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Home My WebLink About0009 GRAY LANE - Health 9�Gay°L�ane:t hr Hyaiims �_ ------------ - I )1 i r �017 n/ od No....1 6....---..... Fss...�....�- THE COMMONWEALTH OF MASSA'CHUSETTS BOARD OF HEALTH .. ...........OF....... .....t............................................. Applirativat -fur Uifipagal Works Tonstrurtivat Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal Syst t:&�7 )-CU l -•---• •--•- .U•-1.,-.. /J........................................................................................... ca on Qlidress --.••••.••--------------•--•------••--•---or Lot No. Owner Address a ... .. .......................... --•-----•-••-•-•---- -------------------------------------------- I all_r Address Type of-Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) U pa., Other—Type of Building ____________________________ No. of persons............................. Showers ( ) — Cafeteria ( ) dOther fixtures ......................................................------...._................. W Design Flow............................................gallons per person per day. Total daily flow..................:.........................gallons. WSeptic Tank—Liquid capacity.__________gallons Length..:............. Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No---------_--------- Diameter-------------------- Depth below inlet.................... Total leaching area------------------sq. It. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by..................................................•---•--•-----••••••••••• Date........................................ Test Pit No. 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water........................ �14 Test Pit No. 2................minutes per inch . Depth of Test Pit.................... Depth to ground water........................ 9 •---•-•-•-----------------------------••-•--•---•--------•--••----•--.-..-..------------------•---•-•-------•-----------..._-------------------------------- ODescription of Soil............................................................................................................:................ x x -------------•--------------........._......----•.......-•---.._....••-•--•....:_.........•---------------•--- .---- .. ------------------. V Na re of Repairs or rations—Answer when applica e. ��_:.,,/...��J.... I ........ ......................... greement: • 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 be7f—,§fued by he board of he Si lth. -a-76 = .-------- --------------------- Date Application Approved By..... / -------- =la.�ls ----------------- ...... --� ...- • e% Date Application Disapproved for the following reasons:................• •------•------•-------------•-----•--•-------------------•••-••..------......-----•--••••..... ••••--••-•--•---------•••-----...---•---------------•---•--••---•------•••-•...... Date PermitNo......................................................... issued_......................................................... Date ---------------------� ' - Z ' 1 � ] r J ��___. e 1 +�,f f � � � r � S e $o '�� I b � � j e f !r �\ , 0 0 a � �� / n � 1 — o � 1 0 o � � � �� 0 n D D �� \ � /, �, �� 1 �� - ,� � � �� r � � � � �.,. r ��._ �. � � 00 No..... .......... Fsa...`,C.................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..Q !'�. ..........OF......!��J .....t............................................. , pphration -fur Disposal Works Tomitrurtivaa Prrnift Application is hereby made for a Permit to Construct ( ) or Repair ( an Sewage Disposal Systpri?tt (� /l/ ,.� f ca on•Address or Lot No. G^ � /l ----------------------------•----•---......-•----------------......-••---•.............. 1 W i Owner Address _... . I aller 1`' Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) per-, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ................................. . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter----------------Depth._......._...... W Disposal Trench—No. ................:.--- Width.................... Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No:.................... Diameter-------------------- Depth below inlet-------------------- Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY.......................................................................... Date--------------------------------------- ,� Test Pit No. 1----------------minutes per inch .-Depth of "Pest Pit-------------------- Depth to ground water...................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a . _ ODescription of Soil- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- x c, ------•---•---•-'••--••----••••----•-•-•..._....