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Home My WebLink About0036 NAUSET LANE - Health Its■■■■■■■■■■■■■■■■■■■■■■■■■■■■t■■■■■■■■■■■t�■�1 / d � h � LOCATION usd SE AGE RMIT 0• H6.67 � 17U o�Fl VILLAGE C: i' 7 TAL. L L� INSTA LLER'S NAME i ADDRESS t1t to le/A--y t2 j6UILDEIt OR OWNER t � A4 17-/1 DATE PERMIT IS-SUED DATE COMPLIAN-CE ISSUED F 1 �' i� • � � �� ` _ � �o _�- `^ �. �\ c% p THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH �CvJf�...............OF.......'�..C&(Y\n!: t,L. 1. ....._... Appliration for UiipntiaI Workii Tnnitrnrtion tlerrAft Application is hereby made for a Permit to Construct (L4 or Repair ( ) an Individual Sewage Disposal System at: ............ C�l ..._. ......--•-----------•-•................. .................... •........ ---.....---------...................---........---- Loca io Addres or Lot o. •----------------..........- -•-.............................................. ............................................ ................................ Owner Address w % s:. �, As a; s �- =- - .........---•--••••._ --------•--....--•-• ....--•--•----•---•- . ...................................... � Installer Add...ress. Type of Building Size Lot...9.--�T .....Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (iLj aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------•------- . W Design Flow..............\A.0....................gallons per person per day. Total daily flow..........33 Q._.._._............_._gallons. WSeptic Tank—Liquid capacity\aQQ_gallons Length................ Width................ Diameter__-_____-__--_ Depth................ x Disposal Trench—No. .--................. Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ' ~' Percolation Test Results Performed by.............B.c�- .....r.._ ........... Date......,.'`'.: ..................... a 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 •••-•-•••-----•-••----•--•:......••--.....-•-••-•---•-•. ...--•••-•--;-....•••••-•...`-------------------•---•------------------------•--•---•---------..... O Description of Soil........... �.............V...�1--•-••--�--•----�-� S C'.e-` ......-•-•••--• •--- -•............... .....................................................................�-�� ---------......v-��------------. UW ---------------------- - �' ._.... --•-- d ` - = ...... - gel 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'!TIE 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. J Signed........-- ��....... ...... _Th �A — ............................. � D Application Approved � -•--•................... - 3 �_a ..= -- . .....-•--- Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------•---•---•----- ...............•••-••---••-•••••-•--••--••-•-•••--••----....••-•--•------•--•--•--•---••-••••------.......---......-••---•-•-•--•---•------••----•-•-•-•-•------•--•••••---------------•----•---••••----- Date PermitNo......................................................... Issued-....................................................... Date No.....&X?n k Fss... ..._ THE COMMONWEALTH OF MASSACHUSETTS BOARD _OF HEALTH ...............OF............ t� ............................... Appliration for UWVos al Works Toutdratriion Prrutit Application is hereby made for a Permit to Construct (L4 or Repair ( ) an Individual Sewage Disposal System at ............W.t ......�!.(' . ............. '`�-------- ----•--- Loca�ign-Address ........................... .......... ....__ .......... -...______-`----__ _________________________ ___ ___•---•---.. ............ ..... ............................... Owner Addres Installer Address U Type of Building Size Lot..-9 .....Sq. feet 31 Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder � WOther—Type of Building ____________________________ No. of persons............................. Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------------•----._.._._..•-••- W Design Flow.............AA 0..... ._.....gallons per person per day. Total daily flow..........Z3. _______.____....__.___gallons. 04 Septic Tank—Liquid capacity��QQ_gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No..................... Width............ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. `-. ( ) Y g- - .__ -)= - -•- .. . ""........... Date------- "�� Other Distribution box Dosing tank , O _ st Percolation piTeoRlsults Performed by Depth oe Pit_. __.. _.___. Depth to round `ater.J P P P g -----------------•••_.. Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water........................ --------------------------------------------••--••••-••• -•----•-•--••--•-----...---•(----•_----•---••--•...........-•--......_.._......------•-••••-•--••- O Description of Soil..........C.?- �'-' �OCl_M ..•--•-aUA_":0,� x ••••---•-------••••• ..............................�.. ' =------------�.�= , - �c•cv- ------------- - - -(� W -•-••---•••••- --------------------------— ----�.............m�a••----•--• �--'`-_�.e�, `°�J'.1�-- �(1�. �� 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 TIT1:;s. 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. Signed....... -------0...._. �............. �� '"_� -- ..... 3 Application Approved BY-•..""' ,-.'4-,.,/ :.... ---.. ................. Date Application Disapproved for the following reasons--------------------•-------------•------------------•--------------------------•-------------------------------- ....................•--•------•-....•--•-•-•--•----•--•--._....••••••--••-•---•••--------...--•-••------------•---...••-•-••-•--•-•------•••---••-••-•--•••••--•-•------•----••-••---•---•••-•--------- Date PermitNo..................................................... - Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � n............of............. arn..!...�.t �..................... Trrtifirttt of Tontplianrle THIS IS T CERTIFY, That the Individual Sewage Disposal System constructed ( VYor Repaired ( ) by............. 0........... ...--••----•----------------------•-------...------...................._..------•-- nstaller at. -----•••--` �- -�P - - ` 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 No.___8,42./4'_w_______.____ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATIS ACTORY. DATE....................•---•-------._.......... ./. .......... Inspector............PAlr' ...................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ( ' .................OF........... �.�.1�.n_.5.. -.s'� U`.---._................ s " No..47-.a�-=_/__ G FEE........................ _. Disposall 'Works Tonstrudi an amit Permission is hereby granted............. •\-t1.`�........ ----------------------•---•--_-_--••---------_____--•--•-----_-___ to Construct ( or Repair ( ) an Individual Sewage Disposal System atNo........... _ .----------.+�C ,._..._...--- > --.----•----h- ........................................................... Street as shown on the application for Disposal Works Constructio�Y '-•1��---y . D t d---•-•-------•-••--•--•-------•-•--- �/� Bo of Health DATE..!:?"/ ............ FORM FORM 1255 HOBBS & WARREN. INC., PUBLISHERS �tt.SGl_t: �v,Mtt..�! - 3 8t=�7�oM ► . . ; : 6 .,e Alf Uo 6AIzr3A1--E Cwgi ?:),&lL-! IrLO%A/ a 110 t 3 • SSC> G•Pv i : ' � � y��,x IG '1 Aa.itC.a 330.r l�o I/# • ��'!6.P.D. '�?t�POtAL_ PIT ---- _ ' : :. l3 Sf1rt�[ . ' . _ -• AG I . . E 150 3e 6.Pt�. :. :. .. ToT•AL 'U E.•S160_4$$ &P-D. L.. .. .: : 4xP ;T^ ^' •: - �_ O f _. ,T-o-rA L •Da t L� Ft.ow 4 330 6�PD. : ' : � ' : � � :.. � • . " .... ,. 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