HomeMy WebLinkAbout0033 LAKESIDE DRIVE EAST - Health r'
33 Lakeside Drive East
252-099 Centerville
i
No.. ..�.y............. a - Fss....... °.................
pl THE COMMONWEALTH OF MASSACHUSETTa
BOAR® OF HEALTH
........ ...... . ...............OF..........................................-....
Appliratiun for %qvuaFal Warkii C9unutrnr#iun Vernfit
'r Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
S, stem at
:T� .. . . �_.----•-. -- ..: .................... ------------------------------------------- ----------------------•--..---------------
..
or
Lo tion Addre,s
........--•................................. Lot No.
Ow Address
Imtalle Address
d S et Type of Building � Size Lot___________________________ q. f
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( Q)
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
� Other fixtures -----------------------••------•-•-•------------•-•-----------•--•-•--•--------•-•--••----...__.........---•-----------•-•...-•------•...........----
w -Design Flow..... -�5_._!...............•..-.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........_...t` iameter_______ ..... Depth below inlet.......(a.......... Total leaching area......r.27Aq. 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........................
Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
9 --•-•-•--•-•-------------------------•-•-------•----•••---•-----------•--•-•----•---•--•••-----................................---•••--••-•--•...........-•--
0 Description of Soil........................................................................................................................................................................
x
U •--•.................................•••-•---•--•--...•---•---••----------.....--•--------•-•---•---•--•--•-•----------•--•-••-•-•-•-•-----------•-----•-•-•••---•-•-•-•-•-•-•••.....-------•--•--••-••.
w
U Nature of Repairs or Alterations—Answer When applicable...............................................................................................
----------------------------•-------•-----...----•------............----•-...........................---•--.....---------------------------------------------------------------------.....-----------•--
Agreement:
The undersigned agrees to install the aforedescribed Ind' 'dual age Disposal System in accordance with
the provisions of iITLE 5 of the State Sanit ode Th ers' ne further agrees not to place the system in
operation until a Certificate of Compliance has been bo d health.
Sl --- --- -------------• --•••-•-••••---•- ................................
Date
Application Approved By........ ..... ....... •--- -••-•• . ---------
y Date
Application Disapproved for the following reasons:........... :.
.... ........ ......... .... ..... ......•••-••.......------••--•••--------••••••------.................. •-•-•-------•-----..............................-----•••--- .-----........
Date
PermitNo..................................................._._.. Issued.......................................................
Date
No.....Q.y .
- -- S z.: FEs...............................
19 THE COMMONWEALTH ,r
�OFUASSACHUSETT
O/"R X
®f HEALTH ,( '
(� ...----- •. ...........................OF.........-..........-....-.-..........
, pplirFation for Dispas al ork Cron rnr#ion` rrtni
Application is hereby made for a Permit.to Construct or Repair ( ) an-Individual Sewage Disposal
ystem at: ti.M
�.... ............ ...........
Lopation-Addrafs or Lot No.
... ..........•--------------...-•---.._._..--
Address
Install; Address
UType of Building Size Lot...........................S feet
Dwelling—No, of Bedrooms............................................Expansion Attic ( } Garbage Grinde r
a` Other—T e of Buildin
4 YP g ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
dOtherfixtures -------•-----•-•-•----............................................
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. .L.�____________ Width1._.._._.___ Total Length____________________ Total leaching area____.___..____ sq. ft.
Seepage Pit No____________ ________ Diameter____..________.____. Depth below inlet______b.......... Total leaching area....__ �sq. ft.
Other Distribution box ( ) Dosing tank ( )
W Percolation Test Results Performed by................................................................•--•---•- Date........................................
Test 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........................
P4 .--•----------•---------------------------------•------••---•-••----•-----•-----....._......._....... =
Descriptionof Soil =------•--------•--•-----••-------------------•---------------•---------•------•-----------•-----••---••-----------••----•--
x
V ---•--------------•••----------•----------•------•--------------------------------•----•--....------....-----------•------••-------•-•------------••---•--------•------•---....-•-•---•------------•••-
W
x -----------•-------•-------------•-----------------••---------._..._------.-.------•-•----•-•-------- -•------------------------------•-------------•-----•-•----•-•---------..........................
U . Nature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________
.._•--•-------------•---------•••----•--•-------•••---•-------••••-----•------•--•---=--•-----_...-------•-----•••-••-•--------•-•••--•-•---•-•--•••----•--•-•••-----••-••----••_...__....._..----••--
Agreement:
The undersigned agrees to install the aforedescribed nd' 'dual e age Disposal System in accordance with
the provisions of TITLE 5 of the State-Samt e Th ers-gne further agrees not to place the system in
operation until a Certificate of Compliance has been e b d 9f health.
Application Approved By........ ...... C �, .
Date
Application Disapproved for the following reasons:--......... --� `'+•-•-- •------•----------
--------------------------••-----------•------....------•---------------•------....--------------�......--••-----..-
Date
PermitNo................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF............... ....-..........................._..............__..............
OrrtifirFatle of (tnutpliattrr
T IS IS T _RTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
bY...............- --•----- :...::......... ......................•---.....------•-------•-------------------------•-------------•-------•--••---•.....----•---•--...-----._.....__......_
fd ....`. .................... r"°` Installer
+� Jj
has been installed in accordance with the provisions of TIT '�
Vkh
5 o tat; SanitaryCode 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.
DATE................:.............. .......................
............. Inspector......P ------•----------••--------•-----•---------•---------•---------........
t r
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
' :.........................................OF........_.. ....._.._._..._..........._.-_...__..... ...._........_._..._........ � '
No.....- •--...... FEE.:.....................
0iiposal Works mitrttr#ion ertnit
Permission is hereby granted...............K-5-2,0 -
k to Construct ( ) or ' Baiy j; vi a an Ind,il ewag Disposal System
••--••--•-----•--•-----••---•----..................
Street }
as shown on the a lication for Disposal Works Construction Perml o._ _PP p
r / ----•-•-••--.... -•-----•-----••-----••-------•----••-
I Board of Health
DATE. ----•-
FORM 1255 A. M. SULKIN, INC., BOSTON
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