The URL can be used to link to this page

Home My WebLink About0065 HORSESHOE LANE - Health Ce Atvrv(►le 2.fo 6 078 /// S M E A KEEPING YOU ORGANIZED No. 12534 2-153LOR SRESTRyNABIE FOO MIN.RECYCLED INITIATIVE CONTENT10%® CcrtifiedF6erSaurcNp POST-CONSUMER sn oin0 MADE IN USA GET ORGANIZED AT SMEADJ= ASSESSORS MAP NO ZQ6 PARCEL NO.: ' , Firm$ ..... 5. ......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH rpliratinn for Bi-spnal Works Tumtrnr#inn amit Application is hereby made for a Permit to Construct (-)(4 or Repair ( ) an Individual Sewage Disposal System at .. S1Qr_)AaS9e.�....Qen rs�]A� ----------- -----------------------------------------------------r------------. ........_.................. ocation-Address or I.ot I\ . osr s ----------------------•------...---._.._......---------- (o...... so s oe �,c�n�..... 'sr.��l l�.-.................-- Owner Address 'I -A 16 W.................................................................. ..�So---lu.... .__.. 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 ( ) Gi Other fixtures ..--•••-•-------•--------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 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. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water..................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------•--------------------------•----••------••-•---•------------.....---------------..................................................................... ODescription of Soil-------•-----------------------•------•----....-_............----•-----------------------:•-•----------•---•--••-•------------------------------------........-------- x V U Nature of Re airs or Alterations—Answer hen applicable. __.____ ____!S Do p�f too�k,� �� \ tp- /' " oAc... _.._._---•-•----•-------....•.. Agreei It The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 51 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. Signed---d � .............. -- ....... Date ApplicationApproved By.................................................................................................. Date Application Disapproved for the following reasons------------------------------------------------------------------------------------•-----•-------------------- --•..............................................................•-•---•---------.......-------•------•--•------•---------•--------•-----••-•-•-...--------............................................ Date Permit No.---........ :._:�1 Issued_..................- ................................ Dattee !J CdO / of 17 QQ�`� �♦ .ice,� 1 �W a7 V ' I Imo✓ •I _ r ASSESSOR'S MAP NO. PARCEL 70 50 LOCATION S WAGE PERMIT NO. looe X. o�0/, 07 VILLAGE ' oc)f INSTALL 'S NAME ADDRESS A ,. � R U I L D E R OR OWNEIC ,zasX6 DATE PERMIT ISSUED DATE COMPLIANCE ISSUED --� ,y I s` �y No ' Fxs..... ............._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. .1 v41W1 ...............OF.. rn Apphration for Disposal Works Tonstrnrtion thrrAft Application is hereby made for a Permit to Construct r Repair App y t t (•�(�..) o p ( ) an Individual Sewage Disposal System a q N� FN AQ (�Yl �Frl3t 1� a� ocation-Address j i + ) or I.ot�I�To. �— l . --.`C......t_ `Y74!2_ M4.--••i.:Y�§2._Ie} 1111.t.............•----•-- nn (� Owner Address �} TT'.1 � �Ct..Cc5 SO .....I h c�f2(2,Q X kJ P (sJt/i IOLc 1n.3---------- Ins;alier Address Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers,~( ) — Cafeteria ( ) a' Other fixtures -----------------------------------•-----------------••--•------•------•------••-•-•------•...---•-•-----• -------•---------------••--------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 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 ( ) F-1 Percolation Test Results Performed by.......................................................................... Date........................................ ,-� Test Pit No. 1__-__--____._-minutes per inch Depth of Test Pit.................... Depth to ground water........................ f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------_____-___--_--_-_- a --••-•----•-----------------••••-----•-•-----•......._...-----•-----.........-------'-'••-"-------'......................................................... 0 Description of Soil--...................................................................................................................................................................... x U x ------------------------------------------------------------------------------------------------------------------------------------------------------ ---------- U Nature of Repairs or Alterations—Answer when applicable--+? a .__.� Q____ - ' _._Q----6-k�_:tY r _. Agreer(dnt: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T- 'p 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. Signed.._ c es M h ....................................... ---rl.1 84P ....... Date ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons:................................................................................................................ ---•-•-----•--••----------------•----••----•-------•---•----.....----------------••-••-------•••.......--•-•--•-••-••---•-•••---•------•-------••-----------•-•---•---•...-------•-••-•----------------- _ Date Permit No---------- == Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..S..ovart......................OF` e. . ............................................................... Tiertif iratr of Tomplinnrr THIS IS TO C R IFY, That the Individual Sewage Disposal System constructed *)•or Repaired ( } by = `�Na1 --------------------------------------------------- --------------------------------------------------------- ------ at......... `�`. nstaller C =te e,...-1..n 0 4= ----- has been installed in accordance with the provisions of "Tice': j of The State Sanitary Code as described in the " application for Disposal Works Construction Permit No`��O__2.71,09.......... dated_""_ 2 ,�__a-1 _____________ THE ISSUANCE O THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A G1 RANTEE THAT YHE SYSTEM WILL FUNCT I N SATISFACTORY.�•ZgDATE-------_... '- _.. ... - -•------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -•7!' c► Yt.................OF..--........�"a."�... '......t ......-. BYO ...................•-• FEE.. :_ Disposal Works Tonstrnrtion unfit Permissionis hereby granted..... ------•--•-----------------------------•---------•-••-------........_..••--•-------.............--------- to Construct ( or Repair ( ) an Individual Sewage Disposal System t Street as shown on the application for Disposal Works Construction Permit Nod"70S______ ated�__�?__ .............. / - ,.........0 Board of Heal DATE ------•-------•----•--•---• t�.4 M 1255 HOBes & WA RR INC., PUBLISHERS