HomeMy WebLinkAbout0044 OUTPOST LANE - Health 44 Outpost Lane
Centerville
A= 172-118
S M E A D
No. 2-153LOR
UPC 12534
mead-com • Made In USA
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No..... ........ Fim.2....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...........................................
.........OF................
Appliration for Uhipas'al Workli Tatuitrurtion Vrrmit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
SystVn at.,
2-/ /Y-
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Locatotd
Locat' Addres Q /-6-.
.............
.........................
X-C-
wner
wner ddress
........ . . . .............. ............................................ ..................................................................................................
Installer Address
Ty;e ro;fBuilding Size Lot.j?.___jj....V.JS--Sq. feet
U
Dwelling-rNo. of Bedrooms............................................Expansion Attic Garbage Grinder ( )
P4 Other—Type of Building -----_--------_---------- No. of persons____________________________ Showers ( ) — Cafeteria ( )
PL4Other fixtures - - -------------------------------------------------------------------------------------------------------------------------------------------
Design Flow_...................... gallons per person per day. Total daily flow------------ ..... .....ga.1 ons.
WSeptic TanOL Liquid capacit
/_1 ---- --gallons Length________________ Width___..__._....... Diameter_____-_-_______. Depth._..._....__.._.
Disposal Trench—No..................... .W'*dtl ,:4otal Length.____.____.____.____ Total leaching area------------ sq. ft.
I -�l ------------- ---- ---
Seepage Pit NO—/-------_----- Diameter...�e,�e ���Jpth below inlet.................... Total leaching area.—.'r .----sq. f t.
Other Distribution box Dosing tank
Percolation Test Results Performed by------- .......................... Date------------------------------------ ---
Test Pit No. I................minutes per inch Depth of Test Pit..._.________.______ Depth to ground water..--___--___________._..
�rA Test Pit No. 2................minutes per inch Depth of Test Pit_____.._____._______ Depth to ground water-_____________________._
D .Rescription of Soil----
0 .....:..... .......
�4 - -------------------------------------------------------------------------------------------------------
--- ---------------------------------------------------------------------------------------------------
---- -- -----
-------------------------------------------------- ...........-...................................................................................---------------
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
U 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 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 the boa of -alth.
gned-_ ... ......................... ....... 3 F=D-..-....----------
Application Approved By............. .... ......... .... ....... ...l
Date.
Application Disapproved for the following reasons:................................................................................................................
.........................r...............................................................................I------------------------------------------------------------ ---_-7----------------...........�/ Date
PermitNo......................................................... Issued..... - ------- - -----7. ..................
Date
-------------------------------------------- -------------------- ------------------- ------ ------------------------
r
f . .ter
No......U. ........ FED.. _...... ..._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
77f7���----------OF................ .. ....
Appliration for Di-4pooal Workfi ( omitrurtion erafit
Application is-hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Syst at:
x _
I�+L}oPcat -Address= 'L O• N� .........................
wner Address ..�
FWD Tof
. ....--- ---•----------------•-•--IstallerAddress
UTyilding Size Lot..11 feet
Dwelling 1-No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type e of Building ------------------- P (----)-------Cafeteria ( )
Other fixtures -----
Design Flow_ ____________________ _ _._____-gallons per person per day. Total daily flo gallons.
WSeptic Tank Liquid capacity, /A __gallons Length................ Width-----------..... Diameter________________ Depth__--_____-___-.
x Disposal Trench—No_____________________ Width------------_____ otal Length---_--------------- Total leaching area--------------- ___sq. ft.
Seepage Pit No.... Diameter____.A"r �Vpth below inlet____________________ Total leaching area_,fi��.....sq. ft.
z Other Distribution box ( ) Dosing tank ( )
'-' Percolation Test Results Performed b _________________-:___________
Y --..__.- cv�'� -_��w�.p- :�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------------------------
9 ----•-------------------------- = -•-----
0 Description of Soil_____ _____________________________
..0
U = '`-�--------------------------------------------------------------------------•----- ----------------------------------------
W
UNature of I:epairs or Alterations—Answer when applicable._______________________________________________________________________________________________
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Agreement:
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 been issued by the board of health.
fs
ign dZ = D
Application Approved B r�
Application Disapproved for the following reasons-----------------------------------------------••---` Date
--------------------••---------•••••. ---------•--•-
Date
PermitNo......................................................... Issued--------------------------------------------------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
: .. . ........OF..... '" ?� �t"
Tatifirate of Tompliana
IS IS TO CERTI , That the Individual Sewage Disposal System constructed ( or Repaired ( )
by -
M-� - ------ ------------
-- - ------------
p t ✓ �.. I stall _ 1
has been installed in accord nce with the provisions of Article XI of The State Sanitary Code as des-ribed in the
application for Disposal Works Construction Permit No...............____f_ __ _....... dated--__.,r , _. ...........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAR NTEE THAT THE
SYSTEM W L NCT N SATISFACTORY.
DATE Gl InspectorY
2--------- G
THE COMMONWEALTH OF MASSACHUSETTS (,
BOARD OF HEALTH
No.--/---•1-�/- FEE -------•---------
Permission 's ereby granted.. - _=-'"' ---- ----- ----- ------------------------------------
to Con ct.( or Rep it ( F; an In vldua ewage Di po 1 S stem �.
t't. f Street .
as shown on the application for Disposal Works Constructio�P„�r�o._��.______ ate
f
,,.
---
Board of Health_
DATE.--•---••---•-----------------------------------------------------------•--•_...
FORM 1255 .HOBBS & WARREN. INC., PUBLISHERS