HomeMy WebLinkAbout0046 LAWRENCE LANE - Health �- _ _ ,�
C�r�''G��v��1B
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265 NYE RD, CENTERVILLE
A= 147-026
No. 42101/3 ORA
ESSELTE
10%
O 0 O
..............................
THE COMMONWEALTH OF MASSACHUSET-fS
BOARD OF HEALTH
-
. l�r ttul� for �ovagal Tx ko C�ontAr' Linn kxttt�
Application is hereby made for a Permit to Construct (e or Repair ( ) an individual Sewage..Disposal
S ::t om. .. ..... . _...._ :' C��h,.��� l 1�..
« ocatr r Add or Lot T" cen� ��.1 •---- I,. ..SQ... v�,�t.�,h ._:..- -T......7-----
(z� /�C./ -L O.4 er
0.r1� �.G 'a....... .... ... •----- to .�_ d<(rss
Type of Building Sin Lot_ � ,_._.. � ; + Sq. feet
U Dwelling—No: of Bedrooms.. _..._-- - ---_ -- Expansion Attu ( ') Garbage Grinder � )
a Other-Type .of Building ------ - ------ ----••... N o. of person---------------------------- Showers ( — Cafeteria
t a
Other fixtures ,r�
Des ;n. flow { :..... g lions per p sonn 1) r day Total daily flow ... . .3� lops
lam,
Septic"1 ank—I squid capac�ty.�7-•gall�ns Length . Width -)_O.. Diameter....
Depth
W
x Disposal Tren h No ..-, Width Total .,cngth .... Total leaching area. sq. ft.
----- Diameter L�?...... Depth below inlet.... � -... .. Total leaching area..Z(cl....sq• it.
Seepage Pit No p
'Z Other Distribution box ( ) Dosing tank O 1 3
Test Results Performed byca `/ '. .._. Date------�
.3
Percal�tion
I
Test Pi \o. :1.:L:�...--minutes per inch Depth of .[est Pit---- Depth to ground water,.:�4.... Z.�
' , 2 ......ntinutes.per inch Depth of Test Pit.--...•............
Test I it No. �,--- - ' - � ...............
Dehtln to ground water .--.:
--
Q Descxiptnon of 5otl G? �'� �oa .. -.. �. � � .._.:
Cao l4 " tc�e
` w -- -• .
r,
.
iN
U , Nature of Repairs or.Alterations 'Answer when applicable.-.-.. ..... ..: ....... .... . .............................................
Agreement
A. The" undersigned agrees to install ,the aforedem-ibed Individual Sewage Disposal System in accordance with
s the;provisi.ons of I�'T: 5 of the State Sanitary Code ! The undersigned further agrees not to place the system in
t operation until a Certificate of Compliance has bee i• ued by the boar( of health.
Signed.... : .. . /
Apl Jio-ition Approved By... ........ � �? ..Q .. ; ...........
/U�� U...:.._. ....
`!/ %% D.ate
>. Application Disapproved for-tbe following reasons _....-- ---.............................-- -- - ...... -. .................... ..---•--
-. ....... -,ram,. ..
•----•--.... .• ..
: _t:; .................. :..-
Date
LOCATION SEWAGE PERMIT NO•
VILLAGE
_e U
INSTALLER'S NAME i ADDRESS
R U I L D E R ON OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
6i
33
a
oI
No... .�_.SbZ`�. Fps... ...�.....`.......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........... ... a.L -5. ......0 F..... .....................................
Appliratiun for Diapriii al Workii Toutitrurtiun Permit
Application is hereby made for a Permit to Construct ()C) or Repair ( ) an Individual Sewage Disposal
System at: '
kL . .... . .... .............. 1 a. ... ......... - ut-
-- .................. lr�/4 ............
Lo `i1on. e.<� or Lo s0
fit!------------------
42 ' AV
Ower r
------ t -------------------------------------•. ---.......0 ..................................................
