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HomeMy WebLinkAbout0052 MOON PENNY LANE - Health (2) S3 �'hovn Pell,, Iil . GoP . IGaI/�� - No.........'1` Ca �J FEB._Z .' ..... M�. H COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...----- --]"0fiVJ .....OF........ �.. .11f A"_ .E...................... .fie liration for Disposal Works Tonstrnrtion Prrmit Application is hereby made for a Permit to Construct (>0 or Repair ( ) an Individual Sewage Disposal System at __- 1CRr. ®���.. ... .le n. a � . .r...�.r __.�''���.✓�P�iv.,r `�• a. -_..'' 3. ....Ce�i wt� - Loc lion-Address 1 r Lo t N. Owner Address W M Installer Address Type of Building Size Lot...!_.��_-a _=1---Sq. feet V a Dwelling—No. of Bedrooms___...--.._.3............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No: of persons............................ Showers ( ) — Cafeteria ( ) �. Other fixtures ---------------------------------------------......................................................................................................... - W Design Flow.......e'i74.�.........................gallons per person per day. Total daily flow__________ 3..................................gallons. WSeptic Tank—Liquid capacity./t q�_ogallons Length....46-_.�-__ Width_____.__.... Diameter________________ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....... ._....._.__. Diameter.....R.... Depth below inlet_-_.Ar............. Total leaching area.;?-W.1!e sq. ft. Z Other Distribution box ( ) Dosing tank ( aPercolation Test Results Performed by___-_. '___ ed r 0.1-............................. Date.... ......... ,41 Test Pit No. I.L-.Z-____minutes per inch Depth of Test Pit___/Zt.......... Depth to ground water___N�. ._.. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ w' .---•--------------------------------------------------•--•--------•-----------....--'-...__-__....•.....•----....._...- '----....--------------•--------- O Description of Soil...... : A.-_...._.�a.1* ....... xY./ ------ - - ------ - - 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'ITLL 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. Signe .__. D P` Application Approved B i e,'' _ .�. Date Application Disapproved for the following reasons-----------------------•----•----•----•-----•-•-'---------•------------------------•--•------...----'---...-''--•-- ..........................................................------•---•-•--------.....---•--•---------•------------•••••----••--------------•---•------------••----------------------'-'-----•----....... Date PermitNo......................................................... Issued_....................................................... Date No..--__..................._._. 1, F$........= .......... } THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH , wd .....OF........! �:.Jr'•N.S /4 Allpliration for Eispoiittl Works Toni#rn.rtion ramit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage-Disposal ,System at Lo-•tion-Address r Lot No. Owner Address akG ,.............................................•_........._......--•------ ----.._........ Installer Address d Type of Building Size ....Sq. feet Dwelling—No. of Bedroom's............ _......................_....Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of ersons________________ __________ Showers — a YP g --------•------------•------ -•-----P -- ( --)-----•.Cafeteria- Otherfixtures --------------- •-----•--•••------------ ---------------•----•----------------••-•••••......•------- . W Design Flow.......... _________________________gallons per person per day. Total daily flow-----_._..�•'__3..� .................. ' WSeptic Tank—Liquid capacity_hi u yfgallons Length....46........ Width....... Diameter________________ Depth................. x Disposal Trench—No........................ Width....._..____._.__. Total Length----------._.__...... Total leaching area....................sq. ft. Seepage Pit-No------- _.,________ Diameter......L•p___.___.._. Depth below inlet_.. :.�•..__.___ Total leaching area.Ag'yg sq. ft. Z Other Distribution box ( ) Dosing tank .f�Percolation Test Results Performed by_______________________e �' ____________ _.____-_ Date___ __ __7 0 Test Pit No, 1_x-� .....minutes per inch Depth of Test Pit_ .j.______ Depth to ground water !a_ ___. 44 Test Pit No. 2.................minutes per inch Depth of Test Pit---------:........... Depth to ground water........................ p+ -------- .... .....:. J .. O Description ofSoil...... :�:- .. , �._..... }- e ilea _.f__________________________________t-___.._._.___._______..____ _________.__________.___________t.____.__.___. ' U Nature of Repairs or Alterations—A swer 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. �. Signe Application Approved..B ....... r n - Dat - f__________-•-----__ --- Date- Application Disapproved for the following redsons:............................ -----•---•-----------•--------•----------------•---•......•-•-----............. Date PermitNo......................................................... Issued-------•--------------..................... ------ Date v+ THE COMMONWEALTH OF MASSACHUSETTS J BOARD OF HEALTH !, Tatifirate of Tompliana i THI T CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) M �� by - -• :._. - • Installer ' k ' ma`s` " has been installed in accordance wit Ti the provisions o L of Th ,State Sanitary Code as,describ d m the a lication-for Disposal Works Construction Permit-No _:_ / dated �' `"._ `..................' PP P �i - -.- THE .ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE-,THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................................... �-........................... Inspector........................................-- n•,. THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALT ......... 1 ....OF.......i.. �................ - .... FEE �� ...... �i��o��tl� orla� �.���trnrtirrn anti# . Permission 's reby granted......._ ,y................_..___.__. `___ to Constr t �(kj or R r ( ) an Individual Sew g posal SysKM r!�"r�IG�A��"' I SttEet+J -•------• --•- - k �, A . . as shown on the application for Disposal-Works Construction Pe o.__. _._�___..____ ted.... � ... �___._._...:_. Board of Health DATE.--�•--•-------6=�----------•----u-------•---•--------------------...... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS , � - — -­------ I-- � . �. I . 1,r�, I,I -. .. � . . �. . — I I I . . ., ,� .7--­7- - .��-.,�'�,'­­�'zt7Io­,,­­ � .",�'. --,�'�, - -,--- . , -1 �. . . I I I . . I I � .1 . . - - I . I - - -- � . I . -- � , ­ . 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