HomeMy WebLinkAbout0289 SANTUIT-NEWTOWN ROAD - Health f�L�q
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L 0 C A T I ko�s� agQ E WA G,E PER IT NO.
VILLAGE
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I N S T A LLER'S NAME A ADDRESS
R U I L D E R OR OWNER
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DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED /�� �,�
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
..........................................O F........'...................._.........
Apptliration for Disposal Works Tonstrnrtinn famit
Application is hereby made for a,Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: HvkrzE' tt a`a`1
C'I..r-ZPa✓.� - �0 �*c�� 11 ,C� '! .................. ---........------•----........----......_.
.._-- ._....... - .............. 9�- Y
Location,-Address or Lot No.
Owner -------------•-......•.............••.......Address
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms._....3.................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............... No. of persons.........._._.._.._.._______ Showers — Cafeteria
Q' Other fixtures -------••---------------•-----•• -
WDesign Flow...................51.T.................gallons per person per day. Total daily flow____'�i3 ..............................gallons.
WSeptic Tank—Liquid capacity./&V....gallons Length._.. Diameter-__^___---- Depth ..� �..
x Disposal Trench—No. .................... Width.................... Total Length..................... Total leaching area....................sq. ft.
3 Seepage Pit No.___----_-..__..... Diameter.....14.__..... Depth below inlet..... --......... Total leaching area..5 4 j._..sq. ft.
Z Other Distribution box ( t.,T Dosing tank (
'-' Percolation Test Results Performed b .....!� -..�.1?! ...... __ .krAIy Date..... •
a Test Pit No. 1......Z------minutes per inch Depth of Test Pit------3.......• Depth to ground water........................
G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a -----------------------------------------------------------•••• ••-------------•••••------------••------------•......•-------•--------------------------------
0 Description of Soil......a•-.-••••-�-?.......A�........�.r- Z3.-•-•••-•--•••--••--.
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 C ificate of Compliance has b n issued by the board of health.
o, Ab -gam
Ap licatio pproved By•-•••..... — .....O-'--------•-•---.......................................
-•---------- ..........................
Date
Application Disapproved for the following reasons:..............•_._....--.•.•..•-_._.•......._._........•__.•-----------------......_....._.........._.._......_
..-•-•--•-•--••-•---••--•.---•---•---•...-•--•-•••••...........•••�-••-•-••-••-•-••--•-•--•.......•••--••.......---•...........-•----•---•---••-•••-••••-••-•--•••--• ........._.Dau......•......_
Permit No. ../...... Issued_ ---••--•----------.
Date
i
No.!� FimB.......... 7 -
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...............:. 4 .:�.: OF.......................... .-....... _..._..
.4.0ra#inn for Disposal Morks Tonstrnrtinn lirrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
.�
_ Location-Address or Lot No.
ALN LL M° Owner Address ..........................................,
a ..................... ......_...._
Installer Address
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms...... ..................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers
a Other—Type g -------------•-•---••-----•• P ( ) — Cafeteria ( )
Design Flow_Other fixtures.: .;
W g ...........gallons per person per day. Total daily flow---?3 .............................gallons. --
�
W 5 t ;, ank—Liquid capacityj�?..gallons Length.._��__ -. Width. .__4L Diameter... _
............. Deptl-1�..____....:---
xDisposal Trench—1Vo:.:.........:.......... Width.......`............. Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No---------f........... Diameter.....44......... Depth below inlet.... `.......... Total leaching area.g_41..__sq. ft.
Z Other Distribution box Dosing tank ( )
W Percolation Test Results Performed by.... .......... -1.__._...._.__!...... .........!�7......... Date___.!' ._._ !_.". `f.........
Test Pit No. 1......Z......minutes per inch Depth of Test Pit.....13......... Depth to ground water.............•._----.--.
Gr., Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_\....--._.........----
Pd •-------------------------------------------------------------------------------•---------•--•-..............................................................
O Description of Soil------..Z.: �-in.......//.I......,...4.13..------•--------------------------------------•-----------------------•-----------•-•-----•-•--•
x
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 TITLE 5 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..-.. . ..`�; t.....-
GJ ---------- - -- --- ----
,... _ Date
Apphcarion Approved By__:...._.,� .�. _ ... __
' Date
Application Disapproved for.the following reasons----------------•--...._..._...-------------------------•-----------------------•-------•--......-----•••......_
..................................
.........................................
.--•-------.....................................................................................................
/- Date
Permit No. ---'.... 7 !a----- Issued......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS Y��
BOARD OF HEALTH
..........................................OF...................................................................................
(Irrtifiratr of TnntpliFattrr
THIS IS O CERTIF , That the Ind; al ewage Disposal System constructed ( ) or Repaired ( )
AVi
by....................... ..........•- - "----..C.1.,... z-......_.....
.�r
In aller _
at..........................----�-�-�--•---------• �"`�'�,"?�.e,ah...�'"_----- fls1�. �j--•�-�-�`,at`----------•-------•----•-------------------------•-
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit ....... dated_ ---- ..............
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM 19e1IL1. U CTION SATISFACTORY.
DATE.............. .... .. f�f���---------------------------------------- Inspecto -----------.....------------.........-----------....----••-•--•-.....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
ZcZ�" N jq ..........................................OF..................................................................................... FEE. �fVJ
Dispns Works Tnnstrwtinn Vprrmit
Permission is hereby anted----... :.._...Tom.' ...............-• ••.Ff------- a. ..t..•. .................................
Construct ( ) qr Repair ( ) an Individual Sewage Disposal System
.>i-
Street
as shown on the application for Disposal Works Construction Permit N = ( _ Dated.....- (g�.._ .......
Board of Health ✓
DATE .. ....... .-...-o
FORM 1255 A. M. S LKI INC., 80STO
I___..__..______-- .__-._ .�______.._...___... Gam•N - --_� ----- --
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iPlan Seale 1"- 50 RU Cape £rb e-uAf
bate 7-9-85 L19 /dazbo-t /oad
14grw� Ma. 02601,
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Sketch. plan ol t and tin. N"A to na Mi,Gl a, Ma.
90ti cizang Wanr,e t
6 i.-4 totes 8 & 9 az shown on a plan of buck Pond
AaaooLat" 94z&.t and "-cb ted .in l5k. 25L1 Pg. 29.
Ctwat.Lona 4hown ate on an ad&mwd datug.
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f Date; Rgn t t3a4,4 tabta 6oatd of idea&
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9"t Pit bata,p-3985
Made 12-21-84
Wit. tZon GiR 4d
No wateA enCounteta
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4YILLIAM s
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