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HomeMy WebLinkAbout0124 PALOMINO DRIVE - Health l a ha�o�u�w ICI✓• 0 0 �� �, �, �, � . a �� �r P ,. V G fi A n s I D C 4ESSO O 42101/3 0RA 10%' P4 LOCATION �g SEWAGE PERMIT NO. L ,oT- 88 - WmtN0 . . VILLAGE ,-�P Yus7-Rl3 t'Ef mAqS S I N S T A LLER'S NAME & ADDRESS B U I L D E R OR OWNER DA T E PERMIT ISSUED DATE COMPLIANCE ISSUED q- /0 - 7 � r a 2� 2'� / w C-d- THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF, HEALTH 7.t V ---...OF........ •7'f�7 .? .............................. Alipliration for Uiipniiai Works Tnnitrnrtiun ir' Mit Application is hereby made for a Permit to Construct (N/) or Repair ( } an Individual Sewage Disposal System at T s. .�. Location-Address or,Lot No. • Own r i Address r 1 a •---•-..... :......._.. �� _1_ _L ............................ Installer Address d Type of Building Size Lot... 4_6®g'..Sq. feet Dwelling—No. of Bedro ................................................:...Expansion Attic (A�) Garbage Grinder ( l aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures ---------------------------•---- - W Design Flow............'I-- ..........gallons per person per day. Total daily flow......... -513 .......gallons. WSeptic Tank—Liquid capacity.)O.Qagallons Length................ Width---------------- Diameter_............. Depth................ xDisposal Trench—No..............:...... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........t........... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ) Percolation Test Results Performed by__.:-. _. ..:.. ..dam.......... Date..........fil _ Test Pit No. 1-_ 42-----minutes per inch Depth ofTest Pit.................... Depth to ground water.....................__. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.--_-_.---_.•__---_-___- -------------------------------------------•--------------------------------------------------------......................................................... O Description of Soil.........0..: _Z.....�-OAK k... ..... -------- � ------•-•--t.- ... 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 THTL L 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. Sign �K.�.. ��a � � t • - Date � d- ZAPPlication Approved BY = ; _ Date Application Disapproved for the following reasons:.............................................................................................................. ..........................................................-••--••-----.....-------•------•-•----.....---•----•-••-•-----------• ------------------........................................... Date PermitNo......................................................... Issued---y ���.7 Date 07* � �— - - No..........[?...G Fx$. ..`_'............._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF. HEALTH . ------- — 4J.........OF........ / try .. .............................. Appliration for lliipnsal 10orkii Tonstrnrtion Vamit Application is hereby made for a Permit to Construct (V6 or Repair ( ) an Individual Sewage Disposal System at: A 1-o Q f ry to .+��a�t" , �1�P+y a t �r�L.C. I-N .... ........ .5.:78C......... .. ..... ......... ................. ....... .........f....... ......._ .......................................... c ll Location-Address or Lot No. , ..... •A- 1.4 r � i Address ^Installer t r Address QType of Building f r" Size Lot...---:.---t--�"�-q 0._Sq. feet aDwelling—No. of Bedrooms----------►-�...............................Expansion Attic (K)o) Garbage Grinder -(k)4 pL, Other—Type of Building ................ ....:..... No. of persons....................-------- Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------* --- - W Design Flow..........:• ]•6_-0..........gallons per person per day. Total daily flow........._-: Q.......gallons. W Septic Tank—Liquid*capacitylOPP.gallons Length................ Width---------------- Diameter__:.......... Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area-----.---_._._-------sq. ft. Seepage Pit 'No........I__-------- Diameter.... ............... Depth below inlet.................... Total leaching area...................sq. ft. Z Other Distribution box ( ) Dosing tank.(0-4 ) Percolation Test Results Performed by.__.-_ _ ,�-?...:. ! _• lr` G/._.._.___. Date___.