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HomeMy WebLinkAbout0054 CAPTAIN ELLIS LANE - Health 5 q C&Pf-. 01's �e-d• , is ago — /a� a 7) yjr- o.. ..... /L.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H.EALT a ................................. ... -----OF. 41k, Appliration -for 43itipmat Works Tutuitrurtion Vrrnift Application is hereby'made for a Permit to Construct Repair an Individual Sewage Disposal System at -------------------------------------------------- ------- ................................................... LocaAn-Ad4kess or Lot No. 1: 4- .-I... ................ -----­--------------A-1-1. .... .. ......................................... Owner Address .................pokC4........ ........................ ---------------------------------------------------- ........................................M_ Installer Address Type of Buildin Size Lot_.7?_v(AJ0rj------Sq. feet U Dwelling� No. of Bedrooms.............................................Expansion Attic Garbage Grinder ( ) pa Other—Type of Building No. of persons-------q----------------- Showers Cafeteria ( ) 0 her xtures --------- --------------------------------------------------------------------------------------- --------------------------------- Design Flow- -------- - -------------------------_gallons per pet-son per day. Total d y flow..................----------------- .......gallons. Diameter__._._.._..____ Depth._..____._..... T,uik Length....._.-__--_ S,eptic Liquid capacityi-M----gallons Disposal Trench—No..................... Width-------------------- Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter......._..........._ Depth below inlet....____ ------- Total leaching area------- ----------sq. it. Other Distribution box Dosing tank 77 Percolation Test Results Performed by....................................................................----- Date.............__._.._....._.____...._._.. Test Pit No. 1................minutes per inch Depth of Test Pit--------------------- Depth to ground water...... ------------ f� Test Pit No. 2................minutes per inch Depth of Test Pit.--___-.--.-__ Depth to ground water------------------------ ............. ..........P.............r......... :-,:::.............. -------------- 0 C92 A-P-ti Description of �Vil ........ 4. ------------------------------------------------------V------------------------------------------------------------ U ...... ----------------- -----1--W !V..... ------------------------------ ...............------------------------------------------------------------- --------------------------------------------------- ----------------------- 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 further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of heal h, . _ PC Signe ................. ..............a...e Application Approved By........ .. ---- - --.---r- ......... . ...... ...... ... ................. ......7 Date Application Disapproved for th* e following reasons:------------------------------------------------------------------------------------------------------------ ............................................................................... --------------------------------------------------------------------------------------------------------------------- Date PermitNo......................................................... Issued----- ............ Date -------------------------------------------------------------------------------- , No.................. "" FEa .. .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA T } .....OF..... = ............. .............. Aop irzttiuu for 134tipuiittl Workii Tontitrurttuu Vrrtuit Application is hereby made for a Permit to Construct (100 Repair ( ) an Individual Sewage Disposal System at g s . t ................" •---•----•-•-----•---•-•---- .. :,Loc46jn-#VtMress Lot No. Ow er ` .�, Address Installer Address OVA UType of Buildin ,,.. Size _..__Sq. feet Dwelling No: of Bedrooms.l_• _--____T__. -_____._-Ezpans>on attic (' )Showers garbage Grinder aOther—Type of Building o. of per,uu5. ____.