HomeMy WebLinkAbout0153 EVERGREEN DRIVE - Health CYrarS�on��� --
LOCATION SEWAGE PERMIT NO.
150 4-'"!/ERGR6 -N //7D, _
VILLAGE
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I N S T A LLER'S NAME i ADDRESS
3 U I L D E R OR OWNER
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DATE PERMIT ISSUED 3Z90
DATE COMPLIANCE ISSUED
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
-W tj.................OF.......�4A.m5n..9.4-L .
ApplirFatitu for Bispos al Works Tonstrurtiun ami#
Application is hereby made for a Permit to Construct ()() or Repair ( ) an Individual Sewage Disposal
System at:
......i-Q-r----Z........0 Y--&R.CrA6.6 nl...bk.. I. RS.7'p!✓ ....l- zjoI L-s_. _a
Location-Address or Lot 1Vo.
....�� , RR.l.-1. .......-Y. .D.,�.PaR�1T .,Q. ........... -------------------------'....... ...---.-•-----••-•---_.... .
Own r !@ ...............
`1 Address
W
nstaller ddress
Type of Building Size Lot -----Sq. feet
Dwelling—No. of Bedrooms............5...........................Expansion Attic,(/� Garbage Grinder{— )
` Other—T e of Buildin
a4 yp g ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
� Other fixtures
W Design Flow............. --'r......................gallons per person per day. Total daily flow.....S-�®........................gallons.
WSeptic Tank—Liquid capacity/5�Q.gallons Lengthr4..�.(. _._ Width5.'.8..... Diameter................ Depth.... ...__.
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.........._.....sq. ft.
If
Seepage Pit No........_.�._ Diameter......16_......... Depth below inlet.,....4._.......... Total leaching areacl! .=....sq. ft.
z Other Distribution box O) Dosing tank ( )
14 Percolation Test Results Performed by._a>._R.,..$WD.R [t.....LNg.:...................... Date....�..�.---------------------------
'I
Test Pit No. 1..<.. ....minutes per inch Depth of Test Pit..... . ...... Depth to ground water..... ..f'..._..
f14 Test Pit No. 2...!�!..?�_..minutes per inch Depth of Test Pit.....#2........ Depth to ground water-___ .._...
a . . • -
Description of Soil...-••-. .... xl.....MEA.... . 4.40................��. ��••• i2o ...........
.-----------------------------------------•--• . - R.9.�r .............................................................. R-�4.v.. _ '
V rr �;....._. a w
--------------------------------------------- ..�N176...M46b_.SA#b.-------------------- .......
U Nature of Repairs or Alterations—Answer when applicable...............................................................`6.R. .6.....•_............
•-----------------------------------------------------------•------------------------...------------------...------------------------------------------------------------.....-•--•-----••-••......-•••-
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITL:, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been is y the boar f health.�,/ %/� `r�
Sign ... . ..c'/�.�.....�...
Date
Application Approved BY ��119 - '-------------------------- ff /pp aa�
t j �! -=D ate
Application Disapproved for the following,reasons-................................................................................................................
-•-------....-•-----•------------------------•-----•--------•-----------•-------.......---•-•----......•..------------....----------•---------------------------•--••-••••-----•••••-----•-••--•---•-.-•-
Date
PermitNo.........................................................
Date
V"�I •tJ m'' _
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...........(,_Q_I sl-.................OF....... .1 .L _
{ Appliratinn for Disposal Works Toustrur#inn Prrmit
Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal
System at:
.....1:.5:.(•__.c!j....... •I),ti......... .... ..)„f)_t�<_j..11.f... -•ii;;
..Location-Address
,• or Lot No.
caner +
W
Ad ress
......
� nstaller Address
Type of Building Size Lot��Y4.6 L"' -----Sq. feet
U 'Dwelling—No. of Bedrooms........... ...........................Expansion Attic,(-') Garbage Grinder-( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
d Other fixtures
_-
W Design Flow...............:— �.
..:....................,...gallons per person per day. Total daidailyflow__._.� 4:3.t�..._...... ....._._..._gallons.
W Septic Tank Liquid capacityLL TOJP..gallons Length/r,.._: Width'":. ?...._ Diameter.,.............. Depth....':.........
x:,
x Disposal Trench—No. .................... Width.................... Total Length_........:A......... Total leaching area....................sq. ft.
r-
Seepage Pit No.-._-____f_.__-__-- Diameter.....Z .......... Depth below inlet..... ......... Total leaching area:~ �_.......sq. ft.
Z Other Distribution box ('�) Dosing tank ( )
a Percolation Test Re$ults Performed by.S: _e`K:... �_4-11 .4'�..........
_ !ID7 • . ...... Date.... ..:_: ..:.. U.............
•- ------.-. ---
Test Pit No. li.... _....minutes per inch Depth of Test Pit--_._1:9.f....... Depth to ground water..... . .r• '......
fT4 Test Pit No. 2:. r. :...minutes per inch Depth of Test Pit.....�`�'�..'. ?'-t p p Depth to ground water....:..... .........
a ..... ...............................................
Description of Soil.. • t .:f.'.r .. ..n .... .-- ... � '�. - ! r??4 1� Z� '&.E_.......--•-
x s
U ................•--------••-- .............................. fir'' ......-------•------
t��y .......................... Ce LI ,`Y ' 4?.�N/ e•--jY? �'�'F-I i --....... -•----....!t't rrr jt_
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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system i
operation until a Certificate of Compliance has been ' by the boa of health. .f, J Ow
V.
Sig �- .... s�✓_ .y.... C ..•......
•
Dat
Application Approved By..... - !-.. .-V�/..--
Date �d
.............................. ........................................
Application Disapproved for the following reasons------------------------------------------------------------••-----------•------••--•--------•--•-......---...._
-•--.......---•-•..................................••-------•-------------....------....----•-•--•------- ----------•-
--------------...--•-•------------•-----------•--••-------•---- ----•-.........-----
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
I (k!. ............O F..~. '
..............................
Tntifiratr of Tnntplianrr
THIS IS TO CERTIFY, That the-Individual Sew D- pos 1 ystem constrzted . ) or. Repaired ( )
Installer +
at ............................ i� '"�s t _... _.. /iitrt2 - r. !x __[.1 G
. •.... . ...................................................
has been installed in accordance with the provisions of T 5 of The State Sanitary de des r' J' the
application for Disposal Works Construction Permit No. '............. dated.... _�_ �..__ "l"
• .................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.............. A
. / ............................... Inspector Inspector..-•- 'd ...............................................................
THE COMMONWEALTH OF MASSACHUSETTS
a
BOARD OF HEALTH -
J� A/ OF.....'^+.F�.. r �r y°;r _tea... 5Q°d
No....... ,"' FEE.....................
Disposal Works Tnn#rnrtinn ernttt
Permission is hereby granted-.%: . .................................f- 1 R.. :_ :a
to Construct A ) or Repair ( ) an Individual Sewage Disposal System
� ' 't at No................. ` -.--. ......_ . __.. = rF .1s......j? ..... /3; �! .................� .
Street fy — Jl I�I[o
as shown on the application for,Disposal Works Construction P tfN (. Il... ........ Dated..........................................
®`` ..•✓
K�o .................•................
dal
DATE..-------- - .
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS