HomeMy WebLinkAbout1250 SANTUIT-NEWTOWN ROAD - Health c
0
02 6a �ql ()o
N6....................... Fmc.........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD E T
--------- OF...........
. . ..........................
Appliration -for Btspviial Works Tomitrurtion Vrrulft
Application is hereby made for a Permit to Construct (Kor Repair an Individual Sewage Disposal
Y at'.
.............................................................................. ....... .......
lValy-1f,84 ;.P— .. �(�!.l.!r Wyv..... ------
_.p ....
............Wo n,Ad _..R
Owner Address
................................................................................................. ..................................................................................................
Installer Address
U Type of Building Size Lot............................Sq. feet
�4 Dwelling—No. of Bedrooms_____________________ ___________________Expansion Attic (A) Garbage Grinder QW)
a
V_ — Cafeteria Other—Type of Building ------------------------- -- No. of persons...___..--_-_-____.__------------- Showers
Other fi es ----------------------------------------------------- ---_------------------- ----------- I
------------ ---------------------------------
Design Flow.__
low ........ ............................gallons per person per day. Total daily flow------------------------------------- -----gallons.
Septic /.....
1:4 ept c Liquid capacity/04.gallons Length................ Width..-__....._---__ Diameter__.__---------__ Depth..--------------
Disposal Trench N Width ...... Total Length otal leaching area--------------------sq. f t.
-�W,e
a.Seepage,,Pit No---- -- ------- lameter..Z _0 Depth.�below le,��. ...... . Total leaching are- -----------------sq. f t.
Other Distribution box Dosing tank
Percolation Test Results Performed by-----------------------------------------------------------------........ Date--------------..........------------...:
,4 Test Pit No. I................minutes per inch Depth of Test Pit_.-_____-________--- Depth to ground water.-..-__-.-__---.--.-----
�_q
�14 Test Pit No. 2--------__---minutes per inch Depth of Test Pit_................... Depth to ground water-..------------------J 4
..............
- --------------- .................................. ..... -----
----------------------------------------
0 Description of Soil----------
--------------------------------- --------------------------------------------------------------------------------- - ---------------- ------------
U -----------------------
-------------------I------------------ ------------------------------------------------------- -------------------------------- -------------------------------------------------------
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 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 b the board of health
---- - ------------------
Si ed........ . .. . ....... .... ... .....................
to
Application Approved By-- ---- -- ..U44- -- -------------------- --------
Date
Application Disapproved for the following reasons------------------------ -----------------------------------------------------------------------------------
a
..................................................................................I---------------------------------------------------------------?p- •S.I ------------ .--.��t-e...............
PermitNo......................................................... Issued.....
Date
———---------------------t/--- ---
1 .,N�.y„ j�
No....
, FEs.....��..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OIV HEALTH
.. OF.-,.. ...
A--ration -for Rsvoottl Works Tonstrortion Vrru it
Application is hereby made for a Permit to Construct (K, r Repair ( ) an Individual Sewage Disposal
XSy, at: /
---------oca on:Ad `-(- �J- f f - '---���� -----�•j off'^ VF-T--- l/-•-�. irrK(f7lY ��/r.......- l�l---------
Owner Address
Installer ! Address .
_
YP of Building i �j Size Lot,_.__---__-•________________Sq. feet
U,_ T Dwelling—No. of Bedrooms--------------------------------------------Expansion/�ttic ( ) Garbage Grinder (A)
Other—Type of Building ___________________________ No. of persons-------:;t............. Showers Cafeteria ( )
Otherfi es -----------------------------=-------------------------------------------------------------------------------- -
Design Flow_._ ________ _________gallo s pe.r person per day. Total daily flow---------- ._............gallons.
WSeptic Tank . Liquid capacity�o�--gallons ength.................Width_._......._.... Diameter------.._....... Depth....:----_.-----
x Disposal Trench—N ___________________ Width_ ..__AA_ ____=':__ Total Length_.__ ________. otal leaching area..---.-._;---_-_.---sq. ft.
Seepage Pit N . ........_... Diameter__ QN:_. Depth below;let �� .Total leaching area-- ---sq. ft.
Z' "Other Distribution box ( ) y. Dosing tank ( ) B �",Z•/""^• 1 :
Percolation Test Results Performed bY.......................................................................... Date..................-- ...............
Test Pit No. 1----------------mmutes per inch Depth.of Test Pit--------------------- Depth to ground water........................
`
f� Test Pit No. 2................minutes per inch Depth of Test Pit.......;.....,...... Depth to ground water..._---------_---:-._.. u
• ---------- . =
D. Description of fSoil---------< " 4t_NL ""�- !r.. o �- �-
• ti - -----
ti
---
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 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 Dyothe b ands health41"" (1- 114-171/
\.i /+ _ D to
1
Application Approved By -•-"•----------'-'-----: ---
� ..
Date
Application�Disapproved'for the following reasons---------------------------------------------------------'____
•-------'------------------------------------------A..--•--------------•--•--•--•------•----'-------•----•-•-----•---•-------•-•----------------•------•------------- ................... .........
a r Da e
-
Permit No. Issued = Z.. .............
Dat
THE COMMONWEALTH; OF MASSACHUSETTS
'��`" '� BOARD OF: EALTH
OF .....................
(9rdifiratr of Tbmpliattrr �,,
THIS IS TO CERTIFY, That the Ipdividual Sewage- Disposal System constructed ( ) or Repaired ( )
by-'--- --------'-- --- ---
Installer
_AAA 44f
V .......
----- - ----- ..........................
"+
has ,heen.nsta)led in accordance with the provisions of Article XI of The State Sanitary Code as descri ed in the
1. application for Disposal;Works Construction Permit No.___-_-_-----7_.!; ........... dated...- _ .. ._. - r_-_-_-__
fs---- -�-fi •
THE ISSUANCE bF THIS CERTIFICATE SHALL NOT BE CONSTR D AS GUARANT E THAT THE
SYSTEM WILL FU CTION ATISFA TORY.
DATE.............. = ----------•••--•------- Inspector.......
i/ .... ._ .. 2
2 j
t ,
1 ' THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALTH
z.
Y S FEE..
Dinpoottl Warkii 01000trortion Frrmit
4 Permission is hereby granted------------------------------------------------------------------------------------to Co uct �or,/�Repair ( an In`liv' ual ag Disposal ystem
at No�CC'It. 6� ' .: . ' (.
as shown on the application for Disposal Works Construction rmit ...... ....... Dated�___�E
.......
-----� ---------
-_..._
ar of alt
DATE------------------------------------ - -
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS '
d '8s reTe►J y ,
3 Loa fu_g
N o�
o� oo j�d.
`y �o
i
Za��- F
. m
Ile
JIG4
Q
_.�.
8.O ♦' Ac.
n1 �'
E
J
m
J
. r r
L
_ O
Ao
0 .4
IV
it r 1 W
Q _
to �
W A �� �X
a
1P k�Y x� v
61
r U
f
Tow+.
,
E3 Ate tom! TA _� ��.o.,�T���-� AA A S �.
n �o
21 c� Awn w $tom A.c tC�-TT ;
r t t t G.
BARNSTABL F_ PLANNING BOARD APPROVAL OS'T���/IL..)r
UNDER THE SUBDIVISION CONTROL LAW ,
- NOT RC U1RED
RS
ER
Ri
7A td
1.�T �- tJaT To 8s Gc�ti�EtZt� As L-csC'
II ,