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HomeMy WebLinkAbout0085 LAKEVIEW AVENUE - Health 85 Lakeview Avenue 's 2 22-101 Centerville I ik- LOCATION ` SEWAGE PERMIT NO. i 409 Z?4 VILLAGE APE- INSTALLER'S NAME i ADDRESS 8 U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED r r Nei�3:� ?_ F>;s ................ t THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...................._0F...... ........................................... Appliration for Uiipnsal Works Tontitrurtiun Prrutit Application is h eby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: 0 07_ I.... !5' F!/.. u.... ................. ... ......c -vr � ....�� = Location-Address r Lot No. f�v 02 ....�!.j............................. ... ............ .....��7--.... Owner , Address d Type g Sq. feet Installer Address T e of Building Size Lot..t�_C©.2-...._ U Dwelling—No. of Bedrooms..•f�.......................Expansion Attic (,V�, Garbage Grinder (&Cf pa, Other—Type of Building .............. No. of persons___.� __-___---•-__-___- Showers (. ) — Cafeteria ( ) :,..a Other fixtures ------------------------------• - s W Design Flow.............................l d.....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-_------------------ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( Dosing tank ( ) a Percolation Test Results Performed by....2r =e__ . YO �!! ___._.�................... Date.._.f ., /" ------- a Test Pit No. 1........ __`_minutes per inch Depth of Test Pit______Via?_...____ Depth to ground water...GW.A ...-e . GTq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil........ G'•: '`j 5�p• <�r --------------------------------------------------------------•-------------_----- cxj ••---•-••••••.......---••-•--•-----••-�.-�----------------------�0•.. ...4`` ^'r�----"--•c3®dui---...... ............................................... UW --------�- '�----------------------- •-•--- '- ......---------•- 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 iI11Z 5 of the State Sanitary Code— The undersigned further agrees not to place the system in oper . l a Certificate of Compli h s been issued by the board of health. 4. .................... Appcation Approved By..., ....... ••••••--------•••••••-----•-•-----••-••.....-••••........................ Application Disapprove o the following reasons:............................................ PermitNo......................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for Uispoiial Works Tomitrnrtion thrutit Application is hereby made for a Permit to Construct (4- or Repair ( ) an Individual Sewage Disposal System at: ....#6 ?.:._.lr'a •- -' .. Act%�'-•-r-..._>'�'r-'S'....... - l_ly..�'�.----- ='- Location-Address r Lot No. ............................. ........ Address Owner K^ es -ci Installer Address Type of Building Size .....Sq. feet Dwelling—No. of Bedrooms..7;�e.......................Expansion Attic (N lf+ Garbage Grinder (,C/t 7 Other—Type of Building 0fIPP.............. No. of persons.....!!�........__._______ Showers ( ) — Cafeteria ( ) a' Other fixtures ................................ . - --- ---- ---- ---- --- --- - • - ••--------- 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..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (V*) Dosin"tank ( ) Percolation Test Results Performed by____.- _. .!'r!,YI*.......................... Date.... ....... ,tea Test Pit No. I........ _..minutes per inch Depth of Test Pit....... Depth to ground water..eg=:. ! -� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P+ ------------------.--•-.....••••-••••••-•-••--•-•-•••••••••••••-•-••••-•••-•--••-•................................................................... 0 Description of Soil........ ................ _ v 'mow l7D�a� s9rv '®may--f•.9..e� - 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operabon until a Certificate of Compliance has been issued by the board of health. Sigd. 1, ......6 ..$--�. to � Appcation Approved By....., --!`�-�-------------------------------------------•--......--•-----------•------•--- r/Do'-'.?........... ate Application Disapproved44�/ the following reasons----------------------------------------------------------------------•- ......-----------------•---------------- ...........................--- /'V ............................................................................................----------------------------------------D---•••-.......... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.... ....�,�.........e........................................................... Trrtif iratr of Tontplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System co ructe,��L.�j"�or Repaired ( ) by........ - --------- P - �._ 1.. �,�?�- Installer at. ' r4_ ...... '' !`......--�---------- .. 7P''c.ri_ .'..p--. --------''------------------------------ has been installed in accordance with the provisions of TI-I 1 5 9 The State Sanitary C de a esgribed in the dated- e - application for Disposal Works Construction Permit No. . .................. ___. _.._.....,�`'.._._.__..___..__._._. THE ISSUANCE OF TH CERTIFICATE SHALL NOT BE CONSTRUED GUARANTEE THAT THE SYSTEM WILY FUNXCI TISFACTORY. / DATF. :--•----....1..... Y ............................. inspector........ ..... ................................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................OF... !'"-!. .................................. No...• ................... FEE........................ Diopooa1 IV k�n uan �erntit Permission is hereby granted.. .................. to Construct (--) or Repair ( ) an Indivi. al Sewage Disposal System ��••++ atNo..._!-G..2........Z ege .. I --•=-------------.. -•-------..............� = Street --- ..................... s r /. as shown on the application for Disposal Works Construction Permit Noy'.. �.._._1�" ated-/`'_�.._...`._....................... ........................ .5..7.- d"� DATE /j5_ /7` Board of Health /(/- J.. --••- ---........�j............. /j FORM 1255 HOBBS'& WARREN. 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