-••••--'------•---...-•-------••••--------------•-•-••--•••-••-•-•------•-•••••••-•••--.....--••-•-•--...-•••-••--•-............-----••-•--•--••-------- W ----_------� ------------------------- V Na re of Repairs or llprations—Answer when n applica le .,.)�.� .....1 ..................... ................ greement: ---/�-7 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 be t ued by the board of health. ISi ed: f!J�`'�1 P.i_/ C' ,��-rf --- �-b--- // vcr v Date Application Approved BY..... --------------------- A /j -•--�._. .'�-........................................ Date Application Disapproved for the following reasons:................................................................................................................ .......................................................................................................................................................................................................... Date PermitNo.:-----------•. - Issued..................... ................................. < _ — _.. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Y!'t ..............O F..../�1vf�Y.... ...1•!� '...:.......................... (9rrtif irate of Tomplitture THIS-IS TO RTI , That the IInrydiv* ual Sewage Disposal System constructed ( ) or Repaired (� by = ... � r. ��' -•---••- "-•---•-•--"--------�--------------------•-•-------•-_-•---- ' Installe - �o has been installed in accordance with the provisY� ------------------------------------- fis of :�ffic e �iI_of 1�he tate Sanitary Cocle as described in the application for Disposal Works Construction Permit No��°.____._:7 PP P - �-------------- dated--.,3.......................................... THE ISSUANCE OF THIS CERTSFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH yG� � -•------ /..f�1...............OF.....jCPiS: .................... .............................. No.......• •• ••--•. FEE Disposal Nor -�oaTutrurtivat rrmit Permission is hereby granted--------- .`�_12._.._( !f�_ to Constru ) e ( �n In vidual Se ge D' .al System C l/ . s at No- r - L = --- -•--•-•----- ----------•-........-•-----------••---------------- ��a Street as shown on the application for Disposal Works Construction PerT't No.... ._. J....-. Datedj_-.2'__7.�7.4................ .-A ,�. /,-D2� DATE.�.. �4 .- --�r---- `-. 7G---------------------- Board of Health FORM 1255 HOBBS & WARREN. INC.: PUBLISHERS �i I . ... � � � � i � • (� ._ � _ ? .� .. � � i . � � '� �` �� jf No.......2-3 �,7. ..... _ t.:}# THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , V..a..c9...........0 F........../ . Appliration -for U spviial Works Teat i#rur#ion Pprulit Application is hereby made for a Permit to Construct ( J11"or Repair ( ) an Individual Sewage Disposal at ocation-Addr or - - .........x -------------• --�-••-----....--- W er �.�%.�•-•---•---- Address � Install Address d Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) P4 Other fixtures t _�ures ......._. .... W Design Flow.................1�- -------__ _ allons per person per day. Total daily flow....____. _..........gallons. WSeptic Tank-t Liquid capacitv�l�----gallons Length................ Width................ Diameter............__.. Depth................ x Disposal Trench— o. .................... ��idxh------------- _ otal L th----- Total leaching area....................sq. ft. Seepage Pit No....1`I o.._...... Diameter%r ___. ept el v i�.. .. .. ._`..... Total leaching area.......... ......s t z Other Distribution box ( ) Dosing tank ( ) _ f%Z _`Pes��— 1C^ e� C�. Percolation Test Results Performed by............................:............................................. Date _?�7y_.. 1.4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f14 Test Pit No. 2................minutes per inch Depth of Test.Pit..-_-_-_--__.__-_--_ Depth to ground water--.-.-.--_-----.-.--.... 9 ...........•----------------•-------------------•--------••-•••••••••..........-----••-••••-•-••••••...................................................... 0 Description of Soil........................................................................................................................................................................ x U •-•••......••--•-----------•-------------•-------•-•-•-•••••...••-•••----•-•------••••••••••••-------•----•----••--••............----------•-. •.•-..........-------------- -•-•- x ^--------- /' D -- aAl U Nature of Repairs or Alterations—Answer when applicable.-.-` �(��.1. . _ -- .. ___ .................... ........... -- 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 been edbard ofhealth. ` A Signed ---------------- -------------- ------ .........