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HomeMy WebLinkAbout0000 FALMOUTH ROAD/RTE 28 - Health (2) <V7 LOB No._.-••--••-••-•...A&.W /✓ Fss.... ....._ THE COMMONWEALTH OF MASSACHUSETTS GG< � BOARD OF HEALTH ..--....off{ 4..............OF....... ! Z&5.1 A,' .L.6.......-----.._..........---•-----• Appliratiun for R, pusal Works Tonstrurtiun 1hrmit Application is hereby made for a Permit to Construct X) or Repair ( ) an Individual Sewage Disposal System at: - /!�/�� �i�r��l�.... .... i -------------------------•--.................--------- --- - Location-Address or No. y�� .... .••........... .... Owner Address a ................., 2 /....�1 !may 1 c�' dG ....._ �llot`'2/.L � ..... ... Installer Address dType of Building QQ Size Lot_.� ..........Sq. feet U Dwelling—No. of Bedrooms..._.SJ......_... Expansion Attic Garbage Grinderql `4 Other-T e of Building No. of persons............................ Showers - Cafeteria a YP g P ( ) ( ) Otherfixtures ---------------------------------------------------------------•---------------------------------------------------•-•-------------------------------. W Design Flow.............S.'F......................gallons per person per day. Total daily flow..... 0.........................gallons. WSeptic Tank-Liquid capacity=.gallons Length.h.'n Al".... Width.l i.._(o`r__ Diameter.........---- Depth..S�_C-'_'. x Disvval rench—S No. ....4............. Width....a............ Total Length....'36........... Total leaching area.1s5K.......sq. ft. gr Seepage it o--------------------- -P4 meter.........----__-•--- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box YEA Dosing-tank (No Percolation Test Results Performed ......................... Date_.5_`.1 .`. ................ Test Pit No. I...At:?-.....minutes per inch Depth of Test Pit.....!Z'......... Depth to ground water. T Env (T4 Test Pit No. 2... ..._minutes per inch Depth of Test Pit.....1Z......... Depth to ground water........................ a' ............................................................ ......------------•----........ ------_.•--- Description of Soil3 k4_ _/--ic�--_ -Tr--.- 2` _ N. `�_._...� ! x .................... �� CbA.�C..... •--------• ------------------••-----•----------------------------------•----.........---.....-------•------ U W -•---------•.......................•----•-•-•-••--...---------.....•---••••-•--•••••-•-----•---•--•----•-•---•-------.......----•• •-----•••----••--••••---•-•---......-•-•-----•----- UNature of Repairs or Alterations-Answer when applicable.------------d�EBtGNING..EN.GINEER MUST SUPEt�VfSE -------------------------•-----...........----------------..............._.................-•----••-----•----------.IMST.ALLAZI.QN.AND_CERTIFY IN WAITING Agreement: THE SYSTEM WAS INSTALLED iN STRICT The undersigned agrees to install the aforedescribed IndividtPaSGOWRANWIM R n in accordance with the provisions of TITI.L 5 of the State Sanitary Code-The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha�eenissuedy the board of health. ate Application Approved By........ , ............... --•. /c � •---- Date Application Disapproved for the following reasons:......................................•----------------------•-------------------------•-•----•--._......-•-- co� I ^ Date PermitNo.......................................-=................ Issued.......... ...... ..-.!_. �1 Date ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / °- ✓sV.........................OF.... .1'"'`S' � ............ ....................................... (Irdifirau of f omplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by...._......•-•-----------------••••.._...................... ..--•-.-• -•---••--......•-•.....- .............,-- ­--- --- ---• ------- i �{ Installer at_._.. - �. -----------r �. •� - -----------------------------------------------------•-••••---- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as despribed in the application for Disposal Works Construction Permit No.�:'�_._rQ._`'7.(........ dated-------!_--'7..-2 _e;�AT ............ NTEE THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARA THE 'SYSTEM WILL FUNCTION SATISFACTORY. DATE............................................................................... Inspector.................................................................................... DESIGNING ENGINEER MUST SUPERVISE THE COMMONWEALTH OF MASSP4%$(FAttffI0N AND CERTIFY IN WRITING BOARD OF HEALI;IHE SYSTEM WAS INSTALLED IN STRICT CORDANCE TO PLAN. (� ��.. No..... .........•..... FEE........................ Dispuod urk �unriun anti Permissionis hereby granted.............................................................................................................................................. to Construct�j ) or Re air ( ) Individual Sewage Disposal ystem atNo... -`- - !!1 - = ------------•-----...-•---...---•--...----•--•-•------ .... ........... Street as shown on the application for Disposal Works Construction Permit No _:____-�?�_ Dated-------------=--•-------- .... ...............•-------------•---.......-----•-------------------•--...------------...._................ Board of Health DATE................................................................................ FOP.M 1255 HOBBS & WARREN, INC., PUBLISHERS .. L° ` �29 No............ ... 71� Fn$........./... ....:..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........`..... .11._K(..............OF..... ................................... Appliration for Disposal Works Tonstrnrtion rumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................