HomeMy WebLinkAbout0695 BAY LANE - Health (2) t
No....... FEic .............
TH B®AO�NW�EALTH�OFLM ESACH SETTS
q.
` 'O� P'1 f� r I� 1
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(� Apphrtation -fur 3-4poii al Workii Tutwtrurtion Pumit
J Application is hereby made for a Permit to Construct (K) or Repair ( ) an Individual Sewage Disposal
System at:
--
Locati n-Address or Lot No.
--------- �`� " _..1 =f ---------------------- '7-:7.....� n� e
Owner Address
/taller Address
Q Type o Buildin�� Size Lot..1? _,- -------Sq. feet
U Dwelling IN"o. of Bedrooms-------------8---------------------------Expansion Attic ( ) Garbage Grinder ( )H
aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a' Other fix es -----------------------------------
w Design Flow___ ____________ -.___---------------gallons per person per day. Total daily flow-----
G%._..._....._._...__..gallons.
W Septic Tank Liquid capacity-_/ka6.0gallons Length................ Width................ Diameter_-.-_.--------- Depth----------
x Disposal Trench No--------------------- Widtl _ of 1 Lel leaching area-----.-----------___sq. ft.
Seepage Pit No__ _________________ Diameter ....._._. ept 1 ;, 1� _.__.....j_ ta
otal leaching ar 1_.----_--.-_--__sq. It.
Z Other Distribution box ( ) Dosing tank ( ) e'
a Percolation Test Results Performed by------------ ----------------------....................................... Date............... --------------....
Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water...----.-----.-.--.---.
rX.4 : Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_._-----------------...
04 ----------------------- ---------•-•--•----••--•-------•--------•--•-••------------•--------...----•.........................................................
0 Description of Soil---------- ..... I` ........ ...... ------••----•-•-----•------------•-• --••---------------------------•---------------
X
U
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 Article XI of the State Sanitary Code— The undersigned fur ier agrees not to place the system in
operation until a Certificate of Compliance has been ' e by the boa of th.
Signed.. ..------L'.....---- `2--- Date 9-
Application Approved By--------- L-: _
SDat
Application Disapproved for the following reasons------------------------------------------ --------------------------------------------------------------------
--•-•--••-•----------------•-•-----.....-------------------•-----------•---•----------•---•--------------.................................................... ------- ---------------------------------
`'� �7Date
PermitNo......................................................... Issued----/-/-- -... --- - .....................
te
THE COMMONWEALTH OF MASSACHUSETTS
7;� EBIIOARD 9F HE
. ....... OF.......!,OC?.4�
Appliration -for Big oiial Works Towitrurtiott Pprutit
Application is hereby made for--a Permit to Construct .( or Repair ( } art- Individual Sewage Disposal
System at
-------
Location_Addre s or Lot No.
•---- --- = 1...-- t.... = --------------------------•-----•----•--•---•----..._....-----•-•••--•----•------------.....
Owner f Address
a .......... ,.
nstaller Address
UType o Buildin�/ Size Lot............................Sq. feet
Dwelling�No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
a4 Other—Type, of Building -----------..-___:_ ______ No. of persons_-______._______________-_ Showers ( ) — Cafeteria ( )
a' Other, fix es .__
d - •- ------
W Design Flow_______________ ..4) �.=per person per day. Total daily fiow�____ __._.._ ____.__._..__gallons.
04 Septic Tank Liquid capacity_/ #� gallons Length_-----_------ Width................ Diameter................ Depth-.-.-----_-_---
xDisposal Trench jNo. . .............. Widtl - of 1 Le �%.� T tal leaching area sq. ft.
Seepage Pit No•-_/ Diameter ------- pt 1�1 otal leaching are•t---------------_sq. ft.
Z Other Distribution box ( )' Dosing tank ( ) �. ��2 a t/
W Percolation Test Results -`; Performed by.......................................................................... 'Date____------_-_----___-------.----------..
Test Pit Nd. '1................minutes per inch Depth of Test Pit-------------------- Depth to ground water..":!�_,___--_.___-----
fXA Test;Pit No. 2_:a__.-____.___minutes per inch Depth of Test Pit____________________ Depth to ground, water :..___--_-_----__..
W -----------------•- ._-•---•---=--•-------------•--•-----------•----------•---••-•••-••--•-•----------•---....................................
O Description of Soill't9'vL : :.:% Y` 'a'� ---------__- _..
x, -- :- •-__. --•-•----------__••.
U -••-------------------•------•--------•-----------•--------•---•---------------------------------------•----------•---------•---------••-•------------•-----------------=
W
x ----------------------------------------------------------------------------------------------•---- -_------------------__-------------------------------
Nature of I:;epaiii'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-fur ier agrees not to place the system.in
operation until a Certificate of Compliance has been ' _ e by the boa offh th.
Signed-- • _ ••----•-- - -••---- ................ - --------------------------- --
r.
Date
i Application Approved By-------- . - - '�'/ ,�.►Dat
v �s� y� Dat�
I
Application Disapproved for the following reasons:--•-••----------------•---------•----•--- ---•--- -------••-•-----------.....------•------ ----------------
_._ .. . ..--•-----•-------------------------------•----------
Date
PermitNo......................................................... Issued........................................................
Date
'--"" THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF ALTH
...
�rrtifirtr f f�rrutli�tnrle �>
S ERfIPY, hat e Individu 1 Disposal System constructed ( ) or Repaired
b C. uY ----•------- --------- ----.....................
a,
w
has been installed in accor an h th provisions of Article XI of The State Sanitary Code as escribe in the
application for Disposal Works onstruction Permit No_____________ ...._.- dated:.:..�.. 5" ! ........
THE;ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A G® RANTE THAT THE
SYSTEM`WILL FUNCTION SATISFACTORY. r
>
DATE............................................................................... Inspector]----------•---•----••-•••-------------•------••--•-••-•----•-----•----------_-•---
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF EALTH
11 _ OF........... .... - FEE ..
%lipotittt Morkii C111mitrurtion Vrrntit
Per fission i by granted-------------------------------------
_
to Con uc . or-) epair an Individual S e Disposal System
T�{ ,�_ y:
at No + ----= �G -=---"----------------------------------------------- ----
Street
as shown on the application for Dispos Works Construction Pe No. _:_________ Dated___
.:
�oarf He
. ISl ---=--•---- ........
„� FORM 1 �55 HOBBS & WARREN, INC., PUBLISHERS
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