HomeMy WebLinkAbout0048 PADLOCK LANE - Health (2) qS' oudlocK
-- . _ /03 1633' �
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N S M EAD
KEEPING YOU ORGANIZED
No. 12134
2-153LGN
SUSTAINABLE FORESTRY MIN.RECYCLED
INITIATIVE CONTENT 10%
Certified Flier Sourcing POST-CONSUMER®
www-Aprogram.org
SR01270
MADE W USA
GET ORGANIZED AT SMEAD.COM
No....... 3 g' .......1 . .......
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® F HEALTH
g t
Appliration -for•3iB oiial Workii Cnomitrurtion Vamit
Application is hereby made foria Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
/ System at
U .K �� VILL46C-)
Location-Add or Lot No.
_Q,wner Address
Type
to No. of Bedrooms................. . ----------------- Attic ( Size Address
Garbage Grinder feet
d YP gSq.X
aOther—Type of Building ............................ No. of persons---------------------------- Showers ( } — Cafeteria ( )
Desi n Flow.................. a............._..gallons --er -_erson per day. Total daily flow.____..1�.Q.d..._--------.------ -----.gallons.
d Other fixtures ------------------------ ----
W g g P P P Y Y g� ns.
WSeptic Tank—Liquid capacityl00Q.gallons Length.._.._.__._--/ Width j D'a et��er� -----:. Depth................
x Disposal Trench—No. ........`......-_.. Width 0 .�s e` i'o�af Men�h.................... T�aMeac�iing area..-...._------_-_._sq. ft.
Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area------- ----------sq. It.
z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed bY........................................................... .............. Date.-------------------------------------..
a Test Pit No. 1................minutes per inch Depth of Test Pit.................-.. Depth to ground water.------------..-.--.---.
fs, Test Pit No. 2----------------minutes per inch Depth of Test Pit....._.._..__._._..- Depth to ground water------------------------
----------------------------•-----......-------------------------------------------------------------------------
-------------------------------------------
O Description of Soil----A16F�1.L.J.�_.__A,.Y7--- =fd�4f .. l`r -----------------------------•----------------..---------..---•---------------
x
U --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
w
x --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------
V 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 \I of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b n issufbye d of he 4 h.
Signe ------ Date
ApplicationApproved BY------------------------------ ------------ --------------------------
Date
Application Disapproved for the following reaVns:........................--•-••-•---•--••------•............................................ ..............
--------------••------•---...........---•------•-.......°...................................
Date
Permit No. Issued �. --�-�---------------------
ate
No.... _ .._..1..•.. FEic............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH*`
' OF "'
Applilratinn-fear M-4 laittl Workii Towitrurtion 13rruid
Application is hereby made for a Permit to, Construct ( ) or Repair ( : ) an Individual Sewage Disposal
System at y,
. 0•---••... ... ..•.. - ••-- •---
Locat'on d 36 ! t
. . �TN2 --------------- --- L .N..o.AM1 A � , ror .
Oner Address
Installer Address
U Type of Building Size Lot.�L f./�_2---------Sq. feet
,.
Dwelling—No. of Bedrooms---------------___ --------------------Expansion Attic ( ) Garbage Grinder
a4 Other—Type of Building ____________________________ No. of persons..____-___-____________-_.__ Showers ( ) — Cafeteria ( )
a
Other firtur = =
W Design Flow................ ----------------gallons per. person per day. Total daily flow__ b gallons.
P; Septic Tank—Liquid capacity JO00_gallons Length___ __ _ �i I - Depth-_.__.__._.--.
��dryy �S
W Disposal Trench—No......._.t Width:�� �farLef h------------------ ota eac rez. sq. ft.
x
Seepage Pit No..................... Diameter.................... Depth below inlet-------------------- Total leaching area._-...____--____.sq. it.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by-------- -----------------------------------............................. Date----...................................
_-Test Pit No. 1-----------------minutes per inch Depth of Test Pit-----------------._. Depth to ground water-------------------------
(� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
DDescription of Soil--- ------------------------------------------------------------------------------
x
U
W
------------------------------------------------------------------------------•----------------•------•-------------•-•----------------------•-•----.•..-------••---------------=-------
V Nature �f 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 further agrees not to place the system in
operation until a Certificate of Compliance h"issuede d of he h.
„....Si neA pfii ation Approved By... ----- Date
------------- -
Date
APPlication Disapproved for the following r -----------------------------------------------------------=--•-•--------•-------•-•--•••-
---------------------------------------------------------------------------------------------------------
Date
PermitNo......................................................... Issued......................----..............................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALTH
_.� I._..........O F.............. .
Tat ifffid
tr �rf Tompli r
THIS IS O CER«TIFY T ndial Se age Dis o ru ed ( - or Repaired ( )
by ---- . --••-
er
........./45------------ `-�4- . .. ... ---- d ..�3' -- ...:.lv�1 . ......................... ---------
has been installed in accordance with the provisions of Article I f TJae State Sanitary Co e crybe t
application for Disposal Works Construction Permit No----------- ---•___-__- dated....... .....................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM.WILL FUNCTION SATISFACTORY.
DATE..................... '`' ' ......-•---•-•••-•..... Inspector.....................................................................................b_ '
i
THE COMMONWEALTH OF MASSACHUSETTS
t r •
BOARD O HEALTH
No. rr ..:-. ..... . . .......... - ..-
-lh--°�.. t :'. FEE..... . .........
%rivolial ork,i� t r it r
Permission i hereby granted - •--- -----
to Cong�t (JJ"'or Re it ( an In ividual wage, Disposal stem
at No.. _ ;,y;, .----. .
- - r .•-_••-•.
' • Street•
as shown on the application for Disposal Works Construction Per o...__ ated______. .ve�__` � .•,•..
y
Board of alth
DATE / /------- ------>
? "Q? FORM 1255..HO138S & WARREN. INC.. PUBLISHERS
� r r
36 QUINCY AVENUE. EAST BRAINTREE. MASSACHUSETTS 02184 • TELEPHONE 843-7000
DAM/EL A. BROWN, JR., INC.
REALTORS & BUILDERS
Complete Real Estate Service
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