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HomeMy WebLinkAbout0179 WALNUT STREET (M.MILLS) - Health Walnut.Street —16'rst6ns.Mills Ar No.._....... lL:.. . >r 'Fus.... 11� . THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..............OF... �� I� -L..JOIJ54 Appliration for Biipogal Workii Toutitrurtion ramit Application is hereby made for a Permit to Co s -•uct (X or Repair ( ) an Individual Sewage Disposal System a A ...... G .42,x.: ......... .. Locatio •Address or Lot No. �r ------------------------------ ................L1�-�.M.V 7 ......5111...-----................ Owner Addresj a d l.. -....... ............................... •--•----.1 �# _ /V, .•••...mil_-/Lo C6 ........................ Installer Address Q Type of Building _ Size Lot.. _, 4.8...Sq. feet U Dwelling—No. of Bedrooms.............. .............._.._.___...Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures -----------------------------•-- . ---•--------•-•------------ W Design Flow...............:: .4'..........._..•_._gallons per person per day. Total dail flow_......�.m.o..................gallons. WSeptic Tank—Liquid capacity/0-pC'..gallons Length._....7....... Width________________ Diameter---------------- Depth----4........ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......I----------- Diameter-__---_---------- Depth below inlet........-........ Total leaching area.?4?0......sq. ft. Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by----47��t�'y--_��._. ...... _.�-- -_ Date...5 h7 �_746....... ,`4-1 Test Pit No. 1_.��__.?_...minutes per inch Depth of Test Pit--___.��_______ Depth to ground waterA4r _,9^". 1 off Jea-b Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------- -•---••--•---------•-----•--- ............................................................. •----- -------------•-----•- - ---•-•-- 0 Description of Soil_. s ...._ -� � -• -. .... ----- ..---...C-0,41...�Z....---- --------------------------------------------------------------------------------------•-------------------------------------------------------........................................................ U Nature of Repairs or Alterations—Answer when applicable..................... .......................................................................... ----------------------------•--------------•-------------------------------------------------------.-•-------•------------•-----•••-----•--------------------•--------------......-----...........---••. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with t'1T�•1:•-• the provisions of iTTLEE 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. Sig {.,.,..... 6 /��/✓N�k�.�YI�V/� --- •---------Date... .�... Application Approved By---------- .. /,lAw- ---------------------------------------- Date Application Disapproved for the following reasons------------------ ---••......................---------•----•---•--•--•----•---•-•............................. . ---------------------------••-----...------------------------......------.....---•---------------------•-------------------------------------------------...........------------------------------------ r-�^c{,,,( � Date Permit No. Issued- --------------------=--1.......•..----------- Date No.�Flot. Fim .' ..r-....... ' THE COMMONWEALTH OF MASSACHUSETTS _1. BOARD OF HEALTH L✓N................ ........................ Applirafiun for Disposal Works Tonstrurtiun Vrrutit Application its hereby made for a Permit to Cons •-uct ( or Repair ( ) an Individual Sewage Disposal System a _ ......... .... ............. -- ---4,49-6 .......----------------.....�:0_-r.:_...... .---------..._._......_..-----• ------- ocation-Address or Lot No. �Ad..----..... t�.�� G���_�.�1.cJ__......-..._,5.?"z5..n......................... wner Addres a �__.... .......... .....•--- ,R '. __I.CaJ.I/ . -----•-------------•-•---•-• PQ Installer Address UType of Building Size Lot._��__.Z b_8__..Sq. feet �., Dwelling;-No. of Bedrooms_____________2_________________.