HomeMy WebLinkAbout1980 - Single Family Residence
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izrasi~illr, Crnnnrrfiruf D53S2
TEMPORARY CERTIFICA'ITE OF OCCUPANCY
This is to-certify that building at 52 Allen Drive (Delta Enterprise.
constructed as_a single family dwelling under
Permit No.. 3117
conforms substanti@lly to the requirem-ants of the Building ~r-
dinances and the Zoning Regulations of the Town of ?~,cntville
and the Basic Building Code of Connecticut and is hereby approved
for use or occupancy under Use Group L°3 (see section 202.0
BBC/Conn.) and a permanent Certificate of Occupancy will be issued
at such time as the following items are completed and accepted by
inspection.
1• Landscaping to be completed
2.
A
3.
4•
5-
6.
7.
8.
0
J
Date 2/29/8 0--~`---
mond Daws on
_•;a,e Delta Enterprises uilding Cff i cial
' ddr ess Box 91 , Niantic
• n (f {nIIlittiffiP
Puilbin~ ;4hi5prHor
3Anrasbillr, (Ennnrrfirui D5382
TEMPMARY C ERTI k'ICATE CE OCCUPAi3CY
This is to certify that building at 52 Allen Drive (Delta Enterprise
constructed as a single family dwelling urger
permit No. 3117
conforms substantially to the requirements of the Building Cr-
dinances and the Zoning Regulations of the Town of '-cntville
and the Basic Building Code of Connecticut and is hereby approved
for use or occupancy under Use Group L'3 (see section 202.0
BBC/Conn.) and a permanent Certificate of Occupancy will be issued
at such time as the following items are completed and accepted by
inspection.
1. Landscaping to be completed
2. h
4
3.
4.
5.
6.
7.
8.
o
J
Date 2/29/80
+ui nd Dawscn
Delta Enterprises ing O fficial
r:ddress Box 91, Niantic
Footing Inspection
1. Turn over - Locate N, Direction Terrain
drain flow, high natural grade on foundation,
low natural grade on foundation.
;I
2. Footing drains required Cellar Floor
30 Foundation partially exposed_
4. Foundation in ground
Must footing be stepped,
6. When back-filled will fill be hauled in
How many yards
7. Is area of house lot wet
Dry Partial
8. Basement area Wet Dry
Partial Indication
g.. Footing size / d X a
f
10. Soil is
a
11. Grade under oting filled compacted
virgin •
12. A Locate any ledge bridged on rear diagram of
footing
13. Comments
14. Re-check it ms
9
kPProved On
Name
Address
..~,M ~ ~ :
r
I
J
. 1 1 t
~
f
1 r ~
_
C _
'-`)ugh Electrical Inspeatior--~
> ) '-7-
Name
Location
Date
Kitchen --12/2 wire (no 14/2 off to switches or
lights)
At least 2 circuits coming up
At least 1 recepticle for each counter
space 12" or wider (sink or stove
interuption = 2nd counter
Size boxes and wires, in and out
Table 370-6-A
Nailer plates needed
bighting - circuit per 500 square feet
Recepticles 6' 12' apart
Circuits baths GFI Outside
GFI wire size box size
Na ilers
Number of recepticles per home run
Grounded box continunity throughout
What circuits and what size wire roughed in
By Initial
Approved Not gpproved
v
CHIMNEY INSPECTION
Fireplace Cbimney
Appliance Chimney _
Flue Size
bt Above Ridge or 10' away
Heig
size X
Footing Inspection
depth sloped,_
Flue extends above concrete
j )ae starts below smoke connector,
clean out below smoke connector
n
Tbimble extends into flue
Tbimble distance from combustibles
Appliance distance from combustibles
were ties built in ?
Fireplace face mortoredto fire box
distance of header tQfirebox
distance of beartb extnsion from face of
firebox
from each side
Raised Heartb
DISAPPROVED
'APPROVED _
Name
Address f ,
16 1,1
Rough Plumbing Inspectio.
