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Home My WebLink About0007 ERIN LANE - Health (3) 7 ERIN LANE CENTERVILLE A = 291017011 n No. 4210 1/3 ORA Pendaflex' i 00/0kv r q � (W7 Off L° No.... ............ Fm3 .....----.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ -...........OF.. Lit.3t� ......................................... ,lip pliration for Uhyasal Workii Tonstrur#tnn JIrrutit Application is hereby made for a Permit to Construct (ms"`or Repair ( ) an Individual Sewage Disposal System at: ..... et/�_...fi L.iN `............... _ •-• ..... :.......... .._.... Location Address r Lot No. _. .. ............................•------•--• ..: (......0�. gam--..---- .... ..._...._. W wner Address ,.� Installer Address Type of Building Size ......Sq. feet Dwelling—No. of Bedrooms............. ................--....Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 44 Other fixtures ............................ . Design Flow..............�l®................._--gallons per person per day. Total daily flow......�2_ ........................gallons. W WSeptic Tank—Liquid capacity/00 >..gallons Length................ Width................ Diameter.--............. Depth................ x Disposal Trench—No. .................... Width................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( )Percolation Test Results Performed by...................................................•••••_-•---•••-.•...._• Date...................................... aTest Pit No. 1...............minutes per inch Depth of Test Pit.................... Depth to ground water.--..................--. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 01 -----•--••-------------•••....----•-•--••--•--•---................•----•.................._••-_...-•......................................................... 0 Description of Soil...............•--•--------•-----.......................----...--•-------...---••-•-•-----------------------.....-•----............•......•--•---•--•-...........---•--. x V .................................-............................................................................................................................••-•-•.....-•---.....---•-•-•--••---•---- W x --------------------------------------------------•---•-----------------•--•------------•------••...----....---•--••-•--------.-•----•------•----•-••--••--••--•-••-•-••-•----.....-••--•-•----..-•-•-- 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 TLITIL- 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance een issued byte bo of Health. ned 3�_........ i6 . ...... . ApplicationApproved BY= - -------- -----------------------------------------•-............ ------- ...... • ----•- ................. Date Application Disapproved r t e ollozving reasons:.............................................................................................................. - .......•--•--•••-•---•----•-•-•------•---.....•--•-..........-•-...••-•---•......._..--•-•....--•--......................•-•----•-•-•--•----•-........--••--........ ......••• ............ Date PermitNo......................................................... Issued....................................................... Date 1 No....r(� .".tl THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF...... .::.....:..:.:..........:...................................................... Appliration for Diipu,i al Workii Tontitrurttuat Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ...................•. Location-Address or Lot No. .................•---••--••............................. -••-•-•--•-••--------•••---•----...---•••-•-----•-•••-----........................................ Owner Address W Installer Address Type of Building Size Lot.................:..........Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -------------•----------...........---••--------------'------------------------•------------------•------------------•-••----•....-----------------••- w Design Flow...............:.:..........................gallons per person per day. Total daily flow.............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water..................... GX, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ---------------------------------------------------------------•--•------....................-•...........-•---•-------•----------..............---•--------. 0 Description of Soil........................................................................................................................................................................ x U •-•---•------------------------------------•---••••-•--••--•••••-•---•-------••-•-•-----------•----•------•-•-•-•-•---.......-------------•-••-••------••-•••................----•-•......------------•- w VNature of Repairs or Alterations—Answer when applicable................................................................................................ • ---------•-...--••-•-•.._..---•-•...................... Agreement: _,._. The undersigned agrees to install the aforedescribed Individual Sewage Disposal'Syst'ef in accordance witly'_''"_Y the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in' f operation until a Certificate of Compliance h s been issued by the board of health. = S ned ..........................:.......................... --•--= ............... Application Approved By....... -•-•--•-• ••••••--------------------------••-•----•-----•---•-----------------•••-....... Z�'........... _ -------- Date Application Disapproved r tlhv' ollowing reasons:................................................................................................................. ••.......-•---•-----•..................•-....._....--------•----•-•--......------......-••-••--•---....••'••----•-----•••---•---•-...------•---••--•---------•--•-•----------------••-----•----•--•---•-- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' ' . .. Y.................... ..................................... Tntifirtt#.r of Toutpliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by .;-/( = - ----- --•-- --- - •----•---•-••----•------- Install- at_ . ��--•-•-•----•-•-- --- Installer W _. �L -: has been installed in accordance with the provisions of TIC, 5 of1}etate Sanitary Co as , sgribed in the application for Disposal Works Construction Permit No. .......... dated_��'.__ �...................... --_..... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS ARANTEE THAT THE SYSTEM 1 !1 L ANCTION SATISFACTORY. DATE...CIZ../ .......................................................... Inspector--•---------------... .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Y3- ...........................................OF..................................................................................... L d No......................... FEE.. .............. u �o #rtion �ermi� Permission is hereby granted_....`.................... `:. ••--•••••-----------------------------•------•--•-------•---•-------•-.....-------•-..............•..... to Construct (�j or Repair„( , ) an I dividu4eva posal System atNo...............-••-•---•--••--.-•---• .......... ........... -------------------------------------•--------•--------•---------------•------......... Street as shown on the application for Disposal Works Construction Permit No..._,_-._...._ .. ated.......................................... •-•---••-•-•---------••-•---- •....... ---•-•oard-- of Health------...-•-•-•-•-•---••-••--------•--•--••.....--•-• DATE.......-(-`m --..r- B - ---- --•-------••---••-----------•........................... FORM 1255 A. M. 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