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HomeMy WebLinkAbout0193 WINDING COVE ROAD - Health T 053 --- M ct i i N SMEAD KEEPING YOU ORGANIZED No. 12134 2-153LGN SWtAKW FORSM MIN.RECYCLED INRINNE CONTENT 10%1110 C9MedMwftwcb9 POST-CONSUMER sfwM MADE IN USA GET ORGANIZED AT SMEAD.COM LOCATION SEWAGE PERMIT NO. L,,- (-a �y Div s�iA) C'nue, r VILLAGE cS7- Qs3 r" [f s o Z 6 ve I N S T A LLER'S NAME i ADDRESS BUILDER OR OWNER Oc ��►w Gam-;� �AL� DATE PERMIT ISSUED DATE COMPLIANCE ISSUED I� ti f ' No.460..-:/®f THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH "....ICJ.Lf�. ......_.....OF........1P'7� .5` i `J-/ •----•---- ` Appliration for U44poii al Workii Tunuuurtion ranfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System -7 �/� .�c,,ram�©/ �,�sd7�drr - .... ......_.. .. ...... .-----•-•- ....................................... ocation•Address - or,I�t No. Ow Address Installer Address Type of Building i z e Lo `/Z ...... feet Dwelling—No. of Bedrooms..____ ___._._�________________________Expansion Attic (/►J Gar age Grinder �Z*Other—Type of Building •-_:__j�__.SlQ✓ B. of persons............................ Showers (/V — Cafeteria ( ) a Other fixtures ...................... W ............................................................................................................... Design Flow......... .....................gallons per person per day. Total daily flow-----------35 .................gallons. WSeptic Tank—Liquid capacit/P A2-gallons Length................ Width-____--_--__..__ Diameter_............. Depth................ x Disposal Trench—No............... .. Width............ Total Length.................... Total leaching area....................sq. ft. /B Q 0 9F"I- Seepage Pit No.------/--------- ................ Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water..................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a .................................... -- --- --------•-----• -- 0 Descriptionyo/f Soil....... ................................-�'.. Sd/` ••- ------ .......................................� .�'�/Z d----•---•------ ---------- ------------------------------------------------------------•--------------------------------------------------------------------------------------------------_------•------ 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 i I p of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ed by the bo -d of hea Signed_ . .......... . ............. Date Application Approved. B - --- --. : _ '_.!......_. _ ------------•-----•------- - ---- � ,,,,, Date Application Disapproved for the following reasons:.............................................................................................................. ................•--------••----------••--••-•••-----••-•----......••------•----•••----......---------------••--••••-••--•-••-----•------•-•-----•-••-------•---•--•-•---------------••-......-•••-•----- Date Permit No. .... ..... Issued. /,x-d2/................. Date No. 0. ./di'. - .�.... ....: THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Appliration fnr' D.iipuial Works Corm rndinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal system -74 ocation Address /°"`y.' .... / r t No t.y G -. Installer Address '4� 1� Q Type of Building ize Lot__Z?' /._-----.._..Sq. feet U Dwelling—No. of Bedrooms...____ _. --------------Expansion Attic (A Ga age Grinder ( � Other—T e of Building ..S ✓ �. of persons............................ Showers — Cafeteria a Other—Type g ----- --- -- P ( ) ( ) Otherfixtures .................................. ••----------------.-•--------------------•------------------•---••-•----------•--•-•------------------------------ W Design Flow........ .✓ ................gallons per person per day. Total daily flow...........7500 ............................ WSeptic Tank—Liquid*capacit/"Pzallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width............ ..-. Total Length__....._...... Total leaching area.___.__ --_-------sq. ft. oo� /-#, .._.__ Seepage Pit No...-._-/.____.__.- )��.................... bepth below inlet..._..........:_._.. Total leaching area..................sq. ft. z Other Distribution box ( . ) Dosing tank Percolation Test Results Performed by........................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ t14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.___..___-__-----_____. W ---- --- O Description of Soil " _ r��rt- S.G �...5`O t . .�........., . .. '.S�;%.±i U -•-•---------•-•-----•---•------•-•--•------••--------------•-----------------------...........-•--•-----------------•••••••-----••-•----•--••-•-----•...------•----------------•----•---••-------•••--- W VNature 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 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee�r>a ed by the bo d of healikv. Signed. . ----- ----- ................--•--• --- ---- --•---........................ le Application Approved B r'! '.....*f/ . �............... ................. Date Application Disapproved for the following reasons:-----------------------------------------------------------------------------------------------................. ...............................•-•----------------------•----•--•-•---•--------..._.......-•---••---........--------------------------...---••--•------------------------...._.......-----------...--•--- Date PermitNo................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............oF.......iG.+�d / N 1°�.!�:. ! '+� ................................ (9rdif iratr of ToutplianrrLor THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) b ....... ......... 411.Z_A4A.!----.":... t A., -------------------- Installer . ^� has been installed in accordance with the provisions of TI' LE j of The State Sanitary Code as described in the w- application for Disposal Works Construction Permit NOA910_«:101................ dated---- ........................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNC110 SATISFACTORY. DATE.. � ----------- Inspector ; THE COMMONWEALTH OF MASSACHUSETTS' BOARD OF HEALTH ..... .G... ............OF .............................. FEE........................ R.Op"ll a1 Marks Tunny radian Vamit Permission is hereby granted................IV.4A-"-4-r/-----_--_-------------------------------------------------------•--••-•-----••-----•----•--- to Construct (6�15 or Repair ( ) an Individual Sewage Disposal System at No..----- d1?`_. . '......... .��?..J,�I!f- ------ JG! ------------ R s' c^�, ---••-.�".J�C j Street as shown on the application for Disposal Works Construction Permit No--------------------- Dated......................................... 2 f Health DATE --------------------------------•----------•-...........-•-•----'•......... FORM 1255 HOSES & WARREN, INC.. PUBLISHERS �.�. •t�,r.l I:ATA I-Aat t_l•f P LOw It o -4 3 t 33o G-P•D• � -EZQF-nc -t-auk - 33o.. ISc % • A9S USA t oOCR 64,L- 0 . \ ovj .�15P�A.L PtT - Asa; IOo� Gbt... �rj•�� Imp SF �c 2.S • 3-IS f�.P.D. t Co9 TOTAL C `rz�To t- 'teal t_�f FLOW = 33p b.r?D. _ pount ORr�a �. 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