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HomeMy WebLinkAbout0307 RACE LANE - Health �a�'' (fie. C�-�e.i � ,� 0 9r - LOC&TION 5Ewiic-xE_ PERMIT UO. VILL AGE _ -DATE-PERNAI-T _ _DATE -_COMPLLQ.tJCE _ LSSUED : - e. 1.0� 35 P®Ad � o No.................(4f. ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD 9F HEALTH _ .OF..... .- —11.0 ..�.. Apphratinn -for Disposal Works Tonstrurtinn Vrrniit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: / �y /� •-- -------------<- Location-Address � .C_ or t NS� --------------------- -���s�e!"_k'll.�=--�1.........�---•---. ..�.a':t`-:t�:����vl../...��Y...7J Ow er Ad ss Installer Address ;� d Type of Buildi#t Size Lot_ v.Sq. feet U Dwelling ATNo. of Bedrooms...----_-..�.........................Expansion Attic ( ) Garbage Grinder ( ) 114 Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Q, OtheF tures ------------------------------ -- WDesign Flow......... : .. ...........................gallons per person per day. Total daily flow.....1.jJrvV........................gallons. WSeptic Tank—Liquid capacity.,**" Pgallons Length................ Width..._-..-._..--- Diameter..ingg �area D -nth................ x Disposal Trench—No. ............ ....... Width-------------------- Total Length----------------- ..+..._...sq. ft. Seepage Pit No.._...._./_--_---. Diameter........C........ Depth belo inle . ............ otal c i .................. ft. Z Other Distribution box ( ) Dosing tank ( ) � � aPercolation Test Results Performed by....... ................................................................. Date--------------------------- ---------- ,� Test Pit No. I................minutes per inch Depth of "lest Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 .....4k----- J------ -- 1 -------- .r ^_ - 'l O Description of Soil___- _0------; 1 ...0.. �' -- - �` ! �.�l.. 1 -- x /�., - , __ -_ -- ---- - ------ w ------- � .• - -----�=-- UNature of Repairs or Alterations—Answer/when applicable.................................. ......_-_............------- ................... ---------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------- ---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance witli 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 ' s ed by the board of he Ith Date Application Approved By----------- - --- -- --- 7 _' 1. D`_----`------- Date Application Disapproved for the following reasons:--------------.............. . ............................................................................... ..............•-•----•-----------•------------------•-----•----------•-•-----------•---- Date PermitNo......................................................... Issued........................................................ Date 0................ .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD /9F HEALTH .. .. .......... .................................................. Apphration -for 43hipaiial Worku Totw4rurtion Punift Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: /-/Z/, .............................................................. ...... ....... ... .. .................. Location Address ....... or Lot No ............... 7, ..................... . ................ A4a�_psr K­�' `='................ ..................111;_IX/1 .. ............................................ Installer Address Type of Building Size Lot-.-- ....Sq. feet DwellingONo. of Bedrooms------------ ----------_-------------Expansion Attic Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons............................ Showers Cafeteria ( ) OtherAxtures ........................................................................................... V -& ................ ---Design Flow..........5. ...........................gallons per person per day. Total daily flow gallons. Septic Tank—Liquid capacity'D00 gallons Length................ Width..-__.._....-_.. Diameter.....-._-...... D )tlI................ Disposal Trench—No_ ------------------ - Width-------------------- Total Length_--.----___ IP941AA-----t.......sq. f t. Seepage Pit No........Z......... Diameter------- ........ Depth bel .. Pot) E.inlp, a ffivigarea..................sq. ft. Other Distribution box Dosing tank ( 11) 1 � _/ y'74— Percolation Test Results Performed by.......................................................................... Date---------------------------------------- Test Pit No. I................mmutesperinch Depth of Test Pit-..__-_._______-__.- Depth to ground water_..--._--..-.-_-....... Test Pit No. 2................minutes per inch Depth of Test Pit_.___-.-___--__-_-_- Depth to ground water...--.-___.--..-.-._.... ------ ---------------- --------------- ----------------j...... ....... ............. ......-------- . ........... ........ (11----------- 0 Description of Soil---'-,C)...... ------- U ­---------------------- ------- . .. ... ....... ........... ..... ........ .... .. ............ -----------——------------------------------------ ----------------_------------ ........ .................. .. ....... .... - -- - -- --------------- ................I--------------------------------- z I U Nature of Repairs or Alterations— nswe when applicable.--__--------------------------------V-------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 beep issued by the board of heald-j— ..... ... Date Application Approved By- -------------- h , ..._..7 Ste_. Date Application Disapproved for the following reasons:------------------------------/------------------------------------------------------------------------------ ...................................................................... ..............................................................................--------------------------------------------------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF ALTH OF............ ............ ................... ................................... ......... . ............... ........ G.rdifirate of 0,11mpliaurr H S 0 CFIYI;TIF , That the Indi dual"SewaZe Disposal System constructed ��) or Repaired IV T �T 4 by..- .... ------ Installer ................ /7------_-------/......... --.7� af" A --------------------- a ------ .. .......�2--- --- -- --- . ...........g -------- has been installed in accordance with the provisions of XI of The State Sanitary Code as described in the rp application for Disposal Works Construction Permit No.- .........?6'i. ......... dated..4/ f111_11 --- ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. - ............................................ Inspector------------�_I- DATE---- _-A� V, ............/------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS Z/ BOARD HEALTH z�7 ...... ........ ...OF.... ,No.............. �.... ................... FE E./- /.............. tt Permission, -hereby granted--_-.--e---�_ - -------- --- --- - ----I—— 1117� ----- ---10A-0---- 5___n-�_ __ - ( - -------------­------------- to Con�it .c �pair. Ind al rage Disposal S t ky, � 14-' ............ at No_;. . ........... ... art Street as shown on the application for Disposal Works Construction Per No......... ........ ---------­------ ........ Pe ........ .... Board of He DATE. • ....................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS goo ly 3g-T�,s .s S.'�. 1_ 5. 1 FFl t-}F R - '• ..-4y.�. A+,- +!' krt,f' �'•T Yt '. _ es� Y .. " - �-. .� ".. t` 'a�' '�. � z'• �� F"l', -, /�,�, tray 1^-; # ti r v. .. - /// ♦ ._ _: 7 _,_7op "`L j Yy y tom'.t. % _ ]� .yy.s•_ t h-'a"• �,X S G3 Oro"3S' E-:-rs./2S'•'90 w s , � � ��. -`�� .��xh, X _ 7 •.PiT W//•3TeivE - - S� . so 0 TLIS T 4 s,t 4 jR .woe yA,_ N srEp # .� �- •.StP>ic � `. SAS.O � 2S� GSA/pF •.�1GCES3 E/�iSEr MEN7-' _ . G oT XZ { CERTIFIED PLOT PLAN E © C A I O N: • S:C A"'L E � "�' D A T E : ..Ft E F E R E k C E: z'3�i t/�J- La7- >,rV /9 A-L/9/V �E�Go.eOEp /�'T THE %C/ >�G/-�N Bd�ff 27? 0 A T I: 4 H.E RE B-Y C E R T I-F Y THAT THE BUILDING R E G. LAND S U R V Y O R 5 H.d W N O N T H_I S PLAN 1- 5 LOC A.T.E D 0 N ' 1`' ftE` G R 0 U ND AS SHOWN HEREON AND f� L-b�s T..F AT IT CONFORM T,O _ THE r ; Z.ONING BY:.- LAWS OF THE TOWN O-F iq:ENS ,8G,C-- W H E -N . C 0 N S T R .0 C T.E D � oEORFy o LOW A V � � a la•ARNSTABL- E SURVEY C 0--N's U L TAN T 5,p I.N-C. ',TVa`�� � Y ° {' .WEST YARMO-U'TF1 AAA � S O31oR�l;� Nket - _ 4 - - tS