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Home My WebLink About0111 EMERALD LANE - Health 111 EMERALD LANE Tmarstons Milis A=046-035 LOCATION IL-, SEWAGE PERMIT NO. VILLAGE 3 INSTALLER'S NAME i ADDRESS � BUILDER -OR OWNER DATE PERMIT ISSUED ^ DAT E COMPLIANCE ISSUED m 1AAf- z 2- P. / I 1 • rho, No.---•.----•- --- Fl�s... ..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 041, - � o ��_-.......7- -------OF......., Appliration -fur Disposal Works Tomitrurtiont Vanift Application.is hereby'made for a Permit to Construct (k-) or Repair ( ) an Individual Sewaa Disposal System at: Location.Address or Lot No. K ------------------ ----- ......�ry N r --------------------------------------- Owner Address .......................... •-------------- -------------------------------- --------------------------- ......................................................... Installer Address Type of Building 5,4 c l= 13 r A Size Lot_g.??,,---l_? '-_---_--Sq. feet Dwelling—No. of Bedrooms--------------3----------------------------Expansion Attic ( ) Garbage Grinder (//O Other—Type of Building ---------------------------- No. of persons-_-.-----..--.--_----.---- Showers ( ) — Cafeteria ( ) Q' Other fixtures ----- ------------------------ Design Flow-------------- -g .......................gallons per person per;day. Total daily flow------------a a -- .--..-..-.-..-.----gallons. P4 Septic Tarrk-L Liquid capacity-lag s-gallons Length_-__'%-__-----. Width-.---5--...--.- Diameter------r..----- Depth---- ---------- W Disposal Trench—No_____________________ Width-------------------- Total Length.................... Total leaching area--------------------sq. ft. x Seepage Pit No.-__----1----------- Diameter.......0........... Depth below inlet....---�. -.-... Total leaching area....1c�9•-_sq. ft. z Other Distribution box ( ) Dosing tank ( ) d D RC 4i- - f 7 -2 7 aPercolation Test Results Performed bY-------------------------------------..................................... Date..------------------------- --------.... Test Pit No. 1-----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water....---------.---.--..-- �14 Test Pit No. 2................minutes per inch Depth of-Test Pit.--................. Depth to ground water------------------------ 1:4 ---_-------------------- .............................a _1--4----------t f y �'� / Description ofb Soil--------------••--- �� ,....- -w..�9 � ---- ------- '� 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 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 the board of health. Si ned... -.�i"Y ------------------------------------ --------------- ------ . Date Application Approved By---- --- --------- --�� ---�=1�` ......-----. _ Date Application Disapproved for the following reasons----------------------------------------•---------------••---------- --------------•-••------ .------ ---------------------------------------------------------------------------------------------------------•--------------•-•-----••-•-------------•-•----...-----•----------------- --------------------- Date PermitNo......................................................... Issued........----------.... ------------------------...----- Date No. Ff�s......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD LHEA TH I� OF. >, -... Appliration -for Diipoiitti Works Tonitrurtion Prrutit Application is hereby'made for a Permit to Construct (t/) or Repair ( ) an Individual Sewage Disposal System at: F ----•• A`u _brA •j!... .......`-4-_...... 02.k t S a// / Location Address or Lot No. �.4.� f--•I`1-1-tr(Lr?tire /Z cv_Kl_ x °XS' � NH �'��-...-• -----•----............................ Owner Address 1� ' Jv-Nl�/ -N ry,F Installer Address UType of Building a i_ r3 ,x Size -------.Sq. feet Dwelling—No. of Bedrooms...----- --3---------------------------Expansion Attic ( ) Garbage Grinder (1V4 Other—Type of Building ----..-_------------------ No. of persons--------------.---------_- Showers ( ) — Cafeteria ( ) Otherfixtures -------------------------•-------•-------------------- ------------------------------------------------------•---------------------------•-------•--- W Design Flow--------------- ..................