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Home My WebLink About0684 BAY LANE - Health (2) �� 1 x� Ise 0-779f y COMMONWEALTH OF MASSACHUSETTS - ...� BOARD F H EALT .`...:......................OF......f ... �-,^ s U� ,� rlir�#iutt furiuuttl urk C� ttrtxriott r amit Application is hereby made for a Permit to Construct ( k1_5 or Repair ( ) an Individual Sewage Disposal. System at:yy / .............. _ ........... ........._ ................ �� .... ....................... - .. ......... n� ation-� ress/f f or Lot Noy[` f ....0....ZIP f... . / A .0 __.................... ... •—✓ • ----.............__...._......... -....................... . .1......._.. Owner Address W ---•---•• -------- Type � - -��- �s: Address A U Type of Building e. Size Lot.4........�!!�.......Z�f. t Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — a YP g ---------------------------• B P ( ) Cafeteria ( ) Other fixtures / .. -- w Design Flow...................._.....Z/.�1.____gallons per pvwmn per day. Total daily flow......................... .... _...gallons. WSeptic Tank—,Liquid capacity.l6'rg'.r✓gallons Length_.......... Width...... .... Diameter................ Depth....._4_1.... x Disposal Trench—No. .................... Width.................... Total Length...............__.. Total leaching area....................sq. ft. Seepage Pit No........./------- Diameter...._4 ....... Depth below inlet...... .r.... Total leaching area...- ...sq. ft. Z Other Distribution box (ky- Dosing tank )/� y Percolation Test Results Performed by-_......._. P.G:.....%I.�/_J..................... Date9� . J d I�7 Test Pit No. 1... _ ._-____minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi Test Pit No. 2_ �.^.minutes per inch Depth of Test Pit.................... Depth to ground water..................... 4 a O Description of Soil -� �' �c� ---- C� /� ..�... x f/ � �,�............. n v --..._.... fi ... 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 TIT= 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. igne ------•---------•----•-•-•-------------------- ------------------ Date Application Approved By...... jy.. f�a�J-------•-- Date Application Disapproved for the following reasons-----------------------•.......---------------------------------------------------------.._......------........-- ..............................................•••-•-•••--•--......•••-••----------•------•----••--••-•-•...-- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH ?............OF.... .......'......................................... T&rrtifirate of Tompliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (/_�or Repaired ( ) by ................. .. ................... I �ta�g at yqr y �- a----- ------ � 7 has been installed in accordance with the provisions of TI ' r'- 5 of e State Sanitary Code as described in the � Y application for Disposal Works Construction Permit No.-'_ _ _.____--v_ _....... dated___..�-1!-_7�...................... THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector............................................ rN FxB.............................. THE COMMONWEALTH OF MASSACHUSETTS A BOARD/ 0 F ...................... .................0 F......................................................................................... Apofiration for Eliqposal 0o;k-s-Zonstrurtion Irru t Application-,is het6y, made for a Perrh* to Construct or Repair an Individual Sewage Disposal SO I/atk, to . . .4$r........................... .....0;.r, 5' Location-AcTdress, ........................ ................................................... ..................................................................... . ........................................... Owner AddrA ................................................................................................. .................................................... Installer Address-/--V8-*;4-e iz Type of Building )1! 1 ._? SizeeLot............................Sq. feet Dwelling No. of Bedrooms............................................Expansion Attic Garbage Grinder Other—Type of Buildi .0av/4-pqrsons............................ Showers ( )yja&teria 'i ---------------- Other fixtures';*e/........................... .............................6........................................................ DesiWFlow'..................................M�4L gallons per person4?e-r day. Total day flow.............................................gallons. P4 Septic Tank—Liquid capacity.'-'.........gallons Length................ Width..'�e..r..... Diameter................�etl .............. Disposal Trench—NX................. ...�."WiM.6;................ Total Length.._....6�......... Total leaching ....... .....sq. f t. Seepage Pit No..............Diameter.::........_.__..... D pthi low inlet_ ............ Total leaching area.................sq. ft. z Other Distribution box ( ) Dosing t 4�16. n'P T j Percolation Test Relffftf t' Performed by.......................................................................... Dates' TestPit _'6.."2 e it No. 1711.. ....--..minutes per inch. Depth of Test Pit.................... Depth to ground water.._..........._......__. fT4 Test Pit Nb. 2....... perch Depth ...../------- _9f Test Pit, DeptlVt*.popd,*aj__,__ e--;q - P2 _7.........................../........................................................................;....... 0 Description of Soil..... ---------------------------- ------ Xz...1.24.... .... ... h— '- . A. --------- ..... .. . _- !�.....I ..............y ... ................................ ........................................................................................................................................................................................................ ti U Nature of,,Repair's'or Alterations—Answer when applicable............................................................................................... ...................................................................................................................................----------------- ........................................ T. Tf 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 operation until a Certificate of Compliance has been issued by the board of health. ;4igned ... ......;54f.................................................................... .......................... D Application Approved By---- ...... _---_--------_-- .......... Date Application Disapproved for the following reasons:............................................................................................................... I ......................................................................................................................................................................................................... Date PermitNo.......................................................... IssuedL....................................................... Date A THE COMMONWEALTH OF MASSACHUSETTS BOARD Of HEALTH . ..........OF....... I .............................................. Tatifiratr of Tompliattrr THIS IS TO CEL?TIFY, That the Individual Sewage Disposal System constructed ( /1,010or Repaired by............................... --- A............ - ------ ------------------- ----------------------------------*"*------ ..... . .. ... .................. at ...le has been installed in accordance with the provisions, of TI 5 of he State Sanitary Code as described in the application for Disposal Works Construction Permit Now_. .... ..�?A!2.......... dated_...Oy 7.1...................... F.I.- 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 OE HEALTH ....... ..... ............OF...... ... . ... . ........................................... No..V. ......... FEE.. . .............. Elisposat Works m5onotruction' amit Permissio hereby anted ------ ----- ...... ................... ...... ------- -------- .................... s ............ .... to Con R r P @,%eWspq t.pfl atNo................................................................. ....................................... ................................................... st t as shown on the application for Disposal Works Constructi8in t;sc ;eAN o....OVI .......... . .... .. Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS