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HomeMy WebLinkAbout0073 CRANBERRY LANE - Health 73 CRANBERRY LANE CENTERVILLE A = 246 - 180 � \ 5-� LOCATION SEWAGE PERMIT NO. VILLAGE , INSTA LLER'S NAME ADDRESS BUILDER R OWNER DATE PERMIT ISSUED �17 E3 DAT E COMPLIANCE ISSUED %7lS�G!c � /-ay-7P- ��: �� �� 4 v' G1 _ � �- �'° �` �' zs THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........-.0......... A.R --v-A. a.4_ E--------------_----- Appliration for Uhipati l Works Tom4rurtiott thrmit