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HomeMy WebLinkAbout0129 CONCORD LANE - Health sac, C t�q TOWN OF BARNST/ABLE LOCATION .m.g:, p t 2 l EWAGE # , VILLAGE ASSESSOR'S MAP & LOT 22' I� INSTALLER'S NAME & PHONE NO. EPTIC TANK CAPACITY Cz-TD (' 'ovLEACHING FACILITY:(type) `cZ o O"e-x (size) ENO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER It UILDER OR OWNER IZY—E(2 DATE PERMIT ISSUED: 07�Zlta DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No X'.._ i LA, z 3�5 - y 36 _ 34 _j THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH X...................OF .... ..... Appliration for Disposal Works Toustnuflutt runfit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: K" ...U44e...... L 9 ..............cm­e.................................................................... Logi�n-.A(ddres or Lot No. . .. ...... ............................................ ............................................... ............... ��ner ,Address ....................................... -----?1?------r ... .................... .......... . . ....... Installer Address U Type of Building Size Lot.ZC)..)J0ZQ....Sq. feet Dwelling—No. of Bedrooms_.....3.................................Ex pansion Attic Garbage Grinder '4 04 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria P4Other fixtures ...................................................................................................................................................... Design Flow.........65...........................gallons per person per day. Total daily gow.......33.0........................gallons. 1:4 Septic Tank—Liquid capacitylC, M..gallons LengthV-0."_ Width.A!7:10'. Diameter.-T�...... Depth.5.�7-6.. W x Disposal Trench—No..................... Width................._.. Total Length.._................. Total leaching area....................sq. f t. Seepage Pit No........I----------- Diameter......_.__..... Depth below inlet....&........... Total leaching area..7.00.....sq. f t. Z Other Distribution box Dosin;tank Percolation Test Results Performed by..0AwX-'MCt..A'4_G...tA.4 ................ Date..72A.(6!.6q---------------- 0_� Test Pit No. I../-.Z.....minutes per inch Depth of Test Pit.....1.1......... Depth to ground waterJJ0.TA5jf0L*J?15M 44 Test Pit No. 2...ZZ.....minutes per inch Depth of Test Pit......J.Z,....... Depth to ground water----1!.............IJ ............................ ....................................... .........2-=i.k...................... .7 t .. ... .....& "' 0 Description of Soil.....TAICM .Z kE----------------D.r. Z' m. ................... ............................------------------------------------------------------------------------------------------ ....................................................................................................................................................................................................... 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 TJITA 12 5 of the State Sanitary Code—T e undeg�g�nerther ag ees not to place the system in u th e operation until a Certificate of Compliance has en;is Ledb he boar d,ofKLKealth. ii n .. ............. ... .. .................... .. ........ ... . ............ ........................... 7 .......-2 t ApplicationApproved By........... ... ....1-12k. ................. ................................................................ ....... Date Application Disapproved for the following reasons:.............................................................................................................. ......................................................................................................................................................................................................... Date PermitNo...... P------..._.. Issued....................................................... Date -4C � %/;�/ �t 4 lg �..^ g i..� �.�•�/r 1.4 �7 No.. . ; S/Y!/_J t \•�y�- t'" Fizs...... ,-Se..,..•.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............OF..... s. � .'i .......................... Appliration for Disposal Yorks Tonstrurtion 1Prutit Application is hereby made for a Permit to Construct ( }, or Repair ( ) an Individual Sewage Disposal System at: ;�=;...... ............ `" -------- ----_._.-•------------------------------- Locatican-Address or Lot No. ...........J.-. �....._.__..�'. !.r.�" ........................................... .......... ....................•....... ... ........... ........... ner / Address �. ` ... . . Installer Address Type of Building Size ....Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic (A b Garbage Grinder04 '4 Other—T e of Building No. of persons............................ Showers Cafeteria dOther textures ............................ . �( WDesign Flow......... .:............................gallons per person per day. Total daily flow.._..-_.,t - ........................gallons},r WSeptic Tank—Liquid capacity j� __gallons Length A..':L%.. Width-''.!( .. Diameter.._..-______.... Depth.: .:: _. x Disposal Trench—No--------------------- Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------A........... Diameter......_e;)......... Depth below inlet....t........... Total leaching area.: .....sq. ft. z Other Distribution box (Yas Dosing tank ( )f I '-' Percolation Test Results Performed by.. Date.... t .. aTest Pit No. L.4L.....minutes per inch Depth of Test Pit......__):......... Depth to ground Test Pit No. 2___ '-:....minutes per inch Depth of Test Pit......t.....•.. Depth to ground water.....?`.............�..f O Descri tion of Soil. 1 L .�.*. _.:_ .J.......SL........................�......{� wL�....%. � L . -'.............................. 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 TIT11 5 of the State Sanitary Code— T e undersigne tl:er agr es not to place the system in operation until a Certificate of Compliance has en iss�wd b the board of ealth. „S e . ......... J . -------- .......... ....... D te......f-•-•••. Application Approved By. -.____::.:'..:_:"..!-L?� - _�--4 f ~ PP PP =_ ----....................•-•- Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------_ ....................................................•---------------------•--------------------------•------..........•-••-••--......_......---•-•-•-----••••-•---•-•---••-----•----•••---•••-••-•-•-••- .W.. L Permit No...... ::.. ........... -•-- �--......... Issued..................---------------------•---.............a Date THE COMMONWEALTH OF MASSACHUSETTS �_..--_-,._,___.-BOARD OF HEALTH J. s P�J .....................................OF.............. '.h?� .............................. Trrtifiratr of Toutpliatta THIS IS TO CERTI , That Individual Sewage Disposal System constructed ( ) or Repaired ( ) • ---•-......... -------------------------------- Installer of. . , at...... ... ` ......._..._ ��. ?r. --•�.. ..---....:w ,.�� ............... •--------•--......---••------------------------------ has been installed in accordance with the provisions of TITI of The State Sanitary Cod as desc_ibed in the application for Disposal Works Construction Permit No.._.�._._...__L�.._t dated.... ��''s _ 7...... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE gONSTRUED AS A GU RANTEE THAT THE SYSTEM WILL FUNCTIO S I�S`FACTORY. DATE ��.. .....--•---_.---•--•--•------------- Inspector..----------•-•-----------•--------------------------------------------------•------ 170 THE COMMONWEALTH OF MASSACHUSETTS OARD OF HEALTH L' �.........OF...:u.... A,&A Nc ................................................ No...��........,./(d' FEE....................��....--��... �io�ro� for �o �tr�rtion rrutit Permission is herebyranted---•--. 1A.1....... . ...•--• --------------------------- g I to Construct ( ) or !pair ( ) an Individual §ewage Disposal System at No....�.`-__-.••... x ="•Cores Gne� L -{ vrGet -•-••-•------•--- - - ---------- ------------------------------------------------------------------------•----•-•••- Street as shown on the application for Disposal Works Construction Permit No.....7_..<(.1-- ated ............................. ---------- Board of Health DATE........... .. .... .. ...�...---..................:. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS �E51 C-i ti1 ��. 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