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HomeMy WebLinkAbout0368 LAKE ELIZABETH DRIVE - Health 3ss tch* Ft za p�' P-1 ack SMF.AC?l KEEPING YOU ORGANIZE® No. 10230 j H163 C' roo POSTONSUMER e�maao MAOEM USA GET ORGANIZED 9 SMEAMCOM Fimic 3.. .................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...... .iniA/:.........OF........ .................................. for M-sp ii al Workii Towitrurtiou Frrmi# Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal System at: --•....Z✓Z!9/�lsJ7`. YG� d � Location---Address -... ............................................... --.Ko...-•-•................................... Location-Address or Lot No. - --• .......---••-•-•..•..... ................................................................................................. Owner Address......................•.------.. Installer Address _ Type of Building Size Lot_ !_ .:5 f.....____.Sq. feet - Dwelling—No. of Bedrooms...........2.............................Expansion Attic ( ) Garbage Grinder ( ) '44 4 Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures ................................. W Design Flow..............._....................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity.C��%!f?..gallons Length.A. e`".. Diameter................ Depth...--t�.7__8_._.. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------/_........... Diameter.._..1Z.__..... Depth below inlet...... Total leaching area..Zel.....sq. ft. Z Other Distribution box ( ) Dosing tank (. ) g `-' Percolation Test Results Performed by. ��� _ .lGtjz.� ^s>. %����`� Date_.. _ l .....- ,aa Test Pit No. .....minutes per inch Depth of Test Pit.... =`�.��..._. Depth to ground water__________ ___________ Test Pit No. 2.5L:4....minutes per inch Depth of Test Pit----e: .`'.... Depth to ground water........................ a •---•---•--------------------------••--•.--••- ------------•------------•--•---••-•.........•-••-••-•-••...-----------••-•----------------•-••••••....---•-- O Description of Soil......��-3 ........IR/aGD i . ..�5 .................................. � /h��_.✓` v da.01.G!P `�•-/44C" l4sLrU. J7�....................................................D 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 LIT12 5 of the State Sanitary Code—The undersigned further a es not to place the system in operation until a Certificate of Compliance has been i s ed b the t}o� he . Sgi ned �x/—.� ------------ ............... ................................ Date Application Approved By....... 1 =----- ------- ....... 11 Date Application Disapproved for the following reasons:................................................................................................................. ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date No...B.2-�I lv---- V� FEB....3 5.-�......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7r.tAIA-'-..-.....-.oF...-....�117dAiS7: _x3e-G ..__... Appliratinn for %epos al Worka Tnnitrnrtinn .ermit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: ... _.............. . ----•--........-•-•---•• ••....---•----._...•----•--...----....---•- .......... ........... . ... --------- J� Location-Address or Lot No. ......................_.................................... ........................ ..........-•...................................................................................... W Owner Address ..............•••••• -..,73'-.......................................................... ....._....•----••---•------•. _ Installea Address UType of Building Size Lot___ _ ........Sq. feet Dwelling—No. of Bedroo Ins___..__.__:_.�'_�______________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ----------.•--• -•---•---•---:--------•_...._ W Design Flow.................`. _________________.._gallons per person per day. Total daily flow_...........................................gallons. x Septic Tank—Liquid capacity�S'-b�.gallons Length_B.��a___. Width.'4'{G Diameter________________ Depth.�.'e✓f Disposal Trench—No_..................... Width.................... Total Length..................... Total leaching area....................sq. ft. Seepage Pit No.......f........... Diameter._.._Z?�........ Depth below inlet_____ ___________ Total leaching area._2 4.77.___sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed ......................c4G "l__ /e'_ L!aar,f"lcDate__.` � �?.. � ` a Test Pit No. 1. ._ _____minutes per inch Depth of Test Pit____ .... Depth to ground water________________________ LL, Test Pit No. 2. ._Z___._minutes per inch Depth of Test Pit....!