Name
Location o I spection
Q 1 f
Date 1 r 2 3
1. Plumbing drain material Cast Iron
pvc cu
2. Number of stories
2A leak test required
3. Basement ceiling check pipe size-, clean,
j outs
4. Double joists under tub
5. Cast iron inspection done
6. Floor drains Floor clean outs
7. Garage drains
First Floor
8. Sink drain pipe size Back vented
Lav drain pipe size vent,-tub drain pipe
size vent on line
9. Estimated inches in front of 'toilet
10. Vents All fixtures back vented
Revent minimum of 6" above highest fixture
served
TOWN OF MONTVILLE ~
OFFICE OF THE BUILDING INSPECTOR
848-7166
TRADE 'PERMITS
PLUMBING HEATING ELECTRICAL
PERMIT NO. _1~-- DATE: ----C-
Property of
r'
Location-
- -
Contractor:
- - -
Address:
+/al.
TYPE OF LICENSE:
LICENSE NO. --------,-40-3- -79
PERMIT APPROVED BY:
4- -
Building Inspecto
INSP. I Date:
INSP. 2 Date:
Contractor or Authorized Agent
Signature
q d
TOWN OF' MaNTVILLL )
OFFICE OF THE BUILDING INSPECTOR
848-7166
TRADE -PERMITS
PLUMBING HEATING ELECTRICAL
PERMIT NO.f/ DATE:
Property of
Location:
- -
Contractor:
-----~'~'z _
Address:
-
TYPE OF LICENSE:
LICENSE NO ` 0-2 P
-
PERMIT APPROVED BY:
Building Inspector 4
INSP. I Date:
INSP. 2 Date:
Contractor or Authorized Agent
_ ~ i / ,
Signature
0,0 TOWN OF, MONTVILL6,
OFFICE OF THE BUILDING INSPECTOR
848-7166
TRADE PERMITS
PLUMBING HEATING ELECTRICAL
PERMIT NO. DATE:..
Property of:
Location:
Contractor:
-
s d
Address:
Z.-o fez r r
TYPE OF LICENSE: ---------W
LICENSE NO. J'6-'----
PERMIT APPROVED BY:
Building Inspector a -
INSP. I Date:
INSP. 2 Date:
Contractor or Authorized Agent
a:~~ r C--4
Signature
R
T0WN OF'MONTV I LLE
BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Permit No. Date 1.7/7P
Estimated Cost 42 l 000-00 Fee o o 2e,47.g, ,5' o C. 0,
Owner Address QoC 9i Tel e. 7-39- i~i63
Contractor Address Tele.
Location of Building Zone No. -vO
Additions /Alterations (Including moving, demolition, sign erection)
New Building - Type of Construction
Size ~,2 V K -~/O Type of Heat V~ Fireplace
No. of Stories f No. Rooms Breezeway
No. Baths Garage Use
I hereby certify that the proposed construction will conform to the applicable zoning reg-
ulations of the Town of Montville and the Basic Building Code of the State of Connecticut ,
and that all statements herein contained are true and correct.
Signed ZZ,L,, ' g~ Approved
Date 9/717p Building Inspector moo,,
Inspections For:
Footings
Framing
Rough Wiring
Electric Service
Rough Heating
Fireplaces
Other Misc.
Final Inspection for C.O.
Approved Rejected Signed
DELTA ENTERPRISES, INC.z#; LLTUC'~ OO G~ °Q~~ L~~LaL
P.O. Box 91
NIANTIC, CONNECTICUT 06357 q
DATEy`/PV JOB NO.
ATTENTION
Pay Dawson
RE:
TO Bu dding Dept. Lot: #1 Alen - Woodland Dr.
