.2453LY UPC 12934 sm®ad.com . Made In USA JA Y '0 . SUSTAINABLE FORESTRY INITIATIVE Certified RberSourcing wmvdpropram orp L O ION SEWAGE PERMIT N0. .0( ",/.,,.,—Z-, 3 - --- vI l Ac INS A LL R'S NA E i ADDRESS (�x razc BUILD R 0 OW s� DATE PERMIT ISSUED _ � _. 2 - 7 7 DAT E COMPLIANCE ISSUED C� _ /� _ 7 �r �r10 ®� C� rtiJ S—� THE COMMONWEALTH OF MASSACHUSETTS BOARD 5�F HEALTH Appliration -fur Uhipwial Works Tomitrurtiun Prruiit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: Location-Address r Lot No. ....�. -gi n.D ./ .. ------ ------WAA�t��---P� Owner Address Installer Address U Type of Building Size Lot...2.qjj P.90..Sq. feet Dwelling—No. of Bedrooms._._._. ...............................Expansion Attic ( ) Garbage Grinder GOP aOther—Type of Building,5?4I.r..Lru-1.No. of persons.......�............... Showers (/) — Cafeteria ( ) QOther fixtures -----------•-- ---------------------------------------•---------------------------•-----..---..-•---------•-•---_-----.--•--•-------------........ W Design Flow------------ ......................gallons per person per day. Total daily flow..............3.0.10----------.._.gallons. WSeptic Tank—Liquid capacity---0--gallons Length---------------- Width........... .... Diameter---------------- Depth_.-..--------..- x Disposal Trench—No- -------------------- Width-------------------- Total Length------------ .._.. Total leaching area--------------......sq. ft. __Seepage Pit No.......I---------- Diameter.......` ------ Depth below i et...._6__-------_ tal leaching area---34..._..sq. ft. Z Other Distribution box Dosing tank - ri F�k H W Percolation Test Results Performed by.,�Q_W11�_.e��,,..,.,�__.,,,,,__�.�,,,,,,,,,,,,,1 ate....................................... Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water-----------.--.--...___- �14 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ ..........................................................................................•••--------••---------------•••---•--••••-•.....--------•--•--••-•----•--•-•--•-•---•--•-••--•••-......••..................................................... 0 Description of Soil........................................................................................................................................................................ x v -•••---•------••••-----------------------------------•....-•••--••---••---••-•---••--••-----••-------•--------------••-•-••••-•---•-••--•---------------•-•-•-••--•-••. -------------------------------- W -•----------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U 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 boardQof health. G Sign ✓ \ ---- ----- ------- 2— Date Application Approved By...... - ------- �/- �l ------/ = ` .�--."a- - - -� - - -- ------ Application Disapproved for tlie'following reasons:..................................................................... ................•---..Date------......•- ------------------------------------------------------------•--•-•-------•-------------•----------------------------------•--------•---------------------••--•----------------------------• ---------- Date PermitNo......................................................... Issued........................................................ Date ...................................................... ......... ........ .�........ -....................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD 9F HEALTH ................ P..t.0 ....OF.... ...... ..`.................................................. 0.1rrtifira#r of Q'i'lantphattrr T IS TO ERTIFY, That the Individual Sewage Disposal S ste constructed ( ) or Repaired ( ) by..... � ---- ----------------------------------------................................ ..................... �!ar//2!�� Installer vet ?.._... lam! c . •--• .�'---------------------- has been installed in accordance with he provisions f A tcl I of The State Sanitary Cod as described in the application for Disposal Works Construction Permit N ...�......__c •��_ - dated..-.- y7._"...^z.......7.7_:........ :. THE ISSUANCE OF THIS CERTIFICATE SHAL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.....................................................................