HomeMy WebLinkAbout0049 LAKESIDE DRIVE EAST - Health 49 Lakeside Drive, East
A =252 -098
Centerville
707
No.......... ...l�l. Fxs...... 1�... `
........
1 It
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�x �.D /1........oF..........
,G�,�9, .....................
Appliratiun for Disposal Works Tonstrnrtiun 1hrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
Location-Address or Lot No.
---------------------- 1. ?.. .......�E.4.G�._.-�.?��--•-- ...................... �a.X..�`�?AC....E.a�d
Owner Address
Installer Address
UType of Building Size Lot------ '_`� __.-Sq. feet
�--� Dwelling—No. of Bedrooms........................?-_.................Expansion Attic ( ) Garbage Grinder ( )
pa, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures --------•----•-•---•----•----•--------••--------------.---.....-----•......-•-•••.......
W Design Flow......................s5.-.�----------gallons per person per day. Total daily flow.............3TQ..................gallons.
WSeptic Tank—Liquid capacity/S'd'ogallons Length Pr✓__-6.. Width... -e__. Diameter................
x Disposal No..................... Width_. .._.....__..... Total Length.................... Total leaching area....................sq. ft.
Seepage Zto....---_-.l____-- leer..Z�. Z.o Depth below inlet.................... Total leaching area.......5rda...sq. ft.
Z Other Distribution box (Z-< Dosing tank ( )
Percolation Test Results Performed bY..............--•--...---••-------•-----......•--••----••-•--------•••-• Date........................................
Test Pit No. I........2.---minutes per inch Depth of Test Pit..........3....... Depth to ground water........-___-_____.
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
9 ••-•...................• --------------------------------------------...---------•-•------------.........--•-•---........----..........._....._•---......
Descriptionof Soil ....... /P---------------------------•----------------------------------------•------•---......---•--.................._..
-- ....... --- -
x ,. P --- ---------- ----
Nature of Repairs or Alterations—Answer when applicable_________________ . v�+ ! __...._'"? 7
-----------------------------------------------------------•------------------------------------------------------••..-•--
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITIEL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issuedby the board of lealth.
79�
....... .....
'- �� ..
Date
Application Approved By....._`�._�_•- -.-- . 1� - ?.-
Date ....
Application Disapproved for the following'reasons:........ .......
:...................................7 .........
..
...............•-----•----....................-----....--------•-•-•-----------••---------•-----------...---------------•-•---------•----------------------............................................
Date
Permit No......................................................... Issued---- .'_ .
Date
THE COMMONWEALTH OF MASSACHUSETT ^ J
- BOARD OF HEALTH y1
wardgfirtt#r of Tum ltanrr �
✓.C� Z�
TH S TO ER F at the In ' i al Sewage D' po 1 Syst constructed or epaired ( )
d
by `�� .. ........ � �` �6 Via. ,
Installer
atY Gdr1.�. . . -- . .... •••---------•----------••--•••------•--•-•-•----.....---•--•....••--•--------------••--••------
has been installed in accordance with th provisions of 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit IN................ dated-. ` ..........
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................•-••-----------------------------------.------..._...--_...._ Inspector....................................................................................
r
No.------- .. FEs...........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Ci..
OF............ . : • .....
4 ppliration for Uhipoaa1 Works Tonstriir#inn ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
_ w
.t9 .
t Location-Address or Lot No.
-...<=eAZ�----- •--•---•-•----------- ........
..._
Owner
ress
•-•- - Es�/�•o-•.............. .....•-•-------- C r�G s`
a ¢
Installer � ess
UType g of,Buildin -i Size Lot.....:�t _ ....Sq. feet
�., Dwelling—No. of Bedrooms ___________________ ___.___________._Expansion Attic ( ) Garbage Grinder ( )
n
aOther—Type of Building; _.______•____-_•__-_-____ - No. of persons............................ Showers ( ) — Cafeteria ( )
� Other fixtures .....-.....................................................................................................................
