HomeMy WebLinkAbout0361 BAY LANE - Health (2) c'ect .
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ASSESSORS N IAp-VI0:
N. .._/ !Z PARCEL NO.. � _
---_...........•---
THE COMMONWEALTH OF MASSACHUSETTS
1�0100I BOAR® OF HEALTH `2-=
..._---"".I.OWn...................OF. s �
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Appliration for RapasFai Workii Tonstrnrtiun 1hrutit
Application is hereby made for a Permit to Construct ( ) or Repair (Y.) an Individual Sewage Disposal
System at
.3(et t3
...........................� ..---- ��ll ------------------- ---.._....___--------•---•--•-----•---•--••--••-••----•-----•-----•-•---••------......--------
Location•Address or t No.
Ps4.!kF}._,To_ �i............................................................ /�..•---------....---._...-----------
.e
Owner Addre
oUg
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms----_______.................................Expansion Attic ( ) Garbage Grinder ( )
aOther Other—Type of Building ____________________________ No. of persons______.._._________-________ Showers ( ) — Cafeteria 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 ( )
Percolation Test Results Performed by........................................................................... Date........................................
W
Test Pit No. 1----------------minutes per inch Depth-of Test Pit.................... Depth to ground water_______.___.__________..
(Z4 Test Pit No. 2_______________minutes per inch Depth of Test Pit------.............. Depth to ground water........................
� •----------------------------------------
•..............
0 Description of Soil....................................................................•-•-•----•-•----------•••••••----•--•---••---••---•----••-----••-••--•--•-----------•-....-•_____.
U .___________________________________•-.____-----_.____.---------•---•-----------•-----------••••---.____--------__._----_____------------------------•---______--•------------____--•-------------------.
W
x
U Nature o{ff Repairs or Alterations—Answer when applicable 16 _-_.3_-__s__,094 Q_F/c� /FT(46 `_S•-•--------.
rGibed............ •••---••---•-------.....••-••--•••••••••---••--•••-•••------•---••--•------••-----••...---•---•-•-•-•--••••••-•••-•--•-•-••------••.
Agreement: 1 .
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of ii t 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
M operation until a Certificate of Compliance has been issued by''the/Iboard of health.
_. .Signed.. 7?wcm = 60 .............'
r'- ( Date
Application Approved BY - :::_____b__�jw.-J- • --•.!.!.••-•-•. ... ---••-...... J-...=- -------r
ate
Application Disapproved for the following reasons:...................................................................
...--------------------------------•-----___.----------._____..._____.__.....___----•-••-----•--------•------•-_....____--------------•------------••--•-------------------------------------•..._-----
Date
Permit No....... .....
I: Issued----------•--••-••-•-.................................
Date
THE'COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
------t.......... ..._..................OF er.:�,�.,..c. ....._.---------------------...----------..._..._...._...__
ApplirFation for UWpasal Works ( onstrnrtwu rrm'd
Application is hereby made for a Permit to Construct ( ) or Repair ( + ) an Individual Sewage Disposal
System at* ,r II
...............••------•..............._...••••-•_-•----_.._..........-•-•-••---.......•••-_.... .�_.....__..._-----•------•-•• --•-••---••--- -------•------._._._...._.__....-•------•--•--
Ili_ Location Address or Lot No.
X }} Owner a _ Address 11 7 IJ �fr e1 C� C� tlf tB'a�� J .c_... j-
Installer r� Addres�,
Type of Building Size Lot............................. q.S feet
�. Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Q, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
py
d 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—NTo_____________________ 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.,I________________minutes per inch Depth of Test Pit.................... Depth to ground water........................
1Z4 Test Pit No. 2................minutes per inch Depth of. Test Pit.................... Depth to ground water---:....................
-•-•--------------------------•--------------•-•--- .....................................................................................................
0 Description of Soil...................................................................................------------------•-----•-----------------•-----------------------•-•-•----•---•-•- '
x
W ---------------------------------------------- -------------------------------------------------- _:.; ---------------------------- -- -----
U Nature of Repairs or Alterations—Answer when applicable-��?a __�_--_:�--��.APP:C�"w_ {_4 P _____________
... ...trec4
Agreement
The undersigned agrees to. install the .aforedescribed Individual Sewage Disposal System in accordance With
the provisions•of ?-'--71 : 5 oi.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-= _—Signed....._..•-•-•! fcF.1.V1A ... ! ' ................-
Application A roved B ................. u...`�� J � - / Olt `
PP PP Y=-••• --•-.. • •-
Date
Application Disapproved for the.following reasons:-----••••--•••-•••••-•-•-••:..••••••••-•-----------•--•••-••-•••---•---•--•-•-•••---•-••--••----•••-•........---
-----------•----•----•----•------•---------------------•-----•-•-----••-•._--_._._._..__....--------••------------------------------------- ---------- ----------
Date
Permit No........." f.. Issued•--•-------------•--•---------------•-------------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
5 BOARD OF HEALTH
`` ,,�
Gtfazl ........... ..OF.:`.........?.C'or-vt. v� .
Trrtif ir" ab of Toutplitatme
THIS IS TO ERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
bY-----------------------r---�'-----------.-..._.... der
has been installed in accordance wiut N; /
provisions of ilt, j of The State Sanitary Code as described.in the
application for Disposal Works Construction Permit No ______ -" ....- dated........f"7.. I__7__� �
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT rHE
SYSTEMS WILL.FUNCTION SATISFACTORY. .
DATE.............. ---•--•-� 21 --------••-•--•----- Inspector..:____-1__2-2)--------•--••----=----------------------._..._.......-------••--
THE COMMONWEALTH OF MASSACHUSETTS
BOARD . OF HEALTH
n.... .OF._ s rt��w. _!.r�................. �O
......
No.=._.. •--• FEE.........--•-...........
DioplasFa1 Works Tnntrurtion rrmit
Permission is hereby granted.........
f hd_�� ................................-••••-••...-•-•••-•••-•••••-•-..._......•••••-••••••----------------
to Construct ( ) or Repair;; _ an Individual Sew/-age Disposal System
T � i r ( �-.
all J\O_____________�at�r..3_._...____.______...._..__________._�!'_^�f�....:�?'�.f�___.._.______________._______._.___.____.________________..___._.__.___.___.___.............
S:ree.t., -—'.
_ ............................
r
as shown on the application for Disposal Works Construction Permit Now_'`___` _ Date _._____
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'%. Board of Health
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FORM 1255 P�'BBS & WARREN, INC., PUBLISHERS
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