HomeMy WebLinkAbout0446 BAY LANE - Health Ray �Omq
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KEEPING YOU ORGANIZED
No. 12534
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FOR SRYNEMIN.RECYCLED
INmAiIVE 03NTENi107
Cerdfied Fiber
Sourcing POST-CONSUMER
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GET ORGANIZED AT SNIEA MU
TOWN OF BARNSTA E
LOCATION_ a e, SEWAGE I �
VILLAGE ASSESSOR'S MAP & LOT 6 9/
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY ®� �.��✓/L-
LEACHING FACILITY:(type) (' l s (size) /O &&e. 'Y-O
NO. OF BEDROOMS R PRIVATE WELL OR PUBLIC WATER ui& C-
BUILDER OR
DATE PERMIT ISSUED: 3//`1�S
DATE COMPLIANCE ISSUED: 10 - 1T�
VARIANCE GRANTED: Yes No j
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PD THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
.......7,::.�; Cl/U........OF......
Appliration for Bhop anal Warkii Tutuarur#inn Prratit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at
�l � 3 _c�� ���
:............... -----....... .�--� ... -
.._.. ---------------------------------------
.o.ation:Address or Lot No.
/�lJ L ------ .....---••--•-•----•-•-Ow 1dL/[ _ 5-fL .
--------------------------------Ad ress
---
Installer Address ``//
Q Type of Building Size Lot..&7y.3�3-�_.Sq. feet <ZIA/
V Dwelling—No. of Bedrooms___________ _______________ _____Expansion Attic (/4v Garbage Grinder (_-)
114 Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
P-4 Other fixtures......................................................................................................................................................
W Design Flow..................s?5..._...._......__gallons per person per day. Total daily Aow-__-_—3_c .j-........_....._...gallons.
W Septic Ttuch
I iquid capactty ?..gallons Lengthy____ Width_.-t`?___ Diameter.......`-__.__ Depth_ __-- �r
x Disposal —No.........I.......... Width....IeA....... Total Length_____....... Total leaching area....lc.L..06....sq. ft.
Seepage Pit No---_---------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box Dosing t� -.-
a�nk,� )
aPercolation Test Results Performed by._ j -,-------f --. ::...d.'e-SvLllV Date....192_`
d
,,..1 Test Pit No. 1______.-----_.minutes per mch Depth of TA Pit../1............ Depth to ground waterl�__�.'^_ ...��
(% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
i
o �l�/ `-
'✓1 -,- .T. .._. ..-0��o Description of S ."_F1__ - -
x
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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliant has been ged by tlboard of health.
Signed ......... �� da J --- ------------- ------ ------------.............
Date
Application Approved By .............` .a � ...�--- 3
Date
Application Disapproved for the following reasons: .......... .... ......... ........................................ .. .......................................................
................................................ .. ......... ....... ............................... ................................ .... . ........................................ ........................................
Permit No. ----------7&--------�7,J7................. Issued
ce
--
Date
77
.:...........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Allp iration for Dhip i al Vorkg C�nn��ra�r�inn �[rraati#
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at:
• ................... .... - .........
I:ocation-Address or Lot No.
-- �/�
/Owner Address
i' ..¢o-a '
Installer Address
__�_.)._._S__L..Sq. feet �'511t—
� Type of Buildi� Size Lot_. � �
U Dwellin No. of Bedrooms............:-�-----..._-__g— ______________Expansion Attic (/�Q Garbage Grinder
Other—T e of Building No. of persons............................ Showers
a YP g ---------------------------- P ( ) — Cafeteria ( )
Otherfixtures......................................................................................................................................................
W Design Flow.................s .................gallons per person per day. Total daily flow----- s�%...............................gallons.
WSeptic Ta�kr iquid capacity4 ..gallons Lengthy-�i a..__ Width_ .:f .-__ Diameter._....-....._. Depth.4.--.(,.
x Disposal ch—No. ........0.......... Width..../:.?.......... Total Length_-___-�....... Total leaching area...�`fl_X2 ....sq. ft.
Seepage Pit No----_-------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( Dosing,tank ( ),
� ._ �Percolation Test Results Performed b d� _4 _ .i`�-........-�'----!' Date � s
Yp ----•��•----- ------�6 --..------------�---------- °
Test Pit No. I...............minutes per inch Depth of Te t Pit_//............ Depth to ground
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
f... =-
Description of Soil.. `..=-----Ai Pe " {f �j°�r.�`• ° .�_. --�--� ....--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
' ' a /`. �.-.Q�tJ
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
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliant has bee is ued y th and of health.
IVIF
Signed ... .... ........ ---------------
-----------------
Dare....---.---------.
ApplicationApproved By .............. Q ` 1. �,<.. ,,.Fl-...............---...------....-----................................ r� Date .
Application Disapproved for the following reasons- ----------------------------------------------------------------------------------------------------------------------------------------
................................................................................. ...... .........................
Date
PermitNo. ....----- ..` Issued --_--_---------------Dare--- --------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS `
BOARD OF HEALTH
, -_l f /'t`�-�' '� = -- . --------------------------
�I =-
� �-
............. of ._C e r#ifica#E of Contylian e
THIS IS TO CERTIFY, That.the Individual Sewage Disposal System constructed ( ) or Repaired (by )
------ -{ --------------------- ---- .....-..
1 f/r J f nstall
at c,�.` ..-%.- . ......-- - .1r�.. f_.r �'�'f `l i.. ----- ---- - ---------•----- ----- --------------------
has been installed in accordance with the provisio is of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ....... -..... ..` ....--- dated ------------------------------------_----------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
�� � p � c �
DATE...................... ....:-...�........ ....-..1 `... Inspector
THE COMMONWEALTH OF MASSACHUSETTS
,--- BOARY OF HEALTH
t
No.. :`.:... . .`. FEE.
Disposal Works ,Tunarudivit unfit
Permission is hereby granted....................................................
to Construct (y) or Repair ( ) an Individual Sewage Disposal Systerii,-)
at No.......... & ,w... ------------- l
Street (1_
as shown on the application for Disposal Works Construction Permit ..........
DATE..............� `................................. Board of Health
.-----1-�-�-�-/7/•_
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
----------------
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TO THG L -'*��r
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No. 29733
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