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HomeMy WebLinkAbout0028 PEACH TREE ROAD - Health r - ; r14'hz+.' `-i.. -.•d ,t � 3 .:.. �i:"-..- Y? �,2. wP.� 4 f( lk ,I..r"s D now ,. • Cz5 — C,17 o " - 5 - -, - ,. - � •. Y-. ; ., ter.' ,, 'S �' - • e� / r a , o, r 1 , i z - s LOCATION n % SWAGE PERMIT N0. VILLAGE INSTALLER'S NAME i _ JADE RESS 67 tLDE R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED J V-• ,. ��� � .ram No.....................-- THE COMMONWEALTH OF MASSACHUSETTS BQLAR® OF HEALTH 1-.©wJ................OF.......... 35�.. l.r......------------........... Appliration for Uiivuual Works Tonstrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal . .........P .......•• .......................................... rL_eat,ion-Addless r or euu....1.:.. ......... �_.Z.... �_... ........................................1 ......... �..... .__..... Owner Address :... _... ................................................................................................. Installer Address Type of Building Size Lot _DJ`��.:..Sq. feet U Dwelling—No. of Bedrooms......... ............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons.....................--.---. Showers ( ) — Cafeteria ( )a! Other fixtures W Design Flow...............1 ..............gallons per personPer day. Total daily .................... Ions; 11 W Septic Tank—Liquid capacity Dgallons Length_.ZS.. ...-. Width. .Z�?.... Diameter................ Depth/�-.. x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No.....1............. Diameter....6. ........... Depth below inlet .. ...�...._.. Total leaching area, 4ZM.:...sq. ft. Z Other Distribution box &/ ) Dosing y tank ( ) ° G - Percolation Test Results Performed b Date.... .._!. Test Pit No. I....�.....minutes per inch Depth of Test Pit......1..._...... Depth to ground water........................ 44 Test Pit No. 2................minutes p inch Depth of Test Pit.................... Depth to ground water.........--............. .--------------------------------•------------........_._...------......................................................... O Description of Soil.....................2 �-------------------------- U -........L� ------------------•--•-------------------------------.-------------------•---•--•- 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 iITIS 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has en issued by the board of health. Si ed...� . .� ---- j 1! .g .._---- Date �+ Application Approved By..... rr GGtl!�• '�• t3►�� • Date Application Disapproved for the following reasons:............................................................................................................... ....-•-•---••- •---•-••---••••----•••-----......-•••••.....---•-•••....-----•..............•-•---................--•-•----•-•--•-•-----••..................•-•`...... Date � - a Permit No.. ............. .. . Issued.---------•--.z.d... .......................... Date do R' THE COMMONWEALTH OF MASSACHUSETTS .'B0, ,.OF HEALTH 0...............OF.......- ............ "`''' .._.. ..._............---•--. Apliliratinn for Dhip ti al Works Tomitrurtion 11amit Application is hereby made Jor a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal' _ 'mod'ataon Ad ss �''"' -� r- r�or Let—No --- - I l i t h�' 1-----"� 1 ",K""'[;GR►w.t. W Owner _.. ....Address a __ ------ - ----- ......... Installer p'Address d C Type of Building Size Loti_.. .r 1--- Z.-Sq. feet U Dwelling—No. of Bedrooms.......... ____________________________Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Building ____________________________ No. of persons............................ Showe, ( ) — Cafeteria ( Other fixt '• - d ;W Design Flow..................� .................gallons per persone; day. Total daily flow------= �".) l�ns. WSeptic Tank—Liquid capacityt� g lons length__ _�_____ Widtki.__-/ .?Gt_ Di`.meter _! Depths' a . x Disposal Trench—No..................... Wi'th.... �..__.. Total.Length........ __ ....i.____ Total leaching area:...................sq. Seepage Pit No.....r------------ Diameter___.. .._ Deptlj below inlet. ._ __.