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Home My WebLink About0021 LAZARUS LOVELL ROAD - Health V2-1 L..a arru5 LDve�1 t R o._-•r------.... ...... Fics.......�.�..... LTH THEBO/"9IZDA® OFH C'SACHUSETTS . G. oZ Appliration for Bhivvii�l Works Tomil.rnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sys esn `...:`::. .... ............... g . ---.�.�.�.. ._..... .........-- .. .......... Locat' -Address No. --. ...__---- __._..._.... ........ .................................. •--....••••••••...-- -�Z .._.. ----•--..........---•--•--•---•----......... �O�wner dr,ss al.... r .......................... ................. ........................................... Installer Address ��} � Type of uilding Size Lot;:' Sq. feet Dwelling—No. of Bedrooms._....,,.. .............................Expansion Attic ( ) Garbage Grinder Other—T e of Building No. of persons.........................:. Showers — Cafeteria Q' Other__fixtures res -------------•------------------- d ._ ....•... W Design Flow....... _Y .`l gallons per person per day. Total daily flow....... _ Ions. WSeptic Tank—Liquid capacit ..3.�...gallons Length................ Width................ Diameter.............. Depth......._........ x Disposal Trench—No..................... Widt .................. Total Length.._...____._ .._... Total leaching area.._____.._.__._.__sq. ft. Seepage Pit No....... Diameter____ .. Depth below inlet_.... Total leaching area_�._.�..'�:..sq. ft. Z Other Distribution box (P� Dosing ( . Percolation Test Results Performed by._. •- ... . ............ Date...I.e._�.J.fl_.7:7�'. 4 Test Pit No. 1•- ; --minutes per inch De tK of Test Pit..._ Depth to ground water------------------------ � � P P P 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ u; O Description of Soil '' ........................................... ` �r /Z___ , x - ---------------•-------- •. • -•-•-•-•-•- • -•- .....V .--------------•-•-••-•---•--•-••••---•----...•--......_...-•----•••....._.....••-•-•---------•----•-••--.....---••-•-•-•••---•-••--- W UNature of Repairs or Alterations—Answer when applicable............................................................................................... --------------------------•-------------------------........................................ Agreement: I The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of LITLL 5 of the State Sanitary Code—The under - ned further agrees not to place the system in operation until a Certificate of Compliance has been . s ed by th o d of health. ^`%�'�' i ne J ' ... !'y g -•-•-••---•••- Date Application Approved By-- -----•. --- - �I !� Date Application Disapproved for t e following reasons:-.................... -----------------------------------------------•---------------------------_. ------•-•-•---•------------------•--.........-•-•••••----•---_•_..._..••••--•--------••-•-••-----•--...•.---•-••---••------••----••------•-•---•••-•-••-------•••-•--•••----•---•---•••......-----_...__ Date PermitNo.-----------•-•••••..........•-••••---------•-=.......... Issued..... --•---•---•--------------- Date CO-/?Z_... Fimz .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF F-I - L__1A .. :...............OF....... r ` ............................ Appliratiun for Khopuml Warkii Tonaitrurtiun jJrrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sy ......................... t:�,y".+ ...........:: _ ioAdress Locat �t�b. No. oe- .. ..-•.... ... ..... ..� — I - .......... r Ownerdress a ............................ ..................... .... .... ..................................... Installer M Address . Type of uilding ( ) Size Lo " i� Sq. feet Dwelling—No. of Bedrooms------ ----- ------------•--•-----_------_ExPanion Attic Garbage Grinder 04 Other—Type of Building ---------------------------- No. of persons............................ Showers — Cafeteria �I Other fix ures ..................................................................._.....0eter*__'_______'NVepth ....___. ........_____Design Flow....... gallons per person per day. Total daily flow.... Ions. WSeptic Tank—Liquid capaclt .....'._._gallons Length................ Width._.._........__. Dia .____..._____... x Disposal Trench—No..................... Wid .................... Total Length........... ....... Total leaching area._.........