HomeMy WebLinkAbout0022 POPLAR DRIVE - Health f
L0CQT1, ,_ 5EW&<CE PERMIT MO.
VILLAGE
S QLLER 5 U&ME AD RESS
6af 11L Lv— ` = - - - -
BUILDER'S U &ME ADDRESS
nI J. 'LWJJL,��
Dt.►TE PERNA T ISSUED
�7 7
D N,TE COMPLI WACE ISSUED ;
Q�
V
,' � `5 111
l � i
x ..� I
�` c
�i i
-`
..................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEAL
�f L -�'1-------- --------OF... ... ... .... .-......
Appliration -for Bii gittl Workii Towitrurtiott Vrrmft
Application is hereby made for a Permit to Construct (VI) or Repair ( ) an Individual Sewage Disposal
System at: .
,o
-----------------------------
Location-Address or Lot No.
C = ._ U/ .® '/P�6 ^�� / .� .� ......'s=..... 1�.... fIV yli9l.�
Owner Address
do
Z-Installer Address
Q Type of Building Size Lot____________________________Sq. feet
X<WL&welling—No. of Bedrooms--------- _____________________ N dXExpansion Attic ( ) Garbage Grinder ( )
per-, Other—Type of Building ---------------------------- No. of persons.--__-_.-_-___-___-_--_---_- Showers ( ) — Cafeteria ( )
Other fixtures __. ��
--------- ------------
w Design Flow__ _______________ ...__....,,.��..�-allons per person per dad. Total daily flow__.. - . :..__. __._.l_.__.____..._-..-.gallons.
WSeptic T ank l Liquid capacity/e-OWgallons ' Length................ Width------.......... Diameter---------------- Depth.--.------------
x Disposal Trench—No- -------------------- Width---------Total th. W___ .----- Total leaching area.......-------------sq. ft.
Seepage Pit No...... ............ Diameter._ ._... ep o in __. __-•_-_- Total leaching area
Seepage ft.
z Other Distribution box ( ) Dosing tank ( ) ' a /O c/)U,, 16_a;t— 7 g/
aPercolation Test Results Performed by-------------------------------------------------------------------------- Date--------_----------.----------------
,� Test Pit No. 1_____ -'___minutes per inch Depth of Test Pit.................... Depth to ground water..:__-_.._-_---.--.--.-.
f1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_.__._--__--_-------.--
: -------------------------------------------------------------
O ----------if-------,i--- _
Description of Soil - ,c�..... .. - ---- ---- ----
r
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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee sued by th board of health.
Sn ---- ------ . •--- . ----• --•-•---------------•- --------------_-----------
/�'�® Date
Application Approved By--. � ______ J't�� ,_.11 .
' � Date
Application Disapproved or the following reasons-------------------•- --•••--••------•----•-..........----------------•-•--•--•-----•--•-------------•--
... ---- ------
PermitNo.............. --•----------•......................... Issued---.
Date-----------•-•----•--.._......
ik,
Ali
THE COMMONWEALTH OF MASSACHUSETTS
BOAR
y Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at y
C
f
Location•A ress or Lot No
`h'.f40-Chp 10&----Owner Address
�yJ i9/.�trJ
.................................. ..........
'Installer Address
Q Type of Building Size Lot............................Sq. feet'
.3 IN ►' welling-No. of Bedrooms_________ ____________________�"Expansiom Attic ( ) Garbage Grinder ( )
Other—Type of Building ---------------------------- No. of persons---------- ----------------- Showers ( ) — Cafeteria ( )
Other fixtures --------------------------.-------=-- --
w Design-Flow---------...................................gallons per person per day. Total daily flo ...............................gallons.
9 Septic jc k—Liquid`ca gallons Length................ Width..._..._::_--- Diameter---------------- Depth----------------
x
Disposal Trench—>No. .-... _'Width........ ......... To I Le h- - --------------- Total leaching area-.--.--._._.._._...sq. ft.
Seepage Pit No ....:.............. Diameter o. e:.-* I .._..__............ Total leaching area------------------sq. ft.
z Other Distributln box ( ) w ''''Dosing tank
aPercolation 'Vest Results. Performed by.......................................................................... Date------------ .........................