Montville.. Ct. GENTLEMEN:
WE ARE SENDING YOU n Attached Under separate cover via the following items:
❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications
❑ Copy of letter ❑ Change order V Water Test Reports
COPIES DATE NO. DESCRIPTION
!~~1SG separate water test reports dated 1/7-1/24-1/31,1'80
i
THESE ARE TRANSMITTED as checked below:
For approval ❑ Approved as submitted ❑ Resubmit copies for approval
❑ For your use ❑ Approved as noted ❑ Submit copies for distribution
❑ As requested O Returned for corrections, ❑ Return corrected prints
❑ For review and comment
❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS
COPY TO
SIGNED.
If enclosures or* not as noted, kindly notify us at onu.
T,-
_1558
O-,ANALYTICAL ' ~~GPATGPIPS
D!v S Cry ^f 12 Case Street, Norwich, Conn. 06360 Telephone 886-0121
CYTO MEDICAL LABORATORIES, INC.
REPORT TO: Diener fill BILL TO:
Delta Enterprises
TTi :znti r Tndus. Parl:
_7iantic, Ct
TELEPHONE 739-4163 REASON FOR EXAM I anganesc
LOCATION OF SUPPLY (Address) ,"oodland Allen S`c, "onty-11e, ^t _
DATE AND TIME COLLECTED 1/31/00 10 • 30 a.m.
TREATMENT ❑ Filtered ❑ Chlorinated ❑ Untreated
TYPE OF SUPPLY 9 drilled well ❑ dug well ❑ other
❑ Complete Profile ❑r=Retest
BACTERIOLOGICAL QUALITY: ACCEPTABLE LIMIT
Total Coliform Colonies per 100 ml Bacteriological Quality: 0 or 1 colony per 100 ml.
PHYSICAL CHARACTERISTICS:
Color units Turbidity ftu Odor
CHEMICAL CHARACTERISTICS:
Ammonia Nitrogen PPM Chlorides ppm
Nitrite Nitroger! ppm pH
NitrateNitroger. ppm IMBAS ppm
ADDITIONAL TESTS IF REQUIRED:
-
Sodium ppm
PPM.,
ro^ ppm
n- PPm r
Manganese 0.05 PPMr ppm
y 'MF
Comments: r 4
-A J
t a
This table of recomrn i ' 'may e onsidere' as a guidelin6 for the director of health in interpreting a well
water analysis.
RECOMMENDED LIMITS itrate Nitrogen: 10 ppm.
9 Chlorides: 250 ppm-sodium should be tested if over
Color: 15 units-if over 30 uri'i=ts removal treatment r
should be provided. 30 ppm.
Turbidity: 5 units-iron & manganese should be tested:' pH: 6.5-9.0.
when turbidity exceeds 5 units. MBAS: 0.5 ppm (FHA 0.1 ppm).
Odor: Free from objectionable odors. Sodium: 20 ppm-if over 20 ppm the consumer must
Ammonia Nitrogen: 0.05 ppm. be informed.
Iron: 0.3 ppm (FHA 0.1 ppm).
Nitrite Nitrogen: 0.005 ppm. Manganese: 0.05 ppm.
BACTERIOLOGICAL QUALITY
❑ Was within allowable limits for potability. This report is an accurate analysis of
❑ Was Not within allowable limits for potability. the sample received in this laboratory
- VV-
2/4/CO
Signature Date
T-71 5 3 3
BIJ-ANALYTICAL `1`-~_~GPATGPIFS
C'v ;Ora OF 12 Case Street, Norwich, Conn. 06360 Telephone 886-0121
CYTO MEDICAL LABORATORIES, INC.
REPORT TO: :1ra--xzrises BILL TO:
/Bill Diener
! iantic Ipaustrial Park
Niantic, Ct
TELEPHONE 739-4163 REASON FOR EXAM (Manganese)
LOCATION OF SUPPLY (Address) Corner o'L Allen and T'oodland,??ontville, Ct
DATE AND TIME COLLECTED 1/24/80 9:30 a.m.