Installer Address
d Type of Building Size Lotll..SQ.T _..Sq. feet
U Dwelling—No. of Bedrooms.......................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ...........................
w Design Flow............110......................gallons per pw-sen pt r day. Total
d_aily flow...........5_.50.....................gallons.
WSeptic Tank—Liquid ca acity.�.gallons Length� Width _ _.LP". Diameter................ Depth_f� _
Disposal
Trench—No..................... Width............ Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..........,......... Diameter......1-.0....... Depth below inlet.......b.`....... Total leaching area...?.. 7....sq. ft.
Z Other Distribution box ( ) Dosing ta ( )
'-' Percolation Test Results Performed by, .. _oi
��a.. .._...!? -........ Date... 2.°..!3_: .
Test Pit No. 1../<_?--....minutes per inch Depth Tes Pit.__1-4.4".... Depth to ground water._�1�t.. �
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---------__---_-.--____.
P4 --- ........--•-. -- ---------------- ..............-----•-........--••••---• . ---.,q-1---•....•--.. ..........
Description of Soil-P .. A' M_.
-`.._
13
w
U Nature of Repairs or Alterations—Answer when applicable...........................:...................................................................
•--------------------•-•----•------..................----...........----------------..........--------------....---------------------•------------•--------------------•-----------•--••------.....---.
Agreement:
The undersigned agrees to install the aforedescribed;1 Individual Sewage Disposal System in accordance with
the provisions of T I T I E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee ed by t oard of health.
Signed-•-- ---••..-•---- ---...m..................... ---••----•--..........
Application Approved By............... �9 % ------------------• ---•----
Date
Application Disapproved for the following reasons:................................................................................................................
..................................................•------•-••-----•---•---•--•----------•....-------•-••-••----•------------••---•--------------....-------------------•-•--••-----------•-----•--------
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOAR OF HEALTH
. .h...................OF..... ...Q rG1...��.. ..... .....................
Trr#ifiratr of Tompliattrr
THJS IS,TO CE IFY, T t the Ind;vidual Sewage Disposal System constructed (t/) or Repaired ( )
by...... ✓ .......... .A&. L444VQ.4..........................................................
... ........
Installer
at.....44.�'.._..7..... .�V -t c�....L Q 4.-t•......------. ...je r'v/ -----------------------------------------------
has been installed in accordance with the provisions of TI1 LF 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No-----YJ_G_`_-�__g-�.__-__-.-_-- dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUAR/ NTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. //
DATE................, � , 0 ..............................
aTHE COMMONWEALTH OF MASSACHUSETTS
BOAR OF HEALT
/o�n F �Q v /-�..^i
..................................O ........................-.. 5
--
No. ...................... FEE
Mtl or To #rnr� nt✓
Permission is eby granted.••------------ -----•----._� . . .....�1....---------••-•----...... ..........................................
to Constr t ( or Repair ( ) an Indivi ual Sewage Dis al Sys em
at No.......7...---- /�'!C�hLt.J...... ..C� .J fi f ............................................
........................
Stree
as shown on the application for Disposal Works Construction ' No.__. .. ..___..._ Dated.
, -
.............•--•---•-------. ---•-•----.....------• ....
Board of 561th
DATE................... ----�...�d
.................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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. LEGEND
,%
' �ry 4 F)
EXISTING. SPOT ELEVATIONS O,A ,�o IIRI:- x ;
EXISTING :CONTOUR- - - 0 - - =. G'{j U.,.
FINISHED '':SPOT ELEVATIONS 0,0
FINISHED CONTOUR; 0 PRQPOSED PLI pLAN
}
APPROVED= SOARD OF HEALTH �w n c M .
>.Ny ,y } I fez tT '_� A s:S-at ;!i ,�
DATE -, AGENT LC� 9 ,.,
. R . ✓. 6WEARN: NC., RL S R,
1348 ROUTE_ 134.-
c ,
EAST DENNIS,, MA"SS ; , 2, , 11
DATE 1qr L-_f..a'O S.CALE: Ia ,o1
JOB No. -76 CLIENT
DR. BY G
I r SHEET 1 OF �' . 1
W �� r.,;