--------------- A Application Approved B ,.t Dat PP PP y- �- �� _... ' �..�- Application Disapproved for the following reasons-------- ---------------••--•-•--.._...__............._._------..........-•---------- ...---••••••-= --.......--•-•........................................................•----•---..-•••-••-----......•.....-•-----••------•-••.................... .•••-•••---•••--.....-----•----........_•---.....••••- Date •..•e.••�. •...a L'rt . fl .._._..-.._'•--•--------------------- Issued......................................................... •��'t iriiiiii......• .•.•.•��. ..•. •.•..•....•... .••.••�•.•...........••........••••a..• pr), Date _� --- _I-----------------------------------'------------------------------ ------------- 77 No........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH A 0 �. ,y .M...........OF.......... Appliratiun -fur IN-4puottl Works Tonotrurtiun Vreutit Application is hereby made for a Permit to Construct ( k5loor Repair ( ) an Individual Sewage Disposal System at �> ------- -----«'L --••• --_ __- -----• --•••••..-_-- - ocation-ve - Addr or rLot N -••-•---•- n Address (� . La Installer Address d Type of Building Size Lot............................Sq. feet. U g ----------------------------------Expansion Attic ( ) Garbage Grinder ( ) Dwellin No. of Bedrooms...___.._.'_______________________ per, Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 0.1 Other fixtures ............... W Design Flow- _________ ___ _.__.__.___ __ M t/Mons per person per day. Total daily flow_________ t'' ...........gallons. WSeptic Tank Liquid capacity 6! !gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench— o_ _______________•____ Width.-..__.._.__.._. _ -otal'L h._._. Total leaching area--------------------sq. ft. Seepage Pit No ---------- Diameter.1 ___. ept e in e __: Total lea -ng area_____--__ ______sc t z Other Distribution box ( ) Dosing tank. (x' ) r.� Percolation Test Results Performed by__________________________________________________________________________ Date,.... Test Pit No. 1................minute's per inch Depth of Test Pit.................... Depth to ground water--_-____-_______-____--- (14 Test Pit No. 2................minutes per inch ,-Depth�of"Tes�it..................... Depth to ground water........................ 0 Description of Soil.........................................=.................................................................................---------------`............................... x V ...............•--•-•-•-•--...----••---• ...••--•---•--•--------•-----------•------•-----••------•--•--•--•---•-•--•--- ----•----..__.__.__._..... - ---------- W UNature of Repairs or Alterations—Answer when applicable.-_.-f_C' _ ___ .....:...:...:.... !:Z --------••-•--------•••---•---------------------------------------•-------•••--•----------------•----------•-•---__ _••-------••-••--•••--•--•__•---•-___--•--•------------------_--- 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 ed by the board of health. fe• r Signe --•--------- ............. ..: ............. Dat Application Approved B e___-____ 15ate . PP ---••--PP f f•--•-----• •--•--•-•-•• •---•--•---9-•-----••---•------------------'-••-----•--•---••-----•••-------------•----------•--•-�kt�""-_._ -----------------•---- A lication Disapproved for the following reasons:...........................:. Permit No Issued Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF VE7ALTH a Tprtif irate of ff..omplinnrp THIS IS TO CERTIFY, That the Individual- Sewage Disposal System constructed ( ) or Repaired ( ) by.....;4------------------------------------ ........ at' C -` •- •-�! tall r ------•----- ... ��y� has been installed in a cordance with -the provisions of A tcle I fe Sta Sanitary Code s descr• ed in the application for Disposal Works Construction Permit No..........: ..: ::, dated---.G _.�_ _ � �.___.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT' BE CONSTRUED AS A G ARANTEE THAT THE SYSTEM WILL-FUNCTION SATISFACTORY. DATE----------- -------------------------------------------------- -------- Inspector---------•--------------------------------"----------------------•••--......_.._.._ ! THE' OMMONWEALTH OF MASSACHUSETTS BOARD O • HEAL .......OF...... . ................. FEE--- ..�- � �i��>a�ttl urk,� C�un,�trurtiun �rrutit Permission 's reby granted --• ---•••---- _- •............. to. Con- ct or Repair ( ) �idual Sew tsposal ,,, � �S et i as shown on t=a � or Disposal Works Construction it N Dated.._ _� /._�_____ b. �- Board of Health DATE ._-_l-- f ff J FORM 1255 HOBBS & WARREN. INC..-PUBLISHERS d: �1Fascn� �c anr�y E;tl uwA�;r� ,-R.AY LANE yAiv.v,s E--- 571 �- 47 } SCALS 404 = I rrvcN SPwAC-B -Fr ;Zi?