TREATMENT ❑ Filtered ❑ Chlorinated ❑ Untreated
TYPE OF SUPPLY ❑ drilled well ❑ dug well ❑ other
❑ Complete Profile ❑ Retest
BACTERIOLOGICAL QUALITY: ACCEPTABLE LIMIT
Total Coliform Colonies per 100 ml Bacteriological Quality: 0 or 1 colony per 100 ml.
PHYSICAL CHARACTERISTICS:
Color units Turbidity ftu Odor
CHEMICAL CHARACTERISTICS:
Ammonia Nitrogen ppm Chlorides ppm
Nitrite Nitrogen ppm pH
Nitrate Nitrogen ppm MBAS ppm
ADDITIONAL TESTS IF REQUIRED:
Sodium ppm ppm
Iron ppm ppm
Manganese 0.07 ppm ppm
Comments: recommend well slushing to remove high manganese level.
This table of recommended limits may be considered as a guideline for the director of health in interpreting a well
water analysis.
RECOMMENDED LIMITS . ` - - Ni,,t4te Nitrogen: 10 ppm.
Color: 15 units-if over, 30' units removal treatment Chlorides: 250 ppm-sodium should be tested if over
should be provided:; 30 ppm.
Turbidity: 5 units-iron & mafigane oul ed ` d pH: 6.5-9.0.
when turbidity exceeds 5 u MBAS: 0.5 ppm (FHA 0.1 pprn).
Odor: Free from objectionable o ors. Sodium: 20 ppm-if over 20 ppm the consumer must
Ammonia Nitrogen: 0.05 ppm,_ be informed.
'Iron:
Nitrogen: 0.005 ppm- 0.3 ppm (FHA 0.1 ppm).
Manganese: 0.05 ppm.
-
BACTERIOLOGICAL QUALITY,a ``Y l•
-1 01
❑ Was within allowable limits for potability. This report is an accurate analysis of
❑ Was Not within allowable limits for potability ! the sample received in this laboratory.
X11
1/2s/Sn
i
Signature Date
i
;t31(D-,Ai**';A1._VTICAL L/AL3CPATOPI LS
G,V'.011" CF 12 Case Street; Norwich, Conn. 06360 Telephone 886-0121
CYTO tti1ED!CAL LABORATORIES, INC.
REPORT TO: Delta Enterprises BILL TO:
D?iantic Industrial Park
13iantic Ct
TELEPHONE 739-4163 REASON FOR EXAM
LOCATION OF SUPPLY (Address) Corner of Allen Drive and T•ioodland Drive, Montville,
DATE AND TIME COLLECTED 1/7/80 11:00 a.m.
TREATMENT ❑ Filtered ❑ Chlorinated ❑ Untreated
TYPE OF SUPPLY ❑ drilled well ❑ dug well ❑ other
IR Complete Profile ❑ Retest
BACTERIOLOGICAL QUALITY: 0 ACCEPTABLE LIMIT
Total Coliform Colonies per 100 ml Bacteriological Quality: 0 or 1 colony per 100 ml.
PHYSICAL CHARACTERISTICS:
Color Less than 15 units Turbidity 1.7 ftu Odor Acceptable
CHEMICAL CHARACTERISTICS`.
Ammonia Nitrogen Less than 0.02 ppm Chlorides 21 ppm
Nitrite Nitrogen Less than 0.002 ppm pH 6.9
Nitrate Nitrogen 0.7 Ppm MBAS Less than 0.1 ppm
ADDITIONAL TESTS IF REQUIRED:
Sodium ppm ppm
Iron Less than 0.1 ppm ppm
Manganese 0.13 ppm ppm
Comments: Recommend well flu na to remove high manganese level.
F
a
This table of recommended limits may be consider-ed as a giJideline fiorthe director ofkealth in interpreting a well
water analysis.
RECOMMENDED LIMITS Nitrate Nit'rog"Ien~A ppm.
-fib
Color: 15 units-if over 30 units removal treatment Chlorides: 250 ppm-sodium; should be tested if over
should be provided. " 30-rrrr .
