HomeMy WebLinkAbout0068 CAPTAIN ELLIS LANE - Health kd-, 6t�aunis
a So- log
LOCATION ' SEWo,C,E PERMIT O.
VILLAGE — — — —�— — — —
WST&LL R S. W&ME ADDRESS
BUILDERS 1. &MF— ADDRESS
DINE PERMIT ISSUED
D ATE COMPLI W-4CE ISSUED
N
W . 3
r
No...........
THE COMMONWEALTH OF MASSACHUSETTS
BOAR HEA TH
�.......O F................................ ......... .................
Appliratiun -fur Biiipuuttl Norkii Tonstrurtiun Vrrntit
Application is her y made for a Permit 'to Construct ( ) or Repair (_ ) n Individual Sewage Disposal
Syst at:
�.. _
Address 4 - or o.
2- 14AD
Owner - A
Installer Address
Q Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms----- 43---------------- -------------Expansion Attic ( ) Garbage Grinder 414
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures _
Q ---------------------------------------------
W Design Flow................ ®______________gallons per person per day. Total daily flow------------ __o__®.__._.._._.__.----gallons.
WSeptic Tank-l-Liquid capacity/09 o__gallons Length---------------- Width---------------- Diameter---------------- Depth.......
x Disposal Trench 74qo_ ____________________ Width ...... Tota en�g�i.................... Total leaching area_.._-_______-_-_____sq. ft.
Seepage Pit No. '_---------. Diameter "�_l e o�w�fi41 `t__.._.. Total leaching area sq. tt.
Other Distributiod box Dosing tank
_ Zi ( ) g ( )
aPercolation Test Results Performed by------------- _____-_____-----_--------_-_ ___ Date----_-----------------------------_----.
Test Pit No. 1----------------minutes per inch Depth of "lest Pit.................... Depth to ground water---____--______-__--__-.
G14 Test Pit No. Z................minutes per inch Depth of Test Pit.................... Depth to ground water_:-____________-______
O ---------
-I----------1+...... ---------------------•-• ff -Z---- /- .
Descrip -or� of Soil/ v "' sZ- L±® � 2
v �6�� ------- -- = i 1�� _ nar�[
1 ..._. °.
x !;�' --,�J- -------- - ------- -- ------------------------------------------------------------------------------------------------
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 hasAbeeissued by ealth.
Sigd ---------------•------------------------------- -- --------------------------------
Date
Application Approved By_____ ._.. .. -.�� ............
----------- - ---- -
Application Disapproved for the following reasons:-----------------------
--------•--•-----------•-------•------------------------------------Date--------------
r
••-'•--••••••-••--'-••------•----'----------------------------------•----••-•••--•-•--••------------•-•-------------------•----------------------------------------------------------------------------
Date
PermitNo......................................................... Issued--------------------------------------------------------
Date
No../b.. FEs... ....
THE COMMONWEALTH OF MASSACHUSETTS
BOAR HEAL.ATH
F
7777 .......O ._.v
Appliratiun -fur Ui.i�ruual urkii C onotrurtiun Prrnnit
Application is hr�y
made for a Permit to Construct ( ) or Repair ( ) t Individual Sewage Disposal
Sy;7'
e& -
-----------------------------------
y� °r
tdel>'Address ' f�L1 Lo4
I
G1
D Owner A dr
Z . ............... ......................................................................
Installer Address
UType-o Building Size Lot............................Sq. feet
�-, Dwelling—No. of Bedrooms-------`-?------------------------------Expansion Attic ( ) Garbage Grinder <yl)o
pa, Other—Type of Building ----------------------_---- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a' Other fixtures ---------------- -------------- - -
W Design Flow------___________�"__v...._..____..gallons per person son per day. Total daily flow 3 0._a------._...__....gallons.
WSeptic Tank--Liquid capacity-���_°_gallons Length................ Width---------------- Diameter..... .......... Deptll._..___._......
x Disposal Trench o. _______._._--- Width b_ Totalkve,
n Total leaching area......._------_-----sq. ft.
Seepage Pit No... °.°v___ Diameter.....� ''�� b �' Total leaching area.________________sq. ft.
z Other Distribution box ( ) Dosing tank ( ) 0 6� �G ��'� - ✓ "1
aPercolation Test Results Performed by-------------------------------------------------------------------------- Date----------.----_-----------.--_.--
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-----------------------
-------------------------------- ----- -
—,
Descripon of Soil ------------- -- ;
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 \I of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee issued by tMl�' alth.
7/�
d----- - ------- --------------•-•--`------------`-e..`--•a'�,__..- --------------------------------
7 Date /
Application Approved By...... . ------- -- -------------•-- .- �!.
Y� Date
Application Disapproved for the following reasons---------------•-----------------••---------------------•-----•--•-•---------------------------•------.----------
---•--•-----------••---------------------------------- --•------------ ••---------------•-•--------------•--•------------------------------------------••------------------ ---------------------•-----
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
wrrtifiratr of Tomplianrr
TH IS TO ERTIFY, That the I idual'Sewage Disposal System constructed ( or Repaired ( )
�✓a Install
at_..-' �`• J '7•'-------— •--••- -----
- ------- - -------- ------
has been installed in accordance with the provisions of : ti �I of The State Sanitary Cod as descried in the
application for Disposal Works Construction Permit No. �---.-i2_--:3-- ------------ dated _---.-&....�''__7_�P_.........
THE ISSUANCE OF THIS CERTIFICATE SHALL, NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL,,FUNCTION SATISFACTORY.
DATE ` . - '. Inspector..............•--------..--------- ----•-c-------------•---------------------•--
t
THE COMMONWEALTH OF MASSACHUSETTS
BOARD Of)F) HEALTH
�� .. ... ..OF..........6Z. ----------------------------------------
No............ -� FEE...... .......
�i��u�tt� C�urk��uu�trnrtiun rrutit
Permission i h eby granted------=- -•----•-• ------------------ ----- ---- •- ••-------. ----------- -----...-----•----..........--
to Const>uct or Repair ( I idual ewage Disposal to em %jam
/( -- ---- - .
L` Street _ -/
as shown on the application for Disposal Works ConstructionAPerto.____. _ _.._h
ted__�,2-._�__._.._..(.�....._......� � --- �G
q Board of Health
DATE < -_/ -------------------------------------
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
s ,5140 A..;0 o -7-31 P/a r7 y e C c a C4.a/ cA /V .5 T le l/C 7-/e7,.*/
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OF'Miss �P�Zl1 OF Alj ,. V t�S E�'N P 9e 461C
oa4�` '�y o�� q�y� FRANK CONERY 5 TRENTON 57.
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FRANK FRANK HYANNIS MASS. 02601
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^- a CONERY 4 ei, CONERY H REGISTERED ENQUVZKR a LAD SURVEYOR
• Y - 9 No. 6573 �4 .p�No. 6232 O
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