__.............................................................................. --•••-•-•--•--............-•-••---•-......-••--••-•---•••••--•••-••-•----•--------•...........--_. Location-Address or Lot No. ......................_.......................................................................... ..........-•..................................................................................... Owner Address W ........ .............................. ........•---------------........................... Installer Address dType of Building Size Lot_ .�.?�a_..__---Sq. feet Dwelling—No. of Bedrooms.....Q...................................Expansion Attic �Q Garbage Grinder �10) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) aOther fixtures --•--------------•----------------------------------------•--- W Design Flow............ ?......................gallons per person per day. Total daily flow.... '.0...............-_........gallons. W Septic Tank—Liquid capacity=..gallons Lengthy...s 1 Width.(2.-C�..... Diameter..... ....... Width.._a....._.._. Total Len h... '___...._. Total leaching area.$3.6 x Dispi sallTr�enc��5 NO._.!------------- -- •• � - g �-�-•----sq. ft. Sed�'Qge it No..................... Diameter.................... Depth below inlet.................... Total leaching area.................. q.s ft. Other Distribution box `cam Dosing tank (�)) z 0-4 Percolation Test Results Performed by.ntl. tl'- _11l'f. ..�- •.......................... ........................ Test Pit No. 1... ......minutes per inch Depth of Test Pit-------:.......... Depth to ground water_tuuT-iZ .: -)U tA-(z-CSJ (s, Test Pit No. 2.. . '._._minutes per inch Depth of Test Pit-----!::n......... Depth to ground water........................ R+ -•---•....•-•••--------•••••••••-----•..............•-•---..........--------------.....--...•-•-•-----••-••--••-- -----------••------•----.--•-- O Description of Soil f `�, ...�'`3`L �--`- h��tI1 �- - t," ._(.. �tL�_ _Sc? _ 44T--- x _-__� .... .. ► .. -----------------------------------------------------------------------•------••-.... V .-. 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 TIT1Z 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. - --------------------- .......................... � G`� Date Application Approved By.................................... .. x......................... � /Date Application Disapproved for the following reasons---------------••--------------------•------------------------------------------------------------------------- .....................................................•-••---••-•------•----...-----......--•--....•--•---•--....--••••------..................••.............--•---------••----..... •-•.......-•- Date —— Permit No............ ................. I-...... Issued-----.1.2� - 7--1.6.. ................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Tnrtifirair of Toutpliattu THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by-•-•-----•.................----•._....................--••• ••• ----- - --------------------_.--------•-•-------------••--•---•----------•----------•-•------- ------------------- Q ry {_•— �j r �1 Installer — (�` , / at -�-.-(. L ••• lru a✓w + . ................ ''' ......d dc.......................................................--------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the THE ISSUANCE OF THIS CERTIFICATE SHALL To.���=`�---(�--`.`7.(.-•••---. dated------ ----- - - ................ cal 7 application for Disposal Works Construction Permit ALL NOT BE CONSTRUE® AS A GUARAN�E,`E`ZATTHE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......................................•-----•-----•-••......------............. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................OF.....................................................................................N. ..L. L FEE(' �s'�............ Disposal Works Twonstrurtion rrtnit Permissionis hereby granted.............................................................................................................................................. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System ....... Ce 1N..1_' _a` .. f'.................................................................................. Street as shown on the application for Disposal Works Construction Permit Ng`. .<'tj. Dated........... �.= ....... -•...........................................•------------------.........--------.......-----._...---_._ Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS f O ---------------- `1 tia . - _/'\.. ..-••..,..,.,_"'"„"L.n-�^""'""""""'L.�-.........,--..,:,..-.ate, _. �( �_ 4, �tea' �� _ �0 2 •�r•1� ';'.00R��T.:.,<::�::.•t-{ ��,/,� � -, � .- �� -� �, /� �PL k Vat) Ki 2o : � � e° ,�� y.� 57J , U �k�_"r, CID � Cam. -7o�l v4 uN�-cis �2' E���c�o►�c� Ec,�-� - c�3rzoos , 6 is,ra tr: IC 1 A �� C >CC %fo= 13?.1J I Et-q9,S _ i�C-��) a C.'S— 1 k C r�tj ' r.... � � �' bc►��a +tea��'i�. 2 , 1?)0NEy. AµD 11 60 40 l�l Prf • E►3 U I U PLUVAN i... Y � i , No 29733 • STV , ASS Y i — I o o ,� zme.- F-Aimkvo Aw.eTM�iTS c C� L� ��so,o ,q I _ Z�n t,,a `1 )+sT k L7 zo' Sz)c lid' VcA,?.No, �7' "• `�`�?�L ��1���la�a��� „ . .. s N ©ilk,t.�'� /�1�'F1'+:.T M E 0 1 o C75 � \ ul: �AKvaD: 4 TR-+ �oTiIL LOT '�61'�p 1.oT o 1�� ��� `%�- ° ', - •�/ �o a Q ffyy . O j �aweE; �'t►,it� QS ; 'De�GREA,..'Cfi ', 1 )uPN+t+e, , --- C. ; � _A t..1 Yti r r _ , iS�+ ,tc-� L� iG\j5 6EI mac_ N E; AN.57 r "'i'.►,K j �Al1. ` So►4 ' 'go S X,G�-'aT`�.p 10 MAN tN ttAq � E 17 -b '! , 14 1 I µ t , 1 .46 , "F G F. 30 q1 �zvttQ �q1,5 : , , '1JoWa�2. ' ILai i , r ; 7 - -Z� �PLTE"� krpL I I j 1r ULLIVAN LVA At Ll 1 No.'29733 { 4 ff i a I i