�_._ _-� Test Pit No. 1..y�._.....mmutes per inch Depth o Test Pit.................... Depth to ground water......................... (? Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... O. ---•---• ------••••. -••......•--••..................................•-- ---...........---....... •- F ''`�- #. '. _. �6.i..... t i 3c..Z A te _....... Description of Soil......... � --�---�-�-�'--��-�•�"-----}----��=------- `' .........................................••.•••• ----------•----••--•--.....-•----------------...---•--••-••---•.... W ----------------•-•---------------------------•-••-----------.....---------•----•------••----..........................------------------------------------------.-.-.---.----------•-------•--------- ' U Nature of Repairs or Alterations—Answer when applicable________________________ --------------------------------------------•------------•-------------------------......:........-•------------------------------......--------------------------------------------------------•-----•- Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with pT the provisions of T IT I.w, 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. �Sig n� f Date .................. _Application Approved B ---• . Date Application Disapproved for the following reasons:.................................... .:............................ _r_ ------------------------------------------------•----------•------------- ....-•--••-----=----------------------•------------------------•-----......----...-----..........•--•-•-••----•-•--..:.......•-----------------------------------------------------•••-•-----•---•... 'Date PermitNo..--.......-••-•-.....---•--•-•................................ Issued--•.................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA 'TH ..........t.. OF.. . wr ifiga mplianrr THIS IS TO CEIj IFY That'th ivl �posal�Sy�stem constructed O or Re aired ( ) , ' . by.............• .:..._ _ �.J. _ —J `� at © _s J + .�i!-aC f t/4 ! °`�'� I?.'' _�. �.f"--------------------------------------------------- has been installed in accordance with the provisions of TI` j f The State Sanitary Code as described in the PP P C --- a lira ion for Disposal Works Construction,Ferm>t No.._ :......... dated__....%jr :.._��.........__ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNC 1 N SATISFACTORY C DATE...................... ....•• •-• D .__ Inspector .1-1--,_--/7?----............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF `HEALTH 7�' p f-C ............OF.......! 1 .f .�L :....... ...............�.. <J FEE.. .....:........ i rr ttl rk i�r per 11 Permission is hereby granted - ..-•-- d - ` - to Constar qt ( ) or Repair ( ) an Individual Sevt ag D sposal Sy term at No..... ...1�, e .../��Q _ ..�� `.'/�!U.. f�{f2. ............................ ................... Street as shown on the application for Disposal Works Construction Perer' No.__ Dated....... ��.....:'.. ...... - a DATE...... <e---------------------------------------- Board of Healt FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS s- r SI�{GL� F'L�,MIt_.�f� "3 •�E_�SZOOM �"" b,&t t_4 P LA\,v I t0 x 3 G•P•D• SE�IG TA�tLC = 330,. (SD % * USA- l OOp G<s L a `."� SPoSAI: PtT - I�SE to0o GAL s ' le. ;1 '�` �,UzWALL AV-EA _ (50 s•t=. icO� O BcJTA SO �T+ K//l �A.yrSOr TOTAL ESIGt.I F w42S G.'P.'o. 1 r o !�L Dad � 'T T Fl-Dw i 4 -no Li tZeT6 "tts Sm1u' o1z Lam ry ,�^.,�.��°a�1r)'� SY`��l: j c9�, ;.t tt➢,? /�.G.o .. _:...a t ':i Rt1UF-i/1F1L3_ �Q 'F7ISt j�G7\y _ �•V'P_`� .I 5.. r r -Y F I 5 A. OAXTERIto ttia 24048 JiGO n i ;y� I •, ''�r�J 4,�.ka��� .`i)li�T��'",.q Y 'VO �S � i '��`it sir � i } � • 7 ... 'SST Tar, two s�co.o • �oA� pe loco i>Jv fuv� �1 ro -i r c SeJG"SOiG� INN• Tit ;L �r 'max. Ra Sc--Qnc . to „� GAL.. .T1�N7' LeAcH'PIT F_ Pi u e F l c 'c t • e t. • W i r4.t ) • � P1zo�-t L� . a i LoCATIO" �A�t��T c. i '. ' l2� Igo VJQ 'CGRTtF�( T14.4 - TN(_ -,t WeU Rc6. C- t-IF L-t�t,1 Gc PL�lS W►Tf-i .TWG SID�_t.t►-1� .. AWr->. 'SETOACV, 7C-4U10EAA&W Tr-. .OF. .'i'W� ;LOT 08 i j To w►.2 of �A 2 d��, t 3 X n .PATE 9 ��� ,t✓ �r '� � �,�r.��., RCGtS•rt-jzm> 1. wo 5u2v&Yom4 Ti-Al-S la'Y.._AW 1'S WOT 01^4 �Sya.lMASSY : .•` �. t 1f.lSt'C?:11LtENZ" Sc} �/tom{ TLAG— UF�S�'C"� StdG�:JID APPLIGAfJT � 1 fir. t3G uScp To nr'Tc m,I W4 :... LOT 1-�►�t`S