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Home My WebLink About0009 LIAM LANE - Health (2) �-�-�-vv� �.sa-,n�-- lC��l-O 1lo—C:O � - c�,�tera�,'�, l / ymma tl11 IDOMBROOM SWOM� Ulm= mmo unmim HOMM MU "ON G3ZINVONO AOA JNId33H =*GVW S i _too 1 Le_ 0 t No.. .................... FRs.........s .... ---... THE COMMONWEALTH OF-MASSACHUSETTS �— BOARD OF HEALTH 0�a,/ .....oF.......... /�J � .................. Application for M-spaoul, Wrkg Tomitrurthin Prrutit Application is hereby made for a Permit to Constructor Repair ( ) an Individual Sewage Disposal System at: G ................--.......... ..._...... Location.-Address or Lot No. Owner Address a -•-------------•-...---••--•_ Ax... ��!�� s..�., 1............ ...-----•--•--------------•--.. e0-4- -e_._ ... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms........._............................Expansion Attic A,�49 Garbage Grinder Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ------------------------------------------------------•--•---------------•---••---•------•-------•-----•----.........--•-----•-__-=---•------------ d Design Flow..................... ... ..... gallons per person per day. Total daily flow..............,d...,�.... !______.s..__'.gallons. W - WSeptic Tank—Liquid capacity P.O Caallons 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;4/ Dosing tank ( �� ]l '~ Percolation Test Res is Performed by......... (�. _!.�( 5:.___ ... Date......... ... ... ...... - Test Pit No. 1_. -.).minutes per inch Depth of Test Pit-------- --- --- Depth to ground water... �. z fi, Test Pit No. 2.� p p p g . __._minutes per inch Depth of Test Pit...... :___�e th to round water...._ - _ •�.� xX•........................ j /... ---------.......... -= O Description of Soil.................................... 1:_------. ....... ....---- ---- -- -- --- --------------•----- -- -------- - - ------ U Nature of Repair's 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,phealth. , /Sied...........9..,0.��.......I��—`/ C-od ----��e' ��Application ?" d �. -----------../..------------.........------1-----.........---------- -- -.---� --•--•--- Date Application r he following reasons----------------------------------------------------------------------------•------•----- Da••............-- ._••-----------------• -----•--------....-•--------••-•-•--•-----•--...------. Date Per .....................•-------------•-------_. Issued....................................................... Date No.!L... % ..... FEB............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........OF......... .;/..[ '.................. -- Apli tration for Uiipoaal Worse Toaastrurtton Frrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at ,! ................_...........- -�j- '� .. ......... .s'.. ............................ ---t om- 'i�?�'....�-`�' 1 �( =..e............ Location-Address ,y or Lot No. ..........................!..:�^sit---:-—��'• �^ � l...........r4��•...... Owner Address .-a ..------• .:::T ........................................... Installer Address Type of Building Size Lot............................Sq. feet U a Dwelling—No. of Bedrooms.........' ................---------.Ex Expansion Attic Garbage Grinder aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------------------------------------••••-•-••-•••••••--••••••••••--••--•--•--•••••-•-••-•••••••••-••••••.........••..........•_•... W Design Flow..................!65:� .............gallons per person per day. Total daily flow.......... _.'j._...t�.................gallons. WSeptic Tank—Liquid capacityj,O Ugallons 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,.01) Dosing tank (�^-), f �° `-' Percolation Test Res Its Performed b ..................!-. �_m !f _ _ t-''W�__. Date..___ �,,rr�`� t- aY •-••-•-•••• -------..1-. .----•••... Test Pit No. 1�.vf!