___.___ Total leaching areaaQ_::...sq. ft. Z Other Distribution box (k) Dosiia tank ( , a ` + '-' Percolation Test Resu Performed by _ .... � .__- Date_. _ :! _'_ ►-1 +� k Test Pit No. 1....._______....minutes per inch Depth of "TAest Fi'�t ____ __ Depth to ground water........................ fT Test Pit No. 2.........._.....minutes,per inch Depth of Test Pit------€ .... Depth to. ground water........................ -- -------•-------------------------•---- ° Description of Soil____.....____ "t "R1-r= t...-- I �a UNature of Repairs or Alterations—Answer when applicable__ y� °^ `` w -- �a..�. ��-: ..: ________________________________________________________________________________________________________________________________________________________________________________________________________ Agreement: The undersigned agrees to install the aforedeps ribed Individual Sewa e Disposal System in accordance with the provisions of TIT1Z 5 of the State Sanitary Code The undersigned further agrees fibt'to,p�l ce;theYsystem in t ,.._a operation until a Certificate of Compliance has en issued by the,.board of health. Sigd f . ...................................................I.............. ...11L_.tt. ........ Date t Application Approved By..::....__t,. �� L444 ,._ ._. Date Application Disapproved for the_following reasons________________________________________________________________________________________________________________ ....................•-••-----•--•-----------•------------=----....---------•-------.....--•-----------------•-•-•--•--•----------•---------•----•----•---............................................. Date Permit No........................................................ Issued-..................................... •--•------ Date r , THE COMMONWEALTH OF MASSACHUSETTS '-, BSA QOF HEALTH .C11 ......................OF;.....`...°A.? 1-: i,C ....................................... IT.rrtifiratr of Tompliattrr THIS IS TO E IFY, Th the Ind vidual�Sew�ge Disposal System constructed ( or Repaired ( ) r=... Ij/ _) Install has bee installed in accordance with the provisions of,.T r r of The State Sanitary Code as descri d in the application fors Disposal Works Construction Permit No.. %� �Z dated-: .-__ :'. ........ THE ISSUANCE OF THIS CERTI.F ,ATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. -- DATEIi#spector=---tr.......................... --------- ..................................... THE COMMONWEALTH OF MASSACHUSETTS f �- �.g@ARE ,0F HEALTH ! .OF..... ......_....-........................ No........... FEE..... . �Iin�u��a1 rk� onn nr�i�n� �ermit Permission i here granted........•._. ..... ................ ......... to Construct �r R pair (. ) an I ivid 1 Sewage i osal S stegm4 { at No._' ... . .. ... . uL ,�/,�f'�W� R �� Y ,bp S ret of as shown on the ztpplication for Disposal Works'Construction Peo.____ ABoar - ;C4Dated..... ... L�! �Health iWswM ,y DATE e ......................... '� t FORM 1255 HOBBS & WARREN. INC., PUBLISHERS a7 i I 1 b 4 -�, z _ �3 o G•P•b• i \ i F�C % = A-95 6-P.D. �•aF'c��iL P!T - use locao G/sL. 1 1 Suzic/AL- AeEA = tso s.F. 4 / I 11�7� SP7 14 2.S = 3 7S G.P.D. , J' Firo,rA AQFA = ST-. TOTAL .42S G.P.D. / '�'`�`�• -r'oTG i` D,dl L`f FLDtiV = 330 6.PD. 41 ,i Z��-�-- { 51t A1rnl. Pr2GDL&no&.1 C ,&-rE `„i" Smiw' oiz l.�'SS. vti LP Mp r �' �T" -t,,• . -.ram l -1 ( �. �j•� 7oY Fa:b. Cock lay. S 4'��� t IW 6AL. . f -8oK qq� SEvnc Io Iuv T.o htK Sorry 1000 4� ��v lwv. 't. Sa.17> GAS.. 4q Z 4q•�J 4 LEACN PIT WI-rw •i l' N CLt1��! wAsa+ED merr>. STouE- e/-a3 F�tzc��i LE LoCATi O" AwT'oM,; �►t t'�tLL4 - �ti� 1 Z ►.1 o Sc A.�.�-- �..:c1�L C-, ��I'- Ei D ��1�.�'� �,lG{.��tz' PW GGtZTt1= i>`!AT TI G ;OTC A-MOl- 'St-lo�ul.1 Pti-AtJ =F=ramt�.IG'c N t_t?t_a!r Gt�tilPL�(5 W I TF-N T": r 7 3 AUK SEYt�ACIC 7C-QLJIQGtAE-"TS Dt= TFiC- �-^ �-kUII ,, •J r`��. P(-Alj Poz. ALA� a, ' MA L4., Ij,.- C- RCGIStt �D Tt-!IS C7LAal I UO-r t',�•;CL7 vc.� 1d�1 l!.!rt'C'=J%/1C=►`1 ��Ut,�/ �{ .` T�1iY UFi_��=r�i il1C:WLD n'- A.PPL-I C_/.J--l-r �j - , r . -.- z ,- �• e t i ::�= 1 r l_!I ii it ISZs:rPr 1ri nidrd�"..1.�AAA