Turbidity: 5 units-iron & manganese should be tested pH: 6.5-9.0.
when turbidity exceeds 5 units. MBAS: 0.5 ppm (FHA 0.1 ppm).
Odor: Free from objectionable odors. Sodium: 20 ppm-if over 20 ppm the consumer must
Ammonia Nitrogen: 0.05 ppm. be informed.
Nitrite Nitrogen: 0.005 ppm. Iron: 0.3 ppm (FHA 0.1 ppm).
Manganese: 0.05 ppm.
BACTERIOLOGICAL QUALITY
® Was within allowable limits for potability. This report is an accurate analysis of
❑ Was Not within allowable limits for potability. the sample received in this laboratory.
1/9/80
Signatur Date
WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER
Q
WDB`' "erg WELL DRILLING PERMIT
464,68
STATE OFFICE BUILDING, HARTFORD, CONNECTICUT 06115 \
/jam , / "
- LOCATION OF WELL (Poxon (Street) (Lot Number) I BATE
OWNER OF WELL
® INDIVIDUAL BUILDER ® OTHER (Specify)
OWNER'S ADDRESS, / f✓" P
TEST - v_ Est. No. of
PROPOSED BUSINESS
DOMESTIC . ❑ ESTABLISHMENT ❑ FARM ❑ People being
USE OF served.
WELL ❑ SUPUBLIC AIR PPpY El IN~IISTRI. LJ CONDITIONING. ❑ ((Specify)
SKETCH OF 'AT-LL LOCATION
Locate well with respect to a4 least two roads, showing distance from intersection and Front of lot
Location of lot to at least two roads I Well location on lot and to house (if present)
Indicate North
ut)
Approximate number of feet from well to
nearest source of possible contamination: U i
The undersigned is aware that upon completion of the well, a "Well Completion Report" containing construction details and information required under Section
25-131 of the 1969 Sup lement to the General Statutes must be sent to the owner, the Board and the Water Resources Commission on the form provided by the
Board. This permit i n valid until all information is filled in and it has been counter-signed by the Director of Health or his agent.
A PLI NT (S% I APPLICANT'S D `mot J A y J I DRESS -EGISTRATION NO.
BY o Health. Officer or. gent) ~~l
19 APPROVED REJECTED
REMARKS
DIRECTOR OF HEALTH
WELL. COMPLETION REPORT STATE OF CONNECTICUT
wDe-s 12-69 REV. 9-71 WELL DRILLING BOARD Do NOT fill in
State Office Building STATE WELL NO.
HARTFORD, CONNECTICUT 06115
OTHER NO.
NAME I ADDRESS
OWNER E r
LOCATION (No. & Street) (Town) (Lot Number)
OF~ WELL ~
'j BUSINESS
PROPOSED LJ DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF
WELL ❑ SPUBLIC AIR OTHER
UPPLY INDUSTRIAL
❑ ❑ CONDITIONING ❑ (Specify)
DRILLING ❑ ~ COMPRESSED ❑ CABLE OTHER
`
AIR PERCUSSION PERCUSSION
EQUIPMENT ROTARY ❑ (Specify)
LENGTH (feet) DIAMETER (inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING
CASING GROUTED?
DETAILS Xa°' t ! ff. ~ ❑ THREADED ❑ WELDED ❑ YES ❑ NO ~ YES NO
YIELD 1777 HOURS YIELD (G.P.M.) t
I f
TEST El BAILED ❑ PUMPED 'i COMPRESSED AIR
ttt
MEASURE FROM LAND SURFACE-STATIC (Specify feet) DURING YIELD TEST (feet)
WATER I Depth of Completed Well
LEVEL in feet below Land surface: 4
MAKE _ (LENGTH OPEN TO AQUIFER (feet)
SCREEN
DETAILS SLOT SIZE DIAMETER (inches) IF GRAVEL Diameter of well including GRAVEL SIZE (inches,) FROM (feet) TO (feet)
PACKED: gravel pack (inches):
DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least
FEFT to FEET - two permanent landmarks.