___.___Expansion Attic ( ) Garbage Grinder ( ) p, Other=Type of Building ____________________________ No. of persons____________________________ Showers ( ) — Cafeteria ( ) Q' Other fixtures ---------------------------••--- - W Design Flow...............5.7.tr..................gallons per person per day. Total daj� flow........Z__Z_0..................gallons. WSeptic Tank—Liquid capacityf4Z-70_.gallons Length___._....... Width__._._....... Diameter________________ Depth....1........ x Disposal Trench—No_ ____________________ Width____________________ Total Length.................... Total leaching area--------------------sq. ft. 3 Seepage Pit No,____.__/..:____.... Diameter.__._._6_........ Depth below inlet........4........ Total leaching area__��'"__pO_.....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by..... ...... ....... W a Test Pit No. l.C..''�'_...minutes per inch Depth of Test Pit------l0_`_.__ Depth to ground water/S/0__ .. U�— f? Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.....� . -------------•----------•--------------------------•-------•----------_...-----•-------..._•---•-••......................................................... 0 Description of Soil--0.. -='3..----L"Of)M----- ----.,.3_1.- W x -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-•-•••---•--•--•------- 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 i T T E, p S 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. 16*Sig e ---------••------------------------•--•----------•---•-••••--•••--• Application Approved By----- Date •------------•--•_ -------••--•-- Date Application Disapproved for the following reasons------------------4F................................................ ...................................... ..._....--•••-••-••••---•...---•--•-•---••------•--•••--•----.._..--•------•---•----------•-••--•------•-••---••---•--•-••-•••••--•-•-••----•-••---•------•-•••-•-•-•••-•---------•---••--•-•----••-•--- �� � Date Permit No......................................................... Issued_- -^ � Date THE COMMONWEALTH OF MASSA,CHUSETTS BOARD OF HEALT ......O F....... .. . . 21 (9rdifirFaU of Toutpliattir T 1 TO CE FY, hat the Individual Sewage Disposal System constructed ( or Repaired ( ) by------ j t--•-- - ---••--• . --•-• •-----•-----•--------- I taller has been installed in accordance with the provisions of TI j of There State SanitaryYUARANTEE d as desc in the , application for Disposal Works Construction Permit No..__ j./ '�► �f-_________- dated--- ------------ r. THE ISSUANCCOF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A THAT THE SYSTEM- WILL FUNCTION SATISFACTORY. f 4: I/ ..a i- 7 ---------------••-•--- DATE.................... Inspector..... . ---- srtw,f }r THE COMMONWEALTH OF MASSACHUSETT BOARD OF HEALTH " 7� X � f ...O F...... a................. "" ............... ..... 01 No._........_..._�� FEE .___---. .... Disposal ko n ion Fermi# Permission is hereby granted......... _ _': ___ -- - -- -------- - - - -•- - to Construct ( r pair ( an ndiva ewage Disp al yst94 . +,,Street as as shown on the application for Disposal Works Construction Permit . ....... ___ ted...... '`'7-•I....... Y. -•------------------fr ,x •. �-• oard of Healt DATE--- = _. ? FORM 1255 HOBBS & WARREN, INC., PUBLISHERS ell LOCATION SEWAGE PERMIT NO. VILLAGE �Civf log s /Y�i��s INSTALLER'S NAME i ADDRESS XM A..AALTO BACKHOE SERVICE t5ow' 'fut Sheet West Sarnstable, Mass. 02668 BUILDER OR OWNER �..)y T�f x0"� DATE PERMIT ISSUED -7 _7� DATE COMPLIANCE ISSUED _ 121 r. wo 1 h H t s7; 1-7 LOCATION S E W A G E PER I ;. VILLAGE INSTA LLER'S NAME i ADDRESS 1XM X+A&TQ BACKHOE SERVICE rifest ilomstable, Mass' 02668 BUILDER OR OWNER 174 7, -?o",� I' DATE. PERMIT ISSUED OAT E COMPLIANCE ISSUED i i 23' -/2 1 1 , 4 Alk 1-1 fw •C .,b [n f - l - F"(.'..�-Y ;'�I- 'Y i r mow'!re r - ���c f%✓�# 1� �'" n �;, _. c } 5.- `. _ ^� 45}F,. 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