W Design Flow__f'________________ 5............gallons per person per day. Total daily flow..............3 _-----•---•-•--•gallons.
W Septic Tank—Liquid capacity,,rs .,gallons Length�d.._�__ Width_.:; .,p._ Diameter................ Depth.....
x Disposal Trench—No............ ....... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage ] .._._ iam _2 *_Z_--o Depth below inlet.................... Total leaching area----..y,=...sq. ft.
Z Other Distribution box Dosing tank ( )t-
'� Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1........!Z-._:minutes per inch,,,,,Depth of Test Pit........�...0.. Depth to ground water____•-_y,r_�.._.__.
Test Pit No. 2............:..minutes per inch Depth of Nest Pit.................... Depth to ground water........................
x -----------------------------•----•-----•••--•....-•-•------•-.....•-•-•-------•--•-•--•---••------....__._...---•-••-••-•----•...--•---••-•••--------_...--
xDescription of �oil.._._..0.....-_9-- -:-----„Gg�4v.X..............................
U Nature of 1Ze pairs or Alteration —Answer when applicable ............`_ ,t---
_._ .. _
Agreement
The undersigned agrees to install' the aforedescribed Individual Sewage Disposal.System in accordance with
the provisions of TITLI:°' 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--- ....... •-•-..B
Date,
Application Approved By---------- ....... ,..-t�+at• ."'*.
, . a;
............Disapproved for theollowin .reasons -::•_
-•------....--•-----••--•---••---•--•----...----••-•-----------•---•------•------•--=-----------•--------'---------------------------------- .
............................................................
Date
PermitNo.......................................................
- Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............. ..OF.......:.......
.........................
(9rdifiratr of Tomptianr
T HISgl.TO C RTI .Y Tt the Indiv•du Sewage Dig osa System constructed ( r Repaired ( )
by ,d ...................
� e, y &Or/...._..
a
at-•--------•----�-'---•-•..... � nstall-
�... "art ► ......---•--•-
�,. has been installed in accordance with theovisions of T "' 5 of The State Sanitary 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 14lIILL;TUNCTION SATISFACTORY.
DATE....................•-•--••-•---•------------•--.........--•----•--•-•--•---••-- Inspector...................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH .
O F....:........ _.........
No.. ..... . , _ FEE.......- -_. r-
r
Dispos I IV rkg Ton iir# i rrmii :
Permission is hereby granted__f"e ...: of Wk.
..,. ...----•-
o Construct �Repair ( ) a Individ ale isposal S�,
at No:. .. . ._ w .......--
� Gr�r " '�'`"'�---sty
as shown on the application for Disposal Works Construction Permit N ................ '�-
_ Dated.----_=�� ��:_ _._.._.
r
_._._.....
DATE---------=-------------------
r o1?
FORM 1255 HOBBS &WARREN, INC., PUBLISHERS
!" °t
_._.. ...............
_ !�
t
- s
1 i I
I -
d
i
3
_.._....__...-......_... 7
,*1 6) G y, .
L O C A TpI,O/N SEWAGE PERMIT NO.
VILLAGE
I N S T A LLER'S NAME i ADDRESS
IUILDEIII OR f0W E-0
2 7q(.
I ,
DATE PERMIT ISSUED �0 - 7- ) 7
DAT E COMPLIANCE ISSUED
l I
°)4dusQ
20, �0
*, �ti'e
ir •y �\ t..` >Yr 1..� - r '€" I ! ��'`'• r
T -......__ .... -._w+--•ti.,r+..,....-+mow..-_..•w.
•
GYM_ 1�
^ . �' ♦...�, n -.._...—•. -...- .wr_.—.—_....Y�y.— w � 1 _ _ _ rr+_ jy .. Yr i � ,•�S
—
t
f. / •�'4.i•.#_ ram. - ` ., _
,�.� /_,..�"'"' 'ram! / +• � � � t � � _y �Jwt"�
•_�
jf 1 A..X .v n, i 1
yy: .. /t 4lw
` r, � ' 4"•Lr.S//f t� G tY.t '1 1Yer�lL*. P ; .