__J`1_....... Depth to ground water_______________________ •---.-.•.--•---.._....-•--••..................•-•----•-•---._._.._..------------.............._.._........................................................... O Description of Soil..-- -` .._We��,rjCas -e S 6,1-�jai L 3�'�`x�N 'I'm Z_''`''�='r'Z) -`4Z.'-we 4 - ----- ........•-• ----------•-----------••--••- V _...-••-•-•--•---••--------••----_---- 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 TITU 5 of the State Sanitary Code—The undersigned further a es not to place the system in operation until a Certificate of Compliance has been i s ed b the ,, - h Signed___.._.__%`'_..'---rr`-.........�.�____............_ce.------- --------- -••----------------- I�����j , D t Application Approved By........ jA---• 8•,A �' Date Application Disapproved for the following reasons_________________________________________________________________________________________________________________ ....................................•--•--------.....-------•-------•-----•--••--•---------•-•---•----------...__.._._...--------------•---------•--•-••----•------------•------...••-••---••----------- Date PermitNo......................................................... Issued-------------------------•---•-•-•--•-•---------•--••- `" ,... Date ' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... .............................. Trr#ifiratr of TaamptiFanrr THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( L-1)�or Repaired ( ) by.................................. -Y--a---------------------------------------------- ------------•-•----•----------------------------------------------•-•-•-----•-•-------------•--- + stall , at-•--••.6,2 _ AaI /G Gj '_/ --------,-)�-`-.............C-kz.t14`----=--------------------------------- has been installed in accordance with the provisions of TIT 5 of The State SanitaryCode as described in the application for Disposal Works Construction Permit No.__._ i_"_y/��_____________ dated ..-___._..-_._..__._._______.__._._._._____._ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISF CTORY. t DATE.......................................... .I- ... .8�............... Inspector................ ..................................... x THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH { �U treoit*-......0F...........' 'Gj?c�ot.- .�f3.Z-Lr-' / _--....... s No... ..........Y..... FEE........................ DisposFa1 Vorkg Twnnitrndinn rrnti# Permission is hereby granted................A-Y.Pp.••-----•--.------•--------------------•-------•---•------------------..__....-•-----•....._..--••---._.... to Construct (vim) or Repair I ) an Individual Sewage Disposal System at No..---•---._4�_-A./.._..----..........•----__A�..----------�- l- 'a ` 7 C 'L-*4 C t ... Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... r - � -- ------------------------------------••- oard of Health DATE................................................................................ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS L 0 C A T P N SEWAGE PERMIT NO. , VILLAGE �l2i�fgy t l�� INSTA ll R'S NAIVE i ADDRESS Ld 5 6UII0ER OR JXNWER DATE PERMIT ISSUED DATE COM`PIIANCE ISSUED q_�o � � .4. - Ro NT may,\ loc- /U00 7 RA)k- 1 �' t7 .5 A37 �\ E rs.-Z M R 6,Y cp�o '' J �o r Zr #2r�, ' � � C IzoQ I SE LEA04 f.r r"o # ��o nosE� k/Ar�iZ TES 7- L/OL,E ,DES UL TS 20 beA � - . 20, ^Nu SF12ViGE MlAr /O ' , -TF-sr o M�a rfz:4m sFo✓aGE '7- Z/- 8 2 ZZ J� A4 Ec. LD7— RC>AJALD A . G/PFo2D PILOPOSIrD 6 23.S E 14' DwI-LLI�1G �9 �� �� l EC. 2/.7 � E� .41 21, 9 , 2• !� fit.3a.3o J ti TOP ce> "@J Svl�S DIL Ec.f�SSUMt 7 ` NEL /8 36 MED, SA^/,D � G'M 35.61 34 0 . f 7 GIZR vEL 48 19 ' MEDIUA4 E�. 9. 7 — 144'. MED/uM + 8 6� I FiAI 5A�D 7 , EL . 8•7 1,Jo wATE2 ISf '!EL. 8.9 9-- . 78 l "16 T C'O,vS 2S )L. MINIMUM O JILV IIA& -befOAa 3 o FAIT /0 611?6 IQ' REAR V - UWOATIOW JAPAN U i. To PowrsRp O f1t41544 GRAM AVW' 2% E• wil'"IN ON FoCT OF FtLtISH GRAPE 8,� OVER I•EAGH AREA •.2'�of PSA SToNE FbQ • (IO�MI M"PtA. 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CAPA C ITY 0-2a REtIJFoRCs✓v GoLIC.iZE;T'1G PROPOSEV 1.EAG.}}C'APAGITy H to LoAoi Nca � � Rt.-JeWA o � Y Nor T DE LO � R � AY Lo ©V SR �/-STEM U1 J L .G S I- 20 y gas� LAN - 954-A41N LOAP�IWCa UcFo f ,. 4� i 13T�• w LOC•ATtoN ALL Pr Pew To Cie WAT9.Ti44 NT SY T'�M Vo 13PS ONI FIB SA►O.5F, 2�/� MNS. Rya, of EFvs ENGINEERING CoRm DESIGNING BUILDING I hHORT INC. wcl Lki "'N AIaFNI-r AP {r 'OVAL DENNIS, MASS. 3850,28ql-j