__.....sq. ft. Seepage Pit No...... . ....... Diameter..._ / Other Distribution box (A''� Dosin a p I' t g f {` sq. ft. Z pag g Depth below inlet____. � Total leaching area_ _... `'' Percolation Test Results Performed by_ ._�ef_x._ .' '.[............ Date... __r .` `_-. a Test Pit No. l...y��...minutes per inch„ Depth of Test Pit.................... Depth to ground water......................... 44 Test Pit No. 2................minutes per inch Depth of Test Pitt................... Depth to ground water........................ a ......... •--- O Description of Soil......•(,' "�."'_..._ " `' �' y'' V ----------------------- --------------- --- •----------•.... -- . -----•-----•--•••..........---------------- - .............................. 4 ....- : . •--------------------•----------......------------------..------ --•---....---•--.•-----•--•---------•----------.................--•--•---•- •----- ---------------------------- UNatur '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'TM, 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. r' Signf ............... .^` .... .. ... ... ......................................... f., .. 4 Date Application Approved By.......... ....:. ` ------------------ Date Application Disapproved for t e following reasons:......................-----•-•................................................................................. ---------------------------------------------------------------------------------------------------------............-------------------------------------------•----------------------................. Date PermitNo......................................................... Issued....................................................... Date. THE COMMONWEALTH OF MASSACHUSETTS tiIN, BOARD OF HEALTH .......OF............./�.�'.. ........................................ a. Tlertifiratr of Taamplttturr THIS IS O T Y, That the Individual Sewage Disposal System constructed or Repaired ( ) by .-- ------.-- •.. - f... ....-----•--•-•----------..A--------- ........................ Installer � -- " .. has been installed-'in accordance ith the provisions of TI 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No... .... .........1-74r........... dated_... _ --..---._------ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THATTHE SYSTEM WILL FUNCTION SATISFACTORY. DATE-----------------•--•--•----.......-----�..................................... Inspector................................................................................... a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF/-HEALTH, t . Q' .........OF..... ...... .......... :......... d^'u / /..... ... ... No............1.. FEE...!^ iaa�rua �tl r n Wit rrntit Permissioni aY ante. .............. ---------`--- . - •••• -•-•--..... ---.---- to Constru or Repair an Individual ew Dis s S . at No.' .....` .. � -d pZ "` tr as shown on the application for Disposal Works Construction Per ,f No.__.... ...._-AM .-9.... ` -~---- =✓ ..................... = F - ' DATE...... ! Board o Health-------•-•••••.....•... . FORM 1255 HOBBS & WARREN, INC., PUBLISHERS .. LOC&.TIOKA at 5E\N&C.4E PERMIT UO. — V ILL/LG,E Centery il1E• MA._ — — IWSTALLER5 W&L AE 6 ADDRESS AltredLEul-er — — — — — — — — — Cotui#�d._ — BUILDER 5 Q &VAE ADDRESS — — Alan E. Small, Inc_ — — Bows — Slenter-ville,-_l am- — — — — — --- D�TE PERKA T 155UED D ,.TE COMPLI WICE ISSUED ; 0Z 73 t � ,:6%"Q Lr= t=4Ml L.Y pa �� ;7L r_>w % t to K 4 a s v L 4`Z �ta tl�t.►t.- 5Es''{"►c. T AW V. = 4�a Itl� OA * (610 6f a 1�t�'�j ur,>=. /259 G?n . I\ - >tSPOSAL PtT V;E RMS Sl VeWALL A XA = I50 S F 2 :'3Or3 sF EJ 300 x-z': _ -750 &FT> 50TTOAA AREA: 56 51r K'4 c 100 '%r- fooSF < (,ox- 100 G?I:> � C i u 2 ho ! �' pd Ore C I ' l��i�i S Rlt�'tA�,) c�•� . —4 , -4 10. 0 I-eST AIZ r (r L"`l�l 77;4c377Cq 7�z �' e 4"P,Pe 125o twv. (..allwf 4"�r� DlST tum (*AL. S r:6D,L.. SsrPl tG t. max. � 4arautc �, Z. tcoo Qb.8 wv. A(, R; GA,L. LEAC-W , Pt Tlj GRn✓c-L. WAitagD cto "g Ct=e T l F t ilia Tel-oZ" PL A+-s � ptZo F t 1.E--' I�re,T lOt.1 (,t t4 Ttpz'V!W.Z g5 12� 1JO Sco.UE= IJo WAT - A pt_n t� 2�Fist c� 1 CimTiF`f TµAT THE --- 1-1EiZE.O rJ (fOM P�-Y S W t T l-1 Tt.4� tilt�E t..►!•t ," �-�) AwD SETBACK 6-FDvje�•MEt4-rj5 OF TWe r TOIAJ" 4 F �t 'f7�}r*6 t7 D,TE. i�.t (� G ►' ►X T B tZ. u`i E 1�.iG. Q�G�.tS't'� TLE"o L.AtJT-> 4L)IZVepev T444 Pt-&" 14 UOT BASED OtJ Au t"4TY.Qme.Mr 0eTe_Zv%l- 1 MASS• SUz%Av'l 4 T"r- OFF5ET; J"OoLD uOT 15E USEt> APPLtCAM•1T To -pmTr_Zmi wL l oT L(WS;. T7