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HomeMy WebLinkAbout0086 BAY LANE - Health (2) I o3(,loo 1 No................_....... -� .,�x . -.-_ Fss. .......................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® IF HEALTH ` L.......OF......... ...:.....G / �'V�!L Apphration for Di-gVos al Works Tomitrurtion rrrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System 5 6 Z3/,►� L./¢/-/Ae �r>17'c�Vie�E j�7" r= ............... .. ._ ---------•--'•-•"-----'........--'--- ----...---------------'----- .......----- / .......................................... Lot No. ✓ :.. /yo Lo n�Addre�s� L U� L�Z/-/'�E/i�1!or L A7/�C .............. ....................................................... ..........------•--.....----•----..............--•- ----.. :--- Owger[ ddrg As � (� �►`/- /T i a ....--------- ........................•.............-------------------------------------•--------- ----------------. ..-.--------------------------....... ._....._....--------- Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............ ..........................._ Expansion Attic ( ) Garbage Grinder (NC) Other—Type of Building ��°� Fie r No. of persons............................ Showers a g -•-•--•----------- P ( ) — Cafeteria ( ) Otherfixtu es -----------••-•-••-•---•--•---------•--•-•-•-------•--...•-•••---••-----------------------•-•-•-----••-••--•--•-••---•------•-•--•-------•------------ w Design Flow............................................gallons per person per day. Total daily flow.._.......3.�._.................gallons. WSeptic Tank—Liquid capacity v0!2_.gallons Length---------------- Width---------------- Diameter---------------- Depth................ x Disposal Trench—No.--__---.--------_-- Width.T......T_._._._.. Total Length.................... Total leaching area_______-----------.-s ft. 3 Seepage Pit No.�©..------- l i J .X 4____ Depth below inlet..... :........... Total leaching area... _`f�_ s :'f Z Other Distribution box ( ) Dosing tank . . '-' Percolation Test Results Performed b ,�L ' '1 �S Z.....�z-�7 Y------ ......................................................... Date........................................ , Test Pit No. 1..../' ___minutes per inch Depth of Test Pit.................... Depth to ground water-----/../ ........... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a - ------------ ------.... D Description of Soil.....••-�. --•�•- - ------- - ....................... U. (..:....... x --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- w 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 TITLE 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. Sign . -----•-------•.........................••••......------• ................................ ..y Date Application Approved BY •..... •. 1 - Gt - ' -- = Date Application Disapproved for the following reasons:.............................................----.............................................................. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH ......J.—O ... .......OF....... ... P....... ................. Tntifirate of Toutplitturr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( /<-or Repaired ( ) by.. Installer at•. .AL... ..... - -- •.. ... . �� �Ui"'' has been installed n accordance with the provisions of `i' 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit N .!�&�................. dated----�:_-� _7'-------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE----•-•---•--•------------------------•---••------------•--••-•--------'---•--.. Inspector..............------------------.................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALT 7� •-� g/ ......... -�, 1.........OF...... .. ............ .... .. E....................... 3 d......... FEE........................ Disposal Works Uonu�rttr#ion rruti# Permissionis hereby granted........................................................................ ............................................................ to Construc V) o.,Repai ( ) div'. al Sew Di sal stemat No — s,,ia - -- ••-••-----•---•--•------•---•--------•--••................ y Street as shown on the application for Disposal Works Construction mit Dated.... =5�_:_�.�................. • �! Ki --------------------- Board of Healt�/� �. DATE................................................................................ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS No................--... Fxs ......... THE COMMONWEALTH OF MASSACHUSETTS A., BOARD- 9F HEALTH 1 ......OF......... .. :. !1 .. ..4 ApplirFation for Ditipas al Works Toustrnrtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System IAA,,/ �' .......- ..... ......................... ................................ Loe(tt n+ Ad s or Lot No. ) �y9 l a > 1tw 4e✓ _ere_ t W .�. Owner ` �+ Addr ss a .... *!....! +`...... l; 4� ' '7a � ........ .--•.........................•--• Installer Address Q Type of Building -----------------------Ex Expansion Attic Size Lot------------g..•----.-•-•-Sq.(fe� U DwellingNo. of Bedrooms.............. a Other Type of Building _-o�..re o. of persons.....................(....)Showers (Gajba Garbage Grinder ( ) 1 dOther fixtures --------------------------------------------------------------------------------------- --------------------------------•---------------•------------ w Design Flow.......... .::................gallons per person per day. Total daily flow__________ .4••----_............gallons. WSeptic Tank—Liquid capacity/0.00__gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench No .................... Width f ...._ Total Length-__..:___ ` Total leaching area....................s a ft. Seepage Pit No. ._ a> �l �.4.._. Depth below inlet....:"df Total leaching area--- ' r. Z Other Distribution box ( ) Dosing tank ` f Percolation Test Results Performed b _ `._ ' �f �' .../)'.q• Y Date. ...... !....... Test Pit No. 1 --- X...minutes per inch Depth of Test Pit.................... Depth to ground Water...../__hn........... G=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... a � • + D Description of Soil------.. " . W"' /- -"` � �'��"t V- _f 'l - x w 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 TI'I 1E 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. Sign -------------------------------------------------------• --------------------•--------- ` A. Date Application APProved BY C_- - ........ ...'_ r x---------------------- ---.� ----•---•-- „. Date '­­Applieation Disapproved for the following reasons:....................................................................................... ...............................................................---------------•-•--•--------••-•----•--•-------------------•------•--•--------------•---•----••--•--••--------•----------•-•-•------••- Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O - HEALTH. +(� .. ......oF.......... ........... (Intifirtttp of TttmptiFanrr THIS IS TO CERTIFY, That the Individual' Sewage Disposal System constructed or Repaired ( ) by , -- _. ----------•-------••---- - ------ - Installer / o �,� has been installeddh accordance with the provisions of . T --of The/.The State Sanitary Code as described in the application for Disposal Works Construction Permit N .____ ..., �[-,___.-_____--•-_- dated I�_--`."---- ................•... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM. WILL FUNCTION SATISFACTORY. DATE..................................................................•-............ inspector.................................................................................... THE COMMONWEALTH OF .MASSACHUSETTS BOARD JQF HEALT -7� � , ' .......:oF...... :.._ :- ........................... d t .......... FEE... ................. %pnoa1 Works 05nns#ra ion rrani# Permission is hereby granted.................................................................... ............................................................ to Construe ) o Repai ( ) dry al Sew Di LS8�_�St at 00, No..:!t - •��- - -- w. - ' Street as shown on the application for Disposal Works Construction mit ... Dated --'?`5t-.. ............ t Board of Healt DATE-------------------------=------............................................ . FORM 1,2,55. HOBBS & WARREN. INC.. 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