HomeMy WebLinkAbout0056 LAKEWOOD DRIVE - Health 56 LAKEWOOD DRIVE
Centerville
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THE COMMONWEALTH OF MASSACHUSETTS
OAR® HEALTH
oF.....
Appliration for U1,5posat 19orks Tonstrurtion Vrrmit
Application is hereby made for a Permit to Construct ( ZJ r Repair ( ) an Individual Sewage Disposal
Sys em at
. c0�10 ...... ...............................
ation-Address ............................................ Lot No.
Oewner` .Address
. .................................... ............................................................................................••....
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms................................. .Expansion Attic ( ) Garbage Grinder ( )
persons............................ Showers — Cafeteria
Other—Type of Building ............................ No. of p ( ) ( )
a
- -- .
W Design Flow.__Other fixtures -- ......__gallons per person per day. Total daily flow............................................gallons.
t� Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 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........................
a ------------------------------------- - --
O
Description of Soil--------------------------------------- -----------------------
W .._.__..___................................................................................................... ... .... ......
....... .-/!.. . .......
UNature of Repairs or Alt ations—Answer when ap licable.r:7:.. !_ .. ----...
♦ 77
Agreement: 4
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee ' sued by th d of ---
Sign e .......-- / `'
ate 11
Application Approved BY 1�d1/L.. ... ...a.....----- y� i�_
Date
Application Disapproved for the following reasons:----• ------------------ --•-•------------------------...-•----•-•-•-....------------......
.................................................•-•-•----------------------...............------------...---------------------------------------....-----/ait.
----------------------------.......
Date
Permit No......................................................... Issued....�1.4Z
No...,,,r1............... FEE.).....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 0' HEALTH
- OF......
r a.r -.-- i;M------------------------------__
, ..
ppliration for Elispvii l lark, Tomitrnrtinn Frrutit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at:
------- -------------•---•---.-------•----.-----.
ocation-Address or Lot No.
L Owners Address
W1
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—Type of Building No. of persons________________________-_- Showers — Cafeteria
P-4 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 ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
r14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a' ------------- '------------......-----••-----------.........................................................
0 Description of Soil-•-------------------------------------- ' ......•••-•----------•-----•••---------•--....---•------•-••------------------•--........-----
x
V -•-•-•-••-••----------------------------------------------••••...---••--•----------.-•-....----•-•--------•----•--•-------------•-----------------•----•----••-•---_-••--�.........................
-----. ..... ,,..........
U Nature of Repairs or Alterations Answer when ap licable iin.Z �r � . __' .
-r.?. g
Agreement:
The undersigned agrees to install the aforedescribed Individual-YSewage'D sposal System in accordance'with
the provisions of Article XI 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, oard of hZA
,,—,Signed------ ... `'. ----------
ate r
Application Approved BY � :• 1 ° r :�e' .
yl, 1 Date
Application Disapproved for the following reasons:.",'............................. -•-----•-•--. .�' .................................................
-••-•----•--.......--•-•-•---------••-•----------------------•-------------------------•-•--------------R---------•---------•---•-----------•------.-------------------...............................
te
��Da--
Permit No......................................................... `� ���:. �` Issued...... . .. ..---- ----. .._...---- -------
D to
R
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF.jiEALTH
OF.....
.................................
(Intifirav of Tnntptiame
THIS S TO CERTIFY That the-Individual Sewage Disposal System constructed ( ) or Repaired ( `}
by `' - ----------` `€ --- ........................•-----........---------------.......----........
at 6f_'_.._ ..� r C 8 '=K== �nstaller 2v
4 ,�'
has been installed in accordance with the provisions of Article✓X-I of Thr—State Sanitary Code as described in the
application for Disposal Works Construction Permit No.......... .............. dated___. ----- __ ✓________..
TIDE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON�T UED AS A GUARANTEE THAT THE
SYSTEM WILL U C ON SAT ' ACT RY.
DATE----------------------- --- ... ...- ............. Inspector....-- ---..................................... ...................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
,!� ..................../..................OF......... .�" '"7 '��:. 7�.................................
No...Z. FEE- ...............
.r�i.�n .ernti�....--
Permission is hereby granted � r G ,. ,t..............
to Constru t ( Kor Repair an Individual Sewage isposal Syste!� `
at No... .. ` -•----`
�r ' Street J
as shown on the application for Disposal Works Construction Permit/No.._..r".!...... Da`t'd_ a�� 7 .1
----- .. .
,.rr/••- Board rHalth
DATE----.. ... ............'...'....................................
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
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