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Home My WebLink About0031 COPPER LANE - Health _31 Copper ��►nQ S M E A D No.2.153LY UPC 12934 amead.com a Made In USA e-Ocyc% Al ) FFOORES RY�M INITIATIVE Cer f ed Rbor Soumbl r � � �� . LOCATION SEWAGE PERMIT N0. VILLAGE ` 1 INST LER'S ME & . A ,RESS j 1 B UILDE R OR OWNER DATE PERMIT ISSUED , DAT E COMPLIANCE ISSUED I ��_ I' � rl _ / Fizic.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR OF HEALTH ALei ---------......OF........... .................................. Apphration for Uhiposal lftrk5 Tonstrurtion IFIrrml Application is hereby made for a Permit to Construct or Repair ( -7—an Individual Sewage Disposal System at:-3 ......................... . .......... ...... ..... ..... ........ ----- --------------------------------------------------------------------- o -- -Address or Lot No. -----------------............. ----- --- -- - ----------—----------------------------- ------------------------------------------------------- Owner Address .... ..... ..... ..... . ......................... .................................................................................................. Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms_._......... ....................Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons-_--..___.________-_-_______ Showers Cafeteria Otherfixtures ...................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W4 Septic Tank—Liquid capacity............gallons Length................ Width._........_..___ Diameter._..._...__..__. Depth........_...._.. 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..___._.............._.. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.._............_._.. Depth to ground water.._......_..........___. 04 ............................................................................................................................................................ 0 Description of Soil........................................................................................................................................................................ x U ......................................................................................................................I................................................................................. .................................................................................................................A-----_j. .... ..... ...... ......................... Nature of Repairs or AlPrations—Answer when applicable---- --- -- U ------------------ C......g / ------------- ---------------------------------------------------------------------------------- ..... ..................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL I IL U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has h6e;)issued b theboa a.�O of healt Signe . . ....... .. . .......... . --- ,Sign .......... Date Application Approved By............. ........ Application Disapproved for the following reasons:......................................................... ................................................Date................ ......................................................................................................................................................................................................... Date Permit No.......................................................... Issued...... d .... .... ....................... Date No.:......... Fss* ........................ THE COMMONWEALTH OF MASSACHUSETTS BOAR OF HEALTH f-4 a.................o F.:,..: ._s-:................._......._---- Ar A liration for .1haposal Works Tomitrnrtiun rrntt Application is hereby made,for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at -•- ./.. ....... :. . .. :. .... 6 •. ....................... ............................................ ...... .......-----••-- Ad or Lot o-_ ` ... -. .... .... .........- Owner Address W Z - ----- r -- ; Inst er y''` � •• e Address •, QType of Building 41, Size Lot...........................Sq. feet Dwelling—No.No. of Bedrooms.__.. ._.. """.....................Ex anion Attic Garbage Grinder a Other—Type of Building ............................ No. of persons: .... :. Showers ( ) -,Cafeteria ( ) ��% i Other fixtures . ._1 ......................... W Design Flow.............................. ,gallons perxperson 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..................... Diameters: W 3 .Depth below inlet.................... Total leaching area..............::=:sq. ft. Z Other Distribution box ( ) ', *Dosing tanlc'r( ) , �r �kr a Percolation Test Results Performed`by ..... �f Date._ ' ................................ A' Test Pit No. ................minutes per mch�, Depths of Test Pit............ Depth to ground water_______-__.__._---_ Is, Test Pit No. 2................minutes per inch t Depth o -,�Mt Pit` :__..._._.. Depth to ground water..._._____.____._______. GL' ---------------------------- ----� ni,_--_ .......... ....••••----•-•-••--•----•--•--•-----•-•---------- ODescription of Soil......................... . ............................................................. . .... ..•-U ...................................................................................................................... ....................................... ......-•...•_____._. ................................................................................................................ _ V Na ure of Repairs or Al a 'ons—Answer when applicable.._ 1 � = = --------------------------------------- ............................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of I I'A U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance hask 6essued b the bo• of MhealtSigne . � --------- � ... Date Application Approved By......... •-�, ,: ..._ ,.f ..�`�.2 ' �' ................ _____ '�. ..._ Date Application Disapproved for the following reasons:................................7 ..................................`.` ::_.................................... .................................................. a c _......_.......__........-------•----............................ Date^ o- 7 jr u: PermitNo.....................................................-- Issued.................................... ................... Date � .v_ 41 THE COMMONWEALTH OF NIASSACHUSETTS r BOARD OF EALTH .... ............................ F .�,- :...... THI S TO CSFY, That the Individual Sewage Disposal System constructed ( )' arRepairedby---••-- x .-. :.. _ ----------------------------------•-------- '.......................... ............. Installer100,fa r has been inAalled in accordan ee with the provisions of T j of The State Sanitary ,ode as described in the applicariori for Disposal Works Construction••-Permit N l f _---. --� '--. dated- � �. ...�.�t'�................ THE••ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY., � �- � DATE...............4. ..0•---Z......•---•--•--•---- Inspector.........L....................•-••----•-••----•------ ........................... THE COMMONWEALTH OF MASSACHUSETTS r ,.y .;. BOARD OF HEALTH No.. FEE.. ... ....... Permission is,hereby granted...... . ..e. 7":.._._.. " .....---•------- ..............................................................•...... to Cons c (+ or Re ' ( ),.an Indivl 1 Sewage Disp sal Sys rn. +v at No:� �... �..... w�. ... d" -------------------••-•--...•-••--...--•-•-......... r' Street Y as shown on the applicatio for Disposal Works Construction P it No w p Dated... �............ ,r -.(, yEr,+_..- rB and"of Healt DATE........ ..._ ` .. 7 vt FORM 125S HOBB$;& WARREN, INC.. PUBLISHERS - -