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Home My WebLink About0028 LANTERN LANE - Health i d 0 II',i LOCUTIcOKi : 5EW&C4E PERMIT MO. WSTALLER•5 U&ME ADDRESS BUILDER 5 kJ' L1 VAF— ADDRESS Dfs,TE PERIIA T 15SUF—D — — -- D b.TE COKAPLI &MCE . ISSUED ; .A.:, t F, � F � C 0 Ph ql THE COMMONWEALTH OF MAs9ACHU8ETTs BOARD HEAL .OF....... ... ..... . ........ ..... ..... .................. -•-•-•---....... Appluttthut for Dtspitia1 vrkg Tanstrurtivu Vanfit Application is hereby made for a Permit to Construct ( ) or Repair epolo)"an Individual Sewage Disposal System at: '�«� 1 4a., f—mod, --%� ....... .. .... Location-Address r or Lot No. 1r-V C_� Gi 1 f ��/ G �.�—ZY t°6 t"e.re EF !�1 re /��/ OQw�n./e�' r Address �'! Se�.`.'7_� 1^ �•-�6..®sue• C...'.�L's� ................................ Installer Address Pq d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms........... .............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ---------------•••-••-••------•-------- . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width_---.__.-_-----. Diameter................ Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter------._--•----.--•- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water.....:.................. G%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil...............................................................................................................................................•-...................... x V •-------•----•--...----•--•------------------------------------------------•-----------------------------------------------------•-•----------------------------•---•------............••---•-••-------- W •---•--------------------•------------••--•-----•-•-----------•••••--••---••-•-----........._..--•--•-------------- UNat ur f Repairs or_,Alterations—Answer when applicable........- ............................. " :_- _ _e ----•: ... ...............••--------------....-•-------------•------------------------------------•----•--------....----------------------...-•-(�------..... 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 health. ned - ----- --............................................................ � � •� Date_ Application Approved By------------ - ---- -- = =Da --------------- te Application Disapproved for the following reasons--------------------------•---• ---•----•---...•--•-----•--------------•------•--•-....-------------••----_•--•- •••-•--•-••.................•----••...----._...••-•--•••--•-------------------------••--•••-•---.......•-•--............•-•----------•------••......----•--•-•---•-••••-------•-....................... ___j Date Permit No......................................................... Issued.:.... . Date --------------------------------------------- --------------- 140----All- ................... THE COMMONWEALTHOF MASSACHUSETTS ®OAR® E/`1L r Appliration for 4:31opotia.l . orko To'n's#rur#ion rnmit Application is hereby made for a Permit to Construct ( ) or Repair (/ ) an Individual Sewage Disposal System at: ...... Location-Address or Lot No. owner Address � ....__..., _'..�: '? f! ..t" . � +aa"' ..... ;� ,e�4�t!+ _> 3� /------------------------------- Installer , "^ n.w Address x U Type of Building Size Lpt............................Sq. feet ,w Dwellin No. of Bedrooms.______.___.. ""`g— _______________________Expansion Attic ( ,• ) Garbage Grinder ( ) PL4Other—T e of Building ............. No. of persons____________________________ Showers — Cafeteria Q+ Other 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. Seepage Pit No..................... Diameter-,................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) w Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth,to ground water........................ L=a Test Pit No. 2................minutes per inch Depth of Test 'Pit.................... Depth to ground water........................ ............................................-................................---------....._...•••--•......................................................... 0 Description of Soil............................................................................................ x W ------------------------------------------------------ ----------------------------------------------------- -- �� /•-,_.._. V p lterations—Answer when applicable. .�4 o�„.? _+x.k+' a Natur f Re airs or,1 _:;--•---------•------------•-------------•------------- --------- -------- -------- ..................... ....... .......... Agreement: Y` 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 health. a=-r -_ ate Application'Approved By...........• ...... ---- -•• • .. -•----- '' ' ..............t Application Disapproved for the following reasons------------ ----------------- -•-•--------------------------------- `----f-----•--•-----•-----------_----- ...................•-----•-•-••---------•-...---......--•--•----•-•-----•-•-•-•-•------....-•----••-._..-•------•------•-----------------------•�// ........ ---••-•---•-•------------•••--_--. ate PermitNo......................................................... Issued........ ------•.....--•••------•- THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH .............OF........ e�w..........._.............................. HIS TC G IFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by. - -----------• -----•--------------- •y" Installer -- �. ------------ has beers installed in accordance with the',llrovisiohs.bfzAt I of The State Sanitary Code a described in fhe application for Disposal Works,Construction Permit No ,� --`f- dated__ ip r . THE ISSUANCE OF THIS CERTIFICATE SMALL NOTj`BE CO FIST UED AS A GUARANTEE THAT THE SYSTEM WILL FUNC ION ATISFACTORY „ r - DATE /r .. `-- . 'Inspector._... �l" .... THE .COMMONWEALTH OF MASSACHUSETTS BOARD HEALT ..........OF....: . _... '............... FEE.. ............. Elio Elio V I rk i T o#r rr-mi# Permission is hereby grant e ___._ ,1;€G ..... ........... ............................._ to Conss r t ( ) or pair (. I' ivid�salwa e . ispo 1 S , at No.. .. Street as shown on the application for Disposal Works;Construction ,Per it o_______ ________ ated._ .."`._. ...................... a ealth DATE:. _.. ; ,«• z FORM 1255 HOBBS &'-WARREN`;,,NC;; PI'JBL7SH S, �• `' -