-------gallons per person per. day. Total daily flow............ o O-_,--------.-------...gallons. WSeptic Tank-L Liquid capacity.kOP--gallons Length..... ......... Widtli-.----5=...__.. Diameter......5--------- Depth..-- ........ x Disposal Trench—No..................... Width.....----------.._- Total Length... ------------ Total leaching area....................sq. ft. Seepage Pit No........ ........... Diameter....... .......... Depth belo}}�v inlet... ..__...... Total leaching area.....! °�...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) W oC � 0- /7- 77 •" Percolation Test Results Performed by.......................................................................... Date----..... ---------------------•------- ,a Test Pit No. 1................minutes per inch Depth of "lest Pit...-.--.------------ Depth to ground water..-..__----------- ... fs Test Pit No. 2......•.........minutes per inch Depth of Test Pit.................... Depth to ground water........._.......--.-.- D Descri t�'on off Soil ~` .-...... .. ` l Y -------------- �. ----- -•----- ---- w x ------------------ ---------------------:-----------------------------------------------------------------------------------------------------------.....------------------------------------- U Nature of Repairs or Alterations—Ariswer when applicable`............................................-....-..-..-.......-....------.----.....--.-.-.---.. == Agreement f =:. Tile'ufdersigned 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. Sing --- -- / y ----------- Date Application Approved By......- +' `"!� `? Date, ---•---- Application Disapproved for the following reasons:------------------••--_---------•--------------••----------,---•-•-•-----•------------------- ------------- .......'.-•-•---------•-••-•--•----•-•....................... ......r r Date .,Permit No.............................. •---• Issued...................... ...._ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH, ..... .........:.. OF........ ..........:........ ................................... (Intifiratr of f"outphaurr TITS TQ CERTIFY, That the Individual Sewage Disposal System constructed (V") or Repaired ( ) Installer at.......k:1.1 L -/�.} `y�/) LAf�t�" 94 . y'r7 L G f -- --"---------------------------------------•----------------••......---•--•--------- has been installed in accordance with the provisions of 6m, XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No .......2 1-_--_------ dated._.�1��_'_l7".�.��................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ...................... .......................... Inspector...-- !=... .4.---................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD Of HEALT 77 .......... ..of........, .7 .................. {.w 2 A5'�- ` No. FEE• .......-- •--••-... �i��u,�tt1 r ,� �oYt�trttr�i�at �rruttf Perfnlsssion is hereby granted..... . -----------•---------------------- ....-•--.........-- to Construct or Repair ( ') an Indi dual Sewage Disposal System at No...l-{-b4........,<-44-I A-10"44------4 444X-----------•-•---•-f�F t+ r 4-5------------------------------------------------------------------------------ Street as shown.on the application for Disposal Works Construction Per ' No.. _-.-. _.. .. Dated / - DATE....................................................................------------- Board of -I FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS sr }. ,r.Y n �. .. `..,. • , � is +. ,.. f�, ti r • , ;t z 1 ', -_ate � �;: '• y f f�^. ('Z Ykt 4. ,fir x i r r rf � .. �� • � S 4 p x` THEREBY CERTIFY THAT THE ,_,? F i_A;. D i3 STRUCTURE. STRUCTURE SHOWN HEREON WAS LOCATED 3; :BY AN 'ACTUAL FIELD SURVEY ON ON t , /Z 197�' AND CONFORMS TO THE ,,� ,`; � ", cs � � 70NING BY-LAW OF THE TOWN OF — - - _ .. MASSACF!USE'TTS. IN MASS. , F ` REGISTERED LANDSURVEYOR DATE CAPE COD SURVEY CONSULTANTS Pj�kOFMgs A DIViSiON OF BOSTON SURVEY CONSULTANTS,INC O2 JAMES tiu,� POUTE 132, g H. HY�atdc�iS, MASS. v WISWELL w .yj No. 11Q,(, O R`G�STER(i. �•r.� , ��'D SUR��•yo , r