3
j"
+~w k
fi' i yy
~ k
Y
c ~ a
3
E
s
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE ^FIS s )
a
I y
t,. ,4•,.`
s N
d ~ f
> f ~ 4
DATE WELL COMPLETED I PERMIT NO. - .I"REGISTRATION NO. I DATE OF REPORT I WELL DRILLERS' Sjgnature)
I
LOCAL DIRECTOR OF HEALTH
st R: lete items 1, 2, and 3.
o our address in the "'RETURN TO" space on
~ e rse. ,
i JT~he f 4' ng service is requested (check one)'.
Shaw o horn and date delivered........;
❑ Shdw o Whom, date, and address of delivery.. $
RFSTtl(tTED DELIVERY
Show to whom and date delivered......
❑ RESTRICTED DELIVERY
Show to whom, date, and address of delivery$ '
m
C (CONSULT POSTMASTER FOR FEES)
Z GASH DRESSED TO: "
n./
ly. CRIPTION:
m RE RE O. CERTIFIED NO. INSURED NO.
2
f9 7e 9
mm (Always obtain signature of addressee-or agent)
l
o I have received the article described above.
Z SIGNATURE ❑ Addressee ❑ Authorized agent
C
m 4.
DATE OF DELIVERY A
D
Z
n' 5. ADDRESS1Complete only it req. st
m A01f
m 6. UNABLE TO DELIVER BECAUS K'S
ITI LS
a'
D
F
l *GPO: 1977-0-249-595 '
a •
tr
9t 1978
Deb
Box 9i
7~ 0a".1.4t0 0A t0 iV L6 f! C-6-357
Daax, L, 1,
im the Town
A reviclq ®f i~ Pla-710 ].s.ldiCatSs avery'ih~ I-ig is in der cr
furthe construction. The cease and es t arc-la-z, date
November 3a.di, 19789 i t''aP.reby reocinae and you are there-
--Po re anthc--rize to cnontirma Construction.
Z7' Q ing Enf o;- canant Office
1,1, h
o
MISS I
s (
T-107e» bar 3, 1978
Dalta Enterprise
®x 91
~_TcAtic, Ot. 06357
Doan Sir$
On Thursday, November 2, 19788 thAl s office 'conducted
an on nit* Inwantigetien of building- lots 1,9 2, and .3,
Located on Allen Dive in the Town o ! Montville, to, et6r-
mina ccnatmcti~3n co plianao in accoy ance with the Pub—
mi tted appro7od plot plain
Eno ranults of said investigation revealed that found-
ationz constructed on lots 1, and 3, are not in acoordamele
with the approved plot plan ub itted by you to this office
Tharefoorav this unapproved change, by yct4 Without benefit
of r~Dquegt han sovere oomplioa ions in.respect to the approved
ant.1neared saptic deigns
This office horab7 ordars 7ou to c aso and desiat all
~ t ctio of Iota 19 and 3 until such time Proper plot
plans and septic derI ns are approved by this office. It
alao agreed upon that all Oeptic sy to a would be in-
stallad before the start of.conatruetione Since you seem
t havs caught the bu .1d . department during y vacation
abaa cz unw4ar6 or our a r mart, and were issued a uildi
omit for those Iota the least, -you could do was follow
io pl pr o It Besm ncmecne within your ®r eni tion an
not read rulers Thin office cannot tolerate deviation
2 are at ts.,z magnituida viewed b7 me, on hurv-
da ,
You ars Oncouraged to take the appy~opriatq s tapo i
lately to comeat thin Aay~iona situation-
Roa ectfU1179
David 34ar tip
Sanitarian-
Zoning Unforc 0n
i ~
DELTA ENTERPRISES, IN
P.O. Box 91 ~~UUL 0)[F TQQRSOTY~
NIANTIC, CONNECTICUT
I~ 0/6357
/ o f ~B7~ fC' DATE
JOB NO.
