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Home My WebLink About0155 ROSARY LANE - Health (2) u r k) 13L)5--c� LO CAT I N SEWAGE PERMIT NO. VILLAGE xv INSTA LLER'S NAME & ADDRESS 120`40- BUILDER OR WNER DATE PERMIT ISSUED gf� j8l _ OAT E COMPLIANCE ISSUED gJ-d- /gl J G ' Y THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �5 Appliratiou for Dispasal Works Tonstrurtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: JOH,N A. A ALTO BACKHQE ---------- MILLI N4a .---------�2A1.5 ........... t street rot No. or ..........--••--------_. le.St.BarAstable __ C' ... .. U ....................... - ®> hq)q ass;'OZ .... ...... Own of 6b0. .•.-.--.•- MA ddress Installer Address QType of Building Size Lot-----ll.}.749......Sq. feet Dwell Griner ( pa., Others—Type of BuildingB mft$l __tKK.r.. No. of personsnsion Attic ( )Showers (Ga>bag Cafet e a ( ) Q' Other fixtures . -•-----------------.............---•---•---•----•---- ------•--•---•------...--•-•-•.......------------------------ W Design Flow.....j.` a..0.......................gallons per parso per day. Total daisy flow...........t_s p.................gallons. WSeptic Tank—Liquid capacityACOO.gallons Length_/o .......Width....6o-..=..... Diameter................ Depth,>A/........ x Disposal Trench—No..................... Width.................... Total Length............_o......Total leaching area....................sq. ft. Seepage Pit No...�_._._...... Diameter...../.�.......... Depth below inlet......6.......... Total leaching areal. 4_......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) J Percolation Test Results Performed by.... _a.F/�1. �N..��.................................... Date.... ) ............ } ,aa Test Pit No. 1................minutes per inch Depth of Test Pit......./1_....... Depth to ground water.:_..f-5.*....___. Test Pit No. 2................minutes per inch Depth of Test Pit.......e.151...... Depth to ground water----JAI.°fr.......__ Descriptionof Soil.........$�!�� ... Il ----------------------------------------------•----.......------.......................................... x V .....•--•---•--•.....----•-•------•---••-----•-•-•......................................•---....-•-•........._------...._.....-•---•------••-•------•--•••--•-•---•-•----•--•-------•----•........_•..... W ..........................-............................................................................................................................................................................. UNature of Repairs or Alterations—Answer when applicable..._.#P0-----fA/ c _.gvt!FGI4_...P:r5........................ ---------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITIU 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee is ue by the board of t ealth. Si ned ...........� �. — ........-- ................................ Date Application Approved By...... ':. -......` ---------••------•--------- ...... Date Application Disapproved for the following reasons:................................................................................................................ --.....--•-•-....•••--••-----------•---•.........---•-------•---------•---•----•--....---••---------•---.......................•--•------•---•---•••---•- ............................................... Date PermitNo......................................................... Issued........................................................ Date r � r_ - 61- sty t. No......................... FEz.....:5..............._. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH � C.. �............................OF...... 1......................T .... .........._......... Appliration for Uiipuiittl Works Tnnitrnr#inn ermit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: ........................ -�CH191E-S RVt -....................... .. ............................ n Ad r s - or Lot No. 1ft�a(nu street �� ": Yf�1 11 ~t t.� (2 cl�? - -.... -- �j MESS. 026b812 Address Installer Address Type of Building Size Lot..... .....Sq. feet U Dwelling—No. of Bedrooms..............�`_�____��`�........Expansion Attic ( ) Garbage Grinder ( ) 0`4 Other—Type of Building ..�..___.`____._t_.t_-`..._. No. of persons____________________________ Showers ( ) — Cafeteria ( ) 01 > Other fixtures -----••----•--•-••------•------- ----- ---- =•...................................••--..._....__.. l ' n � W Design Flow........::..:....:........................gallons per person-per day. Total daily flow........... ................gallons. WSeptic Tank—Liquid capacity_"-C,_.).gallons Length................. Width................ Diameter________________ Depth_!`K._____.. x Disposal Trench—No..................... Width.................... Total Length..............;..... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter......4............ Depth below inlet......l........... Total leaching areal``:�......sq. ft. Other Distribution box ( ) Dosing tank ( ) / Z Percolation Test Results Performed by..... __ _rt_.'!..!' .N.' .................................... Date___. jl-� �.............._... a Test Pit No. I................minutes per inch Depth of Test Pit.....13.......... Depth to ground water......./ !c ___,_.___________. Test Pit No. 2................minutes per inch Depth of Test Pit...ly........... Depth to ground water......!f'_=.......... 04 !. .* ` /• --1-..... -••-••••........:--•••-- ODescription of Soil............ _/7...'=0•. -----==�-•� =�-W=-.==-----•-•--•---••-•---------•---------•-•-------------------•---._..._..-------------•-•-------.._.......---•-•. W ••••••-------------•-•--•---....•••---•---•---•-••••---•-••-- - ...........---................................................................................................................. U Nature of Repairs or Alterations—Answer when applicable-------- ________________________ 1I - 1, ./1 ✓iA 11, / <- �A/ 0l.4i l f /!i . 1-4 f-AI i.(.. -------•-------------------•---•---••-------------••-----7---•--•-----•_-_ -----------------------------••-••----•-----. Agreement: .~.............._. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI.- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee iss ed by the board of h lth. Date ApplicationApproved By--•---•........................................................•--•-•••-----..._....._•-••_------ ........................................ . Date Application Disapproved for the following reasons:................................................................................................................ -•••••--•-•-•-••-------------•--.....-----•-•-•-----••--•-------•---------•-•••-•---•------•--•-•----------••••••----•-••-------•------•---••----•-----•----•------.................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD - .............................. .........OF..................................................................................... ;rJ-athe rrtifiratr of Tlampliatta THIS IO•`C"ERTY i In ividual Sewage Disposal System constructed ( ) or Repaired ( ) by.............•••••-•4 --•--•-- tztr o4.....12, .---- Installer at............................................................................................. - .... E• -•••------•--••--•----••-----------------------••-••-•••--••---••-•••----- has been installed in accordance with the provisions of r of he State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated-............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. . . DATE................................................... .�?-5/g ......... Inspector................... � "_ .._......_........ THE COMMONWEALTH OF MASSACHUSETTS BOARD-� �-aki�G�G.Li s' ......................................0 F..................................................................................... No......................... FEE........................ �ia,�� k� �� nrtuan rrmit Permiss}e* N-is ereb} ante, e .••• ........ ..... ----•-•-•--•----•----•----•--•-•----•..................••-•-••••-•........:........ to Construc`C'( or Repair ( ) an Individual Sew a Disposal System atNo..................................................... Strom r � as shown on the appli tion for Disposal Works Cons r c o erg£✓No.��ed. ..:_..=; �� Board of Health DATE.................................................... .......... FORM 1255 HOSES & WARREN., INC.. PUBLISHES:• `