ISL
' _ . �� y !`' j + •- des r r..\..-.. r � " - e
lipp
7e LE' /L`v' �L_
L4OT 1,33
K v
ci.�1,:.., '� � Il � � ~ LuA.SN�D.G•,GtI,S'NEa.S'TGNf' �'
4�A,5e, P/P6
e _fANr
It
i no
{
L !r C�V//(t' - '..; o { t
iV�T r 7,1, Ti
!•7AQ.fcrNG \ �I"X•. 4it/41 I
e -INt_�•. S• TL�cS•� p�I �.. _— f \ �� !r(. r '/r �•.•�A .�r�!r... / � �' /L.l -�7 --.r 1--._-L•.-- �!+ ,Y\.�.,,.r ' ...� 4
7 "y'._ •. _ \� t. ~/'f/4` �Al2JV. ,_`'•,;J'i�L'G' r� - 4ko_ -A,
ft-Jy'•�7°�.
D.` _. Ot�f L!JL.<r/O.Y t T EArI '_. i'Li" ,L: G i' s,: ��/ ,4y. • -J, o -—
' Z -flit!/i/ _ ^v P.4�iC j. /.Vl� ' 1
�` r •. . ,.`' X:' r�..//�,�/(J�SI� +1', �J��l L L '.'Ki s ✓ ' '� r' /tiI' ,//__ �: �' y� E»� SLi1/rdrl--
/`�. x a .NDQ/"IA�V G�oSSMAN /�� -�„iZ. r • ./ ' t 'lAW -11
i Sr4 ry n 04A Aft.
C.� f` . 4-2 a -77
vY #
F1 LL u//Tit/ESSE'U 49 .�4c.'L. r'c er TCJ •�31 1�: :, r '!/' f��.ttiNG
1 a7 r.' r i t31t.P/✓, c' oTF yG�i9LTfi� f'�`LL1L(/ f Ai/OW !_ ! .t ��• -��. _..►_ _.�.,�►.+-�.�••.
�3-x 3
J
7YtO �aL L �c�o caz. .4�oTiC 1.I�t/.e
K rVa� Ta _ALE
8 LamUo rL Jv
�s�•••a c�efc Igo T.�s[4t♦.A/?6'T K�i 1rs/ ,
yI4lD Is Tr'iA/
Q'K p }
�•,3. <. 3Jx�
1 a
i /•_2jji i. T'�7f. i':i�+ eyL`1' �.�r'7—��)�r�[�J r. n r - , a����1�* %!i�
1� F•+ Imo...- /.r"�'J� �.a .C�, _ - » - _ ..
r� /� �_i i� •y.. :. . ;' �. �'
1 7-
r34X-~ �I
00
�t/G1,a*. .9'
t �3p A0Q' !!/ L/�.ri/�+�44/lIIL�
� rT1C 7_A rVK «rr. .�,¢�'; /M�.�.X,�. f .Y -
3
1 O Gv�l/E� • /''Ji9�,, h"Er9LTf'- Ca fZ�- ,
� 't L�.�f•JEth�.� �,+�.'.4 .��t;_;�.,,rr 3 3o G A L o n..�� '
Po &oX 395 E llQ;VI '',007•-//
1VD/4?i�i�/1/ G,R OSY AfAN n-Z-
- \!'. y _ .. -z�rasQ¢r-aa�C.'c_s:..Rs+'s::.:t,:. - _.__ _-.»r 1 Li.I�i.•/l/IY 6o �i r /Y �/ tiJ�/ T�
h�
,� ......-�...•.,... .+rr......•....aye...-... .,....tib..,..,_ _.._..._ _...�.,�..,,,,� ... . _-.._.._.._. ,`
,