?1/9/73
ATTENTION
RE:
TO Day-i (l M -~-t-in
Town Sanitarian
Town of Montville Conneotirvt
GENTLEMEN:
WE ARE SENDING YOU )t Attached ❑ Under separate cover via the following items:
❑ Shop drawings )0 Prints Plans ❑ Samples ❑ Specifications
❑ Copy of letter ❑ Change order p rn._,.
COPIES DATE NO. DESCRIPTION
2 Lots 1 , 2, 3, Allen Drive MK
THESE ARE TRANSMITTED as chicked below.
VFor approval ❑ Approved as submitted ❑ Resubmit
copies for approval
❑ For your use ❑ Approved as noted ❑ Submit
copies for distribution
❑ As requested ❑ Returned for corrections ❑ Return-corrected Prints
❑ For review and comment ❑
❑ FOR BIDS DUE 19_.__r__`... ❑ P91*n RETt1f *ft `AFTER LOAN TO US
REMARKS
COPY TO
SIGNED:
If enclosures are not as noted, kindly notify us at once.
DEPARTMENT OF HEALTH
TOWN OF M O N TV 1 LLE TAX MAP LOT PERMIT NU
.
PERMIT TO CONSTRUCT ❑ Well
Y New Sewage Disposal System
Check ❑ Replacement Disposal System
p Cash
__________Payable to the Town of Montville
Permit Fee $--~__~_D____,:~_._a ~
Lot Location - --?.ccr2,1------------- Size
Owner - Tel. No. - -
Address /-----t1_--------------
Contractor= License No. - -
l,
Address
C 'r - Tel. No.
Soil Basement Facilities ( ) Baths ( )
Residence No. of Bedrooms Commercial
Water Dug Well ( ) Drilled ( ) Municipal ( )
Septic Tank - Capacity in Gal. -
( ) Garbage Grinder
( ) Dry Wells No.
( ) Leaching Bed
( ) Trenches
( ) Galleries
No. of Feet Depth Width
Size of Stone Size Pipe
Instructions: 1) No backfilling allowed until final inspection.
2) On space at right draw plan.
Locate 3) House Road
4) Property Lines Water Supply
5) Septic-Tank - Dry wells or Leaching Tr.
6) Dist 'butio Box
7) W er pply and leaching on adjoining property.
ctor.••-------------- Date -7/ ---2
Signed: actor
o
-°t!t - -
Sanitarian
The private sewage system serving the above premises was constructed essentially in
accordance with plans filed with this district and the terms of the Permit issued. This
Certificate shall not be construed as permission to create or maintain any sewage nuis-
ance and in the issuance of the certificate, the Town of Montville Health Department
assumes no responsibility for the future operation and maintenance of the system.
130 ART
T
16 M 2 (+M asp ev~ D° _
WS0110 aso ixyhicti°.vi: WAS
0
IT 170 IOPtvjje
r(r J..'.301'zh., :.E;.v loco Pb..P,(, swi'yv.rn ai'' a_.,"a5 Pbb'`.t`v.lt4b:-.CrPe55o
"c' F~ _x yea s° vc yzr;; ~ t ~i p 197?? y' ~.'~Jtja r
. Ja rte., n as;
WAY-
Q11, ' 11w septic W ha au Vie;, HN w3.3 ooi, C -~..e .5.u,t"` -..•&k .dt - ' i~m
_
th- was
a~J kr l a4' tee a3 ~'a ' !W v w ~M j"~~ r s~._ '0 too re
F.C,tne4oo d jv UK o fl ,5.. As rv'.:..E Jd m testa ore da : s -
..,s.~: 5r -.,i.. ,,,2ef.;". fa~.v c ~ ,r ti" t a6a CS aa..8~,.ss:3 '
4T' a .1. p the tii t.. 4. ~..~i a3 j t7 ME:, e re,f y L-; pr : iA ~5 R
R ~ne h se. f y ..s~. c z idea
~ll,'416r pia Of cly prop L - a now, ~~s°W3
have
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