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HomeMy WebLinkAbout0269 WINDING COVE ROAD - Health ��� �� ��� i y o t_ �� Ll/ --L AT ION SEWAGE PERMIT NO.. So V L A G E {� �( G rs/on s INSTA//L��LE�R'S NAME & ADDRESS G✓C�/t r �,r rl is P B UItDf R OR OWNER Lo% 3� DATE PERMIT ISSUED '7 — .29 -rn DATE COMPLIANCE ISSUED 4 Aecll- Ole /6 SC. �r o 1 1% 77 No. -•- s-- Fps........Z�.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OAF HEALTH ........ Y--:�.---.....OF........?? Gl ......c................................................. Appliratinn for Uiipusai Works Tonstrnrtinn Vamit 11-1 Application is hereby made for a Permit to Construct (Z') or Repair ( ) an Individual Sewage Disposal System at; i Locatio - d ess �o Lot No. _.... _ � aner��� - ........................ — ...._.. ......_...-Address .. Installer Address Type of Building y j Size Lot...��,� .---Sq feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (Allo Other—T e of Building No. of persons............................ Showers Cafeteria a' Other fixtures ................................. W Design Flow.......................a_: ...............gallons per person per day. Total daily flow.......__l��.....................•._gallons. WSeptic Tank Liquid capacity/V gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No-------------........ Width............... :. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No._...= ---_---__- Diameter../r1`'c ._Vb-pth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box Dosing tank 7 7 aPercolation Test Results( Performed by.......jo!�?..... .......� %^ -:........._. Date...7..z.......77............. 04 Test Pit No. 1........ ._..minutes per inch Depth of Test Pit.................... Depth to ground water........................ i, Test Pit No. 2.................minutes per inch Depth of Test Pit.................... Depth to ground water........................ _ _ 0 Description of Soil-•-•-- � .,... _ -.. �4....:�------` �E--------J?zt� l------.r'z"s z .. '-........................ U ------ -------------------- ------------ ----------- ....__..------------------------------------------------------------------------------------------ --------------------------------- -------------------- 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 iITI.L 5.of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has 5EEpi-i-s-sped by the bya��ealt Signed. --��` ........ ................ `.( ...................... . ..... ................................ // Date Application Approved By.......... ,-Eiz c` L,..:..._..._ -t /. .f.:........... ...................7.......7------. Date Application Disapproved for the following reasons------------------------•-•-----•----✓.....----------...-----------------------------•---..................... ...................'•-••--------------.....--•--•--•-------------•---•---........------------.._.....---........----------------------------------•----------------------------------------------------- Date PermitNo......................................................... Issued....................................................... Date No................ ..�.. Fps........: ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD 0 . HEALTH -----.O F........ ....::: ..... Aplifiratio for Ui)50s4l Works Tontitrnrtion amit t Application is hereby made for a Permit to'Construct ( or Repair ( ) an Individual Sewage Disposal Syst t, .. a -— I } ( .�,••- ...• - ....f .. Loea o s. Lot No. r' t..-.. ..................... .. ........... ..............-•---- ner Address W ' Installer = Address d Type'of Budding Size Lot_ t ... .Sq* f t U Dwelling—No..iof Bedroom's__________________ ..___Expansion Attic ( ) Garbage Grinder (l ► a\ Other—Type of Building _____________________ No of persons__ ___.______________ Showers ( ) — Cafeteria Other'fixtur a_•-•-•-•-•........................... -- --••-•---•-•----•--• -- W ,Design Flow ;; •gallons per person per day'. Total daily flow*:___._._ '!�' _:;_gallons. WSeptic Tank Liquid capacity gallons Length_______________ Width Diameter_.._._. Depth................ x Disposal Trench— o...................... Width Total Length _ Total leaching.area _. ......_______sq. ft. Seepage Pit:,No____________ _____ Diameter !��_..:_ Depth below,i et _s__. Total leaching area.................. ft. Z Other Distribution box ( Dosing to ( ) '� 4 I *' '"� '" ` ' '-' Percolation Test Results ` Performed by._ :. '' .:___ ..._ �: _.__. Date---7*+1...77........__-. 14 Test Pit No. I.........__.:_'_mmutes per inch Depth of Test Pit____________________ Depth to ground water......................... 44 x �►� Test Pit No. 2................minutes per inch .Depth of Test Pit.................... Depth to ground water......_................. ; { tDescription of Soil •... •••... ..J � • r74 "` ----------- ......................•- W .. ••-• -------- ------•-•------------------------------------ •• --• --- Vy Nature of Repairs or Alterations—Answer when•-applicable........................................................... Agreement: X' The undersigned agrees to install the aforedescrib.ed Individual Sewage Disposal System in:accordance with the provisions of TITTIE 5 of the State Sanitary Code"— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has e ' is d b e rd o. 1 1 . .. Signed -• = = Date• .... _ Date' Application Approved By-------=- -------- ------ r -- --•------- ....;_?...- t~ l --?------ 1wj Date Application Disapproved for the following reasons----------------•---------------------------------------------------------------------•----••--•-••••---•--•-- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS NQ C_A9D t4kS BOARD OAF. HEALTH Trrfifiratr of TOM,* innrr TH T FY, That-We Individ 1 age Disposal System constructed ( ) or Repaired ( ) by tr '"w I 1i�/ al • . at........................................ ------- ------------ _ --• ... has been installed in acc rdance with the provisions of TIT >` gfT.Jie State S itary Code as escribed n the application for Disposal Works Construction Permit No......__ . _______ _______ dated.. ..` -_--­________-__ THE ISSUANCE.OF THIS CERTIFICATE SHALT. NOT BE NSTRUED AS A GYARANTEE THAT THE. SYSTEM`WILL FUNCTION SATISFACTORY. DATE........... .........�.l._1........................... Inspector ------ '` ` .... ....................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF ......................... FEE......................... tea ' r _ Perm>ssionereb ranted•••• r :._. to Constr e air I dlvldu�1, + a osal stem. Street .......A.A, ... . ........... as shown on the application for Disposal Works Construction Permit N 7 ------"._.... � . .._. Boafd-of Health ., DATE• =-• ".. •--- FORM 1255 HO.BBS &_WARREN. INC., PUBLISHERS � r r - • 4 � r f y � i s i ` 0 C A: WILLA i N Y C +} ■� CEeT per.©�( C5$ZTtF -,j Tt4AT T14G. T'-- •. 4:'A.' 'r.: s SLA(3W►J Pt-At`,! uGr-C-REt-.1cF='� Nt=.QEt l" GCMAPL (S V,1ITI-A Ti-!i" �j1Li� 1✓l►-lE !v D►- °.4.1.,ia SETI3ACIC kC-QU1�?i=iNG tom, Tt-t� `�'1{l'S VC la1•.1 Iry LjC�T 1?.>A >i L7 C44 lit`.! 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