{._+ ( ) Cafeteria liertures ---------------------••------------- ---- ---- - - - -------------•--------------•--•-- Desi n Flow_ :. >, W g __gallons per person p r day. Total d dy flow ,_�i________________________gallons. Septic Tank Liquid cau�clty :_gallons Length-_.__. +______ VVulth Illlameter__________ _____ Depth_--____-__-___- xDisposal Trench—No_ _________________ Width_„___-._.__-__-:_: Total Length ....... _ Total leaching area-.__-_-__________-sq. ft. 3 Seepage Pit No ,__..:Diameter Depth belo� inlet _____ _______ Total leaching area.____..-__._ ._._sq. ft. Z Other Distribution box ( ) Dosing tank + .,'�'► ��^ 77 '— Percolation Test Results Performed b a y'------------------------ '--•----••------...,_.....-•----------•--•----- Date_____----------------:;-:- ,� Test Pit No. I................minutes per inch Depth of "Pest Pit_-__-_____________-- Depth to ground water---___________- w Test,Pit No. 2----------------minutes per inch Depth of Test Pit---------- _____ Depth to ground water---------------------- ._. �' t• .t Descript'on..cfpil_j/-- - '�' .: i` +s. x `"' •--- Uw ---------------- --------------------- Nature of Repairs or Alterations—Answer when applicable---------_-------_-----------_________________.-_....._.______-___-_---_.-.________.-__-.__ ------.•..__-_... .... .. --------- Agreement: The undersigned agrees. to install tie aforedescribed Individual Sewage'Disposal System in accordance with the provisions of Article XI of the'Shy e`Sanitary Code— The undersigned further agrees-riot.to place the system in operation until.'.a Certificate of Compliance has been issued by the board of heal Signe ... e Application Approved By......... �_._ . ` - .. . ------•. ---------7 - --- __Date Application Disapproved for the following reasons----------------------------------------------------------------__.__.--------------._._.........------.........--- ••----- ------- ---------•--------•-------------------------_----- Date , x Permit No............................. ----------------•---•- Issued.----- ^ Date f` THE COMMONWEALTH O MASSACHUSETTS y BOARD OF .•,HEA4'. ?; K OF a TMA. irate of f�rrMNX ,Ham T TO CERT That the Iividual Sewage Disposal System constructed (�or Repaired by..... :_ _ --••---- . -- ----• . ------------------------------------------------- r -----L- - �• In�ll-- s y ....................................._ -••------ • has been installed in accordaiiccs with,the provisions of Ar e . I of The State Sanitary C e as described in the application for Disposal Works Construction Permit No.___ ......._..................... dated.......... 77.. THE ISSUANCE OF T14IS 'CERTIF'.'CATE'fi' IL NAt BE CONSTRUE® ASSA1.OU ItAN,TEE THAT THE SYSTEM YdiLL FUNCTION ATIS.FACTORY DATE. -- •�•-=�-..•-�- 7 ......................... Inspector . .................................... AW.. 'its �J .. A- . ;THE COMMONWEALTH OF MASSACHUSETTS BOARD F �HEALT y JI .' No----- •-r ll w,e np FEE...t i� g tti k? 5�t�u tzr iuti rrMit Permission ereby granted ----- ------ . - .................. .... ... / 1� •----- ___-"_-__-•--•----- o Cost t or Repair 'P- spo 1 Systet eW „. Street.. < as shown on the application for Disposal Works Co, struction P No: ____ lted______________ _______ _.._..___ 1 'sad Y 4: r' oa dhof.Health .._.. DATE._ , � t -- FORM 1255 HOBBS K& WARREN. INC.`PUBLISHERS r'. �».;... :.. �._ (�t.i :a.. ... ,"rn..;..:f_..! ...d�hrfiifi�`n k..vs....S,,:_rXu+�'•.yp_r ..v.`-, �.. , SEWAGE PERMI7N0.. VIL AGE 7 INS A LER'S NAME & ADDRESS B UI'LDE:R OR OWNER DATE PERMIT ISSUED �� 27 DATE COMPLIANCE ISSUED IA c � d 1'•' V C` r- �l a -:., .:.:.7 dr.:• .p,..:. ^,�:.. ,-• :,., ..,--':. �.,.. 'e '-.:'_ >+ .a :.:r.r -c`3e.. 'r 'f +^. "r 7 •�'K'.+r-a.rr fi.v . ,. ., ,.!!. i 1". 1,.,.E ? s o. , t . .... ...... -,.,..:... ,n «....,.w _ r ... ....,1....:... ..r .k .,'}..a ...• ,v x .:, k. w a. ,§'Y.,. M; �,i. a „.,'tws ..�...... , �,,-... ,qv.. ,r fi. a. •w.FY , ,. t, a. .w +. a ,i:� °",. .. ,y �..�,. a, Fv a"�+"= +y`r.,.2 •"6g°f,> +, xya,:w.,+ .Y,%y/ <'skt,�.Y;; i s P.q-j u. .art'. ... a....#:<.� ,,.r,�,'",. a1"z. . to.. p. -n ,. ra, x..n h 1 «`:�. ws r 5a.. ., ..:, v ..+!. :H, h`.. 'aFt .. ;Z.^`.n # .. .4 y• r.. .> w n '7 �, , ,i4. <.€ .: c, �. - :,i.'I.-,'.�E6' -s*.,. .+?, -1" 5.. >.. ,, t*'4 a .# 11 .p� " fti ,a. 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