�A..minutes per inch Depth of Test Pit------- ...... Depth to ground water.__ f=, Test Pit No. f. -_-_minutes per inch Depth of Test Pit..._ .__ ~" Depth to round water....t-�*/ �4.•�- P P ------ P g x 2L.----- - ;;�--- j :...: .. - - .:: -• - - -------- D Description of Soil----------------------------------- -........._.....r�_ � �... '?" - �_ ... x --------------- -------------------------------------------- ...................................................... .-Y.r'�--`-'....------. 5 `° 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.j / ,r .- ( Signed.........� 1 c!ttF,�...... -3 '.!? _3._......1-------------------- -7 h Z -•, i Date n` ApplicationApproved By........---•••••••••••-•••-••••••-•••••-•--•••••-••••-•••---••-•••••...................•-•--••-•-- ........................................ Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------� ............ ....................................................•••••.........._•---•_....._...._.._ •-•----•----------•----------------------------------•--------•-------....--••---------------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ ...............................OF........ `� �!f "!9........................ Aft %lunttftrFair of Tootplitturr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed-r(f' ) or Repaired ( ) bs'�, .��'S ....�. .I_. ._(.. .t ---------------•----•-------.....---•-------... Y•-•-----•-•-•.............. '� Installer ______________ y_.._ has been installed in accordance with the provisions of TITIZ 5 of The State Sanitary 030eas described in the application for Disposal Works Construction Permit No .._ _27...................... dated: lf%t__'"-:...___.___--.----_.--._.__ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SAT).SFACTORY. DATE.......................................... .- i' A-V................ Inspector........... __&......................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH, 1' zj`? 5 No . ................... FE ...................... Ropm al Works boo ttr#ion rrattit Permission 's 'hereby ._...ranted.....................:.. *4' __ __-_-- _ +'� � / _ to Construct.{) or Repair ( ) an Individual Sewage Disposal System 7 atNo.................................... . ' " •1 ................................................` ....... Street as shown on the application for Disposal Works Construction Permit No d..� ... Dated..�.................................. .F � - .-- -~ / DATE-----------°� Board of Health - ! c'__ •••. ••-•••••.....••--••••••......-•-•••......•_-_.. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS M L. 48.97 O %OF M GOD pig 2w4 a; O C� 4 0/8T% - S\ 1'X NO '• :� SUS 1-1 Ul U1 WAT�'RiiUE ,+ so L �r 1000 S.F. PI�^I L S W uiw P-s:(3: o_0, /S/ Ic�t �RA7N.. E'S T. cq l� 60 'LEGEND CERTIFIED PLOT PLAN EXISTING SPOT ELEVATION EXISTING CONTOUR 0 _ ,< P'pj IOFMgss FINISHED ' SPOT ELEVATION a �' �., �' ACSERT �� .OT S BUMPS R►VE�. D�t� CE, RVI FINI9HED.• CONTOUR --:0—1-- ii6 IN AMR OVEQ 8 BOARD OF MEALTM Y : no,10e51 o,4 i A9n GISTEP�� GATE ASENT yej fSS/ONA1F.� .SCALES 1 " = 30 DATE urn '82 blikoar ENtSINEEPt/NQ CQ/ CLI9NT i CERTIFY THAT THE PROPOSED Ot9 ! RESI9TE#LD OB N0. 2grr BUILDING SHOWN ON THIS PLAN CIVIL LAND CONFORMS TO THE ZONING LAWS o.`Y�---- - --� OF SARN9TAB E, ASS. 712 M.AJ N'S TR E:ET CH.,BY MYAwNi3,: MASS 9NEET�L OF . ... DATE r R d. LAND SURVEYOR 1` for i r► � �` �,.� � �4 � to O 11A pa ` ��• � �.. � � ,f[�,�f 1 b.� `�O+ '� � ski fit y C . sins � � o, y : � 0 ,. !�.cc.�' r1: r• -. ��► W � - ::_ wZ Wwwwi► ro p. rj M O i Goo 0 r 0 rn ? V► Lj {q Q y o t n. N. FFR S�� 11 �► ?f� .11 . y y ^t y L �� • � � r ; ° yro tj mVi o �� o • . .-- tN It In ' - rz m IA ru ci it 0 . . . . . o .� C2 � y3RI �o polb 0 u♦ of vyy3 y N to Rt l Q1 Iq �► Rr Z :n �{ u o r rn 0 p rn o' by . � r� Ri 3 ti A — It b �. a tv