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Home My WebLink About0040 DUNCAN LANE - Health (3) �o biom �. i ven W opul • UWD == C"Z&adn MOICS'ON ® � 8 /// U Fizic .2............ THE COMMONWEALTH OF MASSACHUSETTS BOARD E-iEAL -------OF........ �. Appliration -for Bi,gVuiittl orkii ontitrurtion Urruti# Application is hereby made for a Permit/tonstruclt ( ) or Repair ( ) an Individual Sewage Disposal System ` --�----- - --a�.2---- o Address or Lot No. J -•-•--......... . -- ..... ...--------_---------------- ------------------------------------ .....---------.. caner Address - W •--- --------- ........ . - --•- ---� .......................................... .............. Installer -Address UType of Buildin X Size Lot-.I--_. ._(-...l---_."_-.Sq. feet ., Dwelling-F No. of Bedrooms--------- -------------------------------Expansion Attic ( ) G.rbage Grinder ( ) per, Other—Type of Building ---------------------------- No. of persons..-_-__-.--___----- - --_ Showers ( ) — Cafeteria ( ) G4 t e ures ... Design Flow Other fixt ��-= --_ :gallons per person per day. Total daily flow...:-.-........ ..._.gallons. W jr...G�l� WSeptic Tank iquid capacity�, allons Length................ Width.........------- Diameter---------------- Depth---------....... x Disposal Trench—N -------- Wid 11---- ------ - ---- Total Length-------------------- Total leaching area--------------------sq. ft. Diameter_ _.- 1 e�l�below inlet_-_-_-. _ � Seepage Pit No.'s"._ _ p ._.__-__. Percolation Test Results Performed by otal leachii are/a.�..-. _. ._....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ------------------------------------------------------_---------------- /ate .-------•---------------------- � Test Pit No. 1----------------minutes per inch Depth of "lest Pit.................... Depth to ground water------------------- LT, Test Pit No. 2----------------minutes per inc Depth of Test t-------------------- Depth to ground water..._.....-------------_- a ------------ -------------------------- ------------------------------------------------------------------------------------------- O Description of Soil--------- -------------- --... 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 Article YI 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 and of health. l� Date Application Approved BY-------- -- ---- -•-•---•-- •-- =. �... <. Date Application Disapproved for the following reasons:-----------------------•----------------- --•-•.........----••-•----............----------••......---•-----•••. ..........................•------•---------•-----...--------------------------•-•-•--••-----•---------......---•------------- ---•----•---------•-•--------.......... Date Permit No......................................................... Issued.......€ i �...•. Date L - i -��-----------------u---u.------------------------------------------------------------------------------- r No. Fas.... ........... THE''COMMONWEALTH OF MASSACHUSETTS, BOARD t-6 EA'L ---------OF....... :.:..:.......... Appliratiun -fur Uiupguttl Works otttitrurtiutt Vrrutit a Application~is hereby made for a Permit to nstruct ( or Repair ( ) 'an Individual Sewage Disposal System ; . r . = .. •-•-• •••. - 1101 o Address or Lot No. net fF - ---------------- ----- -address a ...'.-_-.......' ... ... . --' ---- - - �" ..... ................ .. . ....................................... 7-------- Ia nstaller Address // -j Q Type of Building/ - Size Lot....-_�? �-+- Sq. feet 1/ j, V Dwelling No. of Bedrooms.--.---. --------------------- ---Expansion"Attio( ) Garbage Grinder ( ) Other—Type of Building _.--__--.-- Showers Cafeteria a g ---------------•--•-••---,- . No. of persons-=--=--•------:.. ( ) — ( ) dOther fixtures - -- ------------ -- -- --- --:------------------ --• --------------------- Design'' W slow ............... .--.- Mons per person per day. Total daily flow _ ..-gallons. Septic TankT.4_iquid capacity allons ; Length Width.: Diameter--.... ,T�eptll......... ... . r >�aiyt f x Disposal Trench—N «yid i. - Total Length.;- -_- Total leaching area sq. ft. 11 Seepage Pit N0.,=._.._. Diameter.. . --- Dep"lh-below inlet...... otal,leachn are. z Other Distribution box ( ) Dosing.'tank ( ) •.. � vvV PPP��' `-' Percolation Test Results Performed by.-._.---_------------------------------ --- n �;-.^ '• a -=----•------•................ ate ==::------...-------------------- Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.....`..-.._........ Depth to ground water------.------------------ Test Pit'No. 2-----------------minutes per inc Depdi of lest t---_----__._.._,.... Depth to ground water---_----__:_---:-.:-. -•------- ---- ------ ,-- •-•--........................................... ------- - Description of Soil------- -- .--- ..... '- -------- --------- ---------------------- ----- --------------------------------- -------- - -- -- --------------------------------------------------------------------------------------•----•--•----- V Nature of P.epairs or Alterations—Answer when applicable............................._--..------.-..-:...--.--.-.----.--.--------------.--..---..-...... r ----D------------------------------------------------------------------------------------------•----------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article YI 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, oard of health. Signe /� ? - ate Application Approved By. _ k Date Application Disapproved for the following reasons-.......................................... ---•-------•-----•----_-------------•......------------•-----------= .........................................................---_--_...--.---_-_--_--.._............_._........---.-....--_-_-._..---_......-.....--......-.--_--_.-..--.-...--_------_-----......------•_-__- Date PermitNo.•-•---•••••••-••----••-•••-••_.- ...................... Issued...................... ................................. Date ?/ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EAUff, FH . .. 4�. - .....oF............... ... ---....... a Trrtifirate of 6MVIiaurr THIS IS 0 -'�R , That the Individual Sewage Disposal System constructed ( or Repaired by• • " ................................. ------------• -- y �1 � Ins er at.. %J�f ! `' ` t'"`- has been rrist lled in accordance with,the provisions of Article I of The State Sanitary Code as escri e r he application for Disposal Works Construction Permit No --- ----- + .-----....,. dated -� rx1 ----- THV ESSUANCE'OF THIS CERTIFlCAT !.L NO BE CONSTRUE AS A GUA ANTEE THAT THE SYSTEM—WILL FU14C SA T� • DATE = ^L pector..... ../ THE COMMONWEALTH OF MASSACHUSETTS t` BOARP)7 HEALMH No, y----�-------- ,� FEE... .............. Dispoli �'Nark,�" n n .#rat t' t tirrutit Permission s, ereby gra ed --- -- . --- -- "--- -.---- y to.Construe or Repai ( ) n Individual Se ge Dispos y t at No.. - -- k+ Street :., as shown'on the_application for Disposal Works CF-onstruction" rt N. ._ ...-_ _ _--. Dated---�-� .--7- _1 •••.__- . . , , �. s '' -- - - - -- -`--- --- Board of Health - r-------------- ------- aDA E - -YFORM `1255:HOBBS & WARREN. I:NC..,.P,UBLISHERS . �_sue� � •� 'tj cA F ICI - '- - - w .- � �.• b ,