Test Pit'No. 1................n1inutes per inch Depth of "Pest Pit.................... Depth to ground water....__-.......------ ..-
,( rz., Test Pit No. 2-----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
i O - ......................................................................
y ....
Description of Soil: .._-. .-....... .r
--------------------- ---------------- -- ' 3- Y -••--- . •... . �, 1� — ,
W C1009
UNature of Repairs or Alterations—Answer when applicable..._____..,;..._......_......................................... ........_--------_..._.......
---------------------------------------------------------------==----------------•---------------------------------- ------------- -
Agreement: _
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System iii accordance with
the provisions of Article XI' of the State Sanitary Code=The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee • sued by th board of health.
n.,. Signed
--•-•-• -----f-----e--
Y y
Application Approved B r --r'j/--------------------
Date
Application Disapproved for the following reasons.:'...............
........................................:.-:___.____-_..........._._..___.___._._.._.._.._.•._._
f ---•--•----••-••-•-•••-•••-•-••---•-•-----•------•-------•-•-••-••-------------••-•-•-•--•--••-----------••-•-•••••••---•-------•-•-•----•-.............................................................
Date
Permit No......................................................... Issued.............
...........................................
ziP Date -•`
- -
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEAL H
Trrtif iratr of 01.11,11mliliatta
T^3 IS TO CERTIEVs That the I dividual Sewage Disposal System constructed ( ") or Repaired ( )
by `r ------------------
----' =
at staller .. /�+1 zr: ............
.•••.... a.
has been installed in ac r�lance with the provisions of A` iclr I of The State Sanitary C Vea e�ribedn tieapplication#or Disposal Works Construction Permit No. � ..�_...__...... dyed:... ..__-.�./......
THE,ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR'UED,AS A GUARANTEE THAT THE
SYSTEM, WILL FUNCTION SATISFACTORY.
DATE.................................=" --= :: ` Inspector.--
-•----------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O "HEALTH
... .... L . .......OF
No. ,Z �34 FEE-_
Ar
j Permission is Yeby granted....... ,. . �___' ..
to Constr or Re. r, ( an ividual ewage "i .al
at No. d � ...... .........
u. Street r .�
as shown on the application for Disposal Works Construction P it No .... .. ated-_:: �� ��'ls---.•..
r r ,
!.,.r oard of Health
DATE
FORM 1255 •HOBBS & WARREN.'-INC.. PUBLISHERS
a
OD
L 0 T 56 LOT 57
127.00
LOT 48
ire c ��
LEACHING PI
Sto>1 e T�L�G� -� 14
C EANOUT
lee dy� _
m SETIC TANK °D
v'
0 4
J
62 1`
PROPOSED
c\j h
DWELLING
N (With bsm't) F—
a O
12 18 J
32' 26±
C
O
w
POPLAR DRIVE
��Q�;�H OFMgss9
HERMAN �y
a; RICHARD Cam•
WEINER na PLAN OF LAND
10 IN
BARNSTABLE, MASS.
SCALE 1/4"= 5 FEBRUARY 10, 1975
OWNER : P. M.C. HOME BUILDERS E & H
281 PLEASANT STREET ENGINEERS
BROCKTON, MASS.
73 CURTI S AVE. STOUGHTON, MASS.
I
® co
Y JJ
r
L 0 T 56 LOT 57 O
J
127.00 "
LOT 48
E ,
LEACHING P�T
CLEANOUT
_
SETIC TANK co
o 4
J
62
CI'
PROPOSED cv r�
DWELLING
N
N (With bsm.t)
10 O
N
12� 18 J
32' y 26t
CD
O
rn
1
POPLAR DRIVE
p HERMAIV
j RICHARD .
a o WEIN3 Ell
No. Zn� :� �~� PLAN OF LAN D
10
a.
IN
BARNSTABLE, MASS.
SCALE 1/4 = 5 FEBRUARY 10, 1975
OWNER : P. M.C. HOME BUILDERS E & H
281 PLEASANT STREET ENGINEERS
BROCKTON, MASS.
73 CURTIS AVE. STOUGHTON, MASS.