••••...... Inspector.................................................................................... �7 `+► THE COMMONWEALTH OF MASSACHUSETTS v / BOARD O HEALTH _........ .-..........OF....... f'�!�it�L -----------------------------------........... Application -fur 43hipati l Workii Tnnn#rur#inn Vrrnfi# Application is hereby made for a Permit to Construct (, or Repair ( ) an Individual Sewage Disposal System at � J Location-Address o Lot No. O er Address Installer Address Q Type of Building Size Lot.. t #. QQ.Sq. feet U Dwelling ' No. of Bedrooms.--__ _.:.-Expansion Attic ( ) Garbage Grinder aOther—Type of Building f r i , No. of persons....... Showers ( }) — Cafeteria ( ) Otherfixtures ------ --•------------------------------------ ----------------------------...........................-•-----------------------------•------•- W Design Flow._______________________ __________gallons per person per day. Total daily flow..............,t;�Q.Q-.........._..gallons. WSeptic "Dank—Licjuid capacity�� gallons Length________________ Width................ Diameter------.......... Depth................ x Disposal Trench No -------------- Width ------------- Total Length Total leaching area..... _..sq. ft. Seepage Pit No .... ._ L. Diameter _ :_____ Depth below it et � u tal leaching iret.._"«�4-----_sq. ft. Z Other-Distribution box J)' Dosing tank ( >, ) +'",l • �• y ; Percolation Test Results . Performed by�,ow-----__r_fl'0 -,e _,w D.ate-------------'_.__.:..... .._._..... Test.Pit No. 1-------------- minutes per inch .Depth of Test,Pit-------------------- Depth't'o ground ,water...-----------.J...... Test Pit No. 2...............minutes per inch , Depth of Teat Pit................._--- Depth to ground water--.--.-..-_.-_.- _.... a ------------------ -- -----.---- .------..--- Descriptionof Soil-------- ----------- ----------------- ------• ----•- ------ - '-------------"..............--- -- •--- .... ......----------------------- -- U ; •--------•-••------------------------------ -•------------------------------------------------ ------------------------------------;-- W . U . 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 NI 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 thetboard of,health. Sign �aF�s ? = ------- E. ._. _ �. � Ir ate Application Approved BY------- sue r ----- - - 7 -- - '- ------ ate rls .er... _?.�.7."T �+dCR°�`y� Date Application Disapproved.for the following reasons----------- ----•----------------------------------•-----•...------•----------•----------------------------------- -------•-•------------------------------------------------------------------------------ Date Permit No.-------- ........................... Issued................................ ....... Date } . THE COMMONWEALTH OF MASSACHUSETTS — BOARD F OEALTH v,RZZ t��,�atw....OF.... o err#ifira#r of T11(inpliaurr TAhiI ZS T ERfIFY, That the Individual Sewage Disposal S stepconstructed ( ) or Repaired ( ) by L" ,r , Installer ------- -- . . . ---------- 0 ------------- has been installed in accordance with he provisions f A icl 'I of The,State Sanitary Codp as described in the application'".for.Disposal Works Construction Permit N ._. :_-.._t a S�'....... I............ THE ISSUANCE OF THIS CERTIFICATE SHA NOT BE CONSTRUE© AS A GUARANTEE THAT TIME SYSTEM WILL FUNCTION SATISFACTORY. DATEInspector-----------------=----•--------------•-•----•------------•----...--•--••---•-•-•--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT . �.... O F... ................:. �.AL0 Na FEE.. .„._ rk� nn�#rnr#init err i# Perrntssion is ereby granted ----.----- -- to Cbnstru (�or Repair ) a�f Individual Sewag�sal m S reet as shown on the application for Disposal Works Construction >f„� Per o__ letaetd__ e 7 �% . .. .. ........ rdo_______ ____ DATE-------� FORM 1255 HO�BBS & WARREN. INC.. PUBLISHERS tza- .!k 2 ft.. = d J•'K .4' 9 X. l(} !I�F ummr c=nm 4.4 - f �f/ '\ •\. ��\ \`fit • `r � aF 95�-0��' r f 6x L-< h �+.(G' \ •'�• ---_-.__•__.._.. � -..-_ D! . . t. Sri �•w. ��.�q - - r yr } 4yF y ' 1 y• /' t \ ,- o GJ . I I . i .SPD' L. t �• = 4ti7• � D,®TL$: '�',L '_�, �,-, , �r7n !��?!_:. ..`�FPT/r Ti�lN/t! 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