HomeMy WebLinkAbout0105 ACRE HILL ROAD - Health '�
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LO�CA 10 EWAGE ERMIT NO. �
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VILLAGE I7
INSTA LLER'S NAME i ADDRESS
9UIL ER OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED -3-2,2 -7
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THE COMMONWEALTH OF MASSACHUSETTS �r V
BOAR® OF HEALTH
.0.cv IV..............OF..........S/.. RI .5.74,64.4C.------...------•-----•--•----
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Appliration-far Uiipnsal Works Tomitrurtion Famit
Application is hereby made for a Permit to Construct (L,�or Repair ( ) an Individual Sewage Disposal
System at:
e .CRC:----&1�Ii:....R..P:......---..Z?ARA1_57A- .8K4 .. .........4.07.......a.8.........................................................
Location-Address or Lot No.
Owner Address
a . -•--------•-••------------•-•------ --•---........c.. ...........................................
Installer Address
d Type of Building Size Loth 36/A'I.....Sq. feet
U .............Ex Expansion Attic mod) Garbage Grinder
Dwelling—No. of Bedrooms_____________________________ p ( g (1V�)
_________ Showers — Cafeteria
Other—Type of Building ----,A,1_1,2!4.......... No. of persons.................:. ( ) ( )
a Other fixtures ----------------------------------
W Design Flow..........//0.......................gallons per_;4X P day. Total daily flow................;Z__R.4........-gallons.
W Septic Tank—Liquid ca acitY 40a allons Length Width_Y_.'/d__` Diameter................ De th_.•e---�--e-
"
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.........._.........sq. ft.
� --Seepage Pit No..__...._ .._------- iameter------� Depth below inlet.....6........... Total leaching area..c2.,0.0..sq. ft.
Z Other Distribution box ( Dosing tank ( )
'"' Percolation Test Results Performed by. 0..dV,$ -.1?....A.t.... l ftll�l?...�t_ _ Date_ _._,ll
aTest Pit No. 1__G.Z_minutes per inch Depth of Test Pit...l�?- Depth to ground water.._IJtQ_bu�_...__.
Test Pit No. 2...� __.minutes per inch Depth of Test Pit_/.Z..... Depth to ground water._Ajj9_ay.&.......
---------------------------------------•----------------------------------------------------------- ..--- ----------.------•----•-••-•--•---------------------
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Description of Soil-------- .tyd-----Xt!/.L>------ .........................................................
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 iI'= 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..(ba. - n'`" -.... ---•---------------•- /--Z4---� ..
/ C Date
Application Approved BY----le
=l 1.............................................•---............----- --•• J/ /6
---- - ---------------
ate
Application Disapproved forfollowing reasons---------------------•---------------------------------------------------------------------..Da.,e..............
.....................•---.....------.......------------------------------------------.._....-----..........-------•------------------------.............................................................
Date
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Permit No--------2.2-3.:...................•-----•---........ Issued_ 3-'� �....--••••••--•.-----------
Date
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NOF-7-3. ............... l Fizz........... ......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
o F.........?'.A..R141.:�'.<,�24_47...............................
Appfiration for Disposal Works Tomitrnrtion Vrmg,,
' A lication is hereby made for a Permit to Construct d� or Repair an Individual Sewa e''Dis osal
PP„ Y ( � P ( ) g P
System at:
.....R-8�`..-------. _,6R 6�-5 A.. •. ... ........4-0-7....... - ...........................................................
.RLocation-Address -•^Q(��, or Lot No.
•i} i^.�. .. .r...- 3'h ____ ________•--.._..........___-____---__---. . ....-.......__.. --.........._-....-......................._ .
\ r --.Address
a ----------------------------------------- _____ l,.a . ....-------.._....._._..__......_...._..__.
Installer Address
Type of Building Size Lot138 S_ ..._..Sq. feet
U Dwelling—No. of Bedrooms.__..._.____..-___________________________Expansion Attic (tit?) Garbage Grinder QV0)
a -
p, Other—Type of Building ...Aa.1A...........No. of persons____________________________ Showers ( ) — Cafeteria ( )
Q' Other fixtures __________________________________
WDesign Flow......... _______________________gallons per pel`son per day. Total'daily flow.............. ._� _. _-_..__..gallons.
WSeptic Tank—Liquid capacity,1�lC-_gallons Length�_:"�."`._ WidthY'!A_0" Diameter................ Depth_`.,�_�8. '�
x Disposal Trench—No. ..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No........Z---__-_-_ Diameter.....! ......_._ Depthbelow inlet.... ...... Total leaching area_A2_00-_sq. ft.
Z Other Distribution box (Vf Dosing ( )
''' Percolation Test Results Performed by.___-')e1J4 e ?___._+ �_._ �` ram_ ��. Date
as Test Pit No. 1-_,e _:?�-:-.minutes per inch Depth of Test Pit.__!"` ........... Depth to ground water_.A:k !�_e_-_.....
(i Test Pit No. 2__!5:.3-._minutes pe Finch Depth of Test Pit _. ............. Depth to ground water-_AJ Kic.__.__..
•-----------;----•-- ---------------------------------------------------•-------- ------------•---------------------------•---------•-----------
D Description of Soil......... -- �!ar.�i.►_/_'�'._ ,./1L� ��1 S'�t?%�".........................................................
�4 e�-....._/........................................''d` K S .. 51►dU ...................... ...............................................................
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 TITLE 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........ ........... ............:....__.._..--•--...._..--•••-•-••• ................................. 7r
----•••-•
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Application Approved By....... :-' ----- .../�� fat.
A
Application Disapproved for he following reasons:----------------•--•-------------------------------------------..._____-________:�_•-•-•.Date
------------._
................................................-----------••-------•-•---------•---------••--------------•-••---•----•-•-••••••••-•--•••-------•••---•••-•-••••••---••••-•••••••••-••--•-•----.._..._
Date
PermitNo................•---- =2�;............................ Issued-----•-------------=-----------------------------•----
Date
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iTHE COMMONWEALTH OF MASSACHUSETTS
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BOARD .OF HEALTH
............e ..............OF... ....................................•.•••••
M :Alydifiratr of TuTowr
THIS IS TO CERTIFY Tha
t t1i8,Individual Sewage Disposal System constructed ( ) or Repaired ( )
by........................,......................................................................................................................................••-•--...............................
Installer
has been;'r"- alle;4 ac4 e �tlhe p �i Ions of"EEP '�he State Sanitary Code as described in the
application for Disposal Works Construction Permit No.......V V-3------------------------- da.ted.._.._��'_—A-?r_._..-_:_
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEW+WILL FUNCTION SATISFACTORY.
�7DATE.... �
Inspector 1 -----------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH ` r` `'-
7 73
No.......................... tcwt>,r Cuu FEE....._. _..-AFC
Disposal Yorks ��ntrnr�ion rranit ` `�
Permission is hereby granted--------=- ------ ,:;----fir/���------;----------------------- -----------------------=---------------------------
�, urn:
to Construct ( )/or Repair ( ) anLiniwit ual Sewage Disposal tystem
atNo... _ 1� �._�,r... --------------- -------•----------------------------•--•----_--_-__
� 07� � ��S�reety.�.sL.
as shownlon f1'e application for Disposal Works Construction Permit No.___7 '_ Dated_-_-__-_. . -
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x lw ......................................... 1 ...................Board o He'alEh -
DATE.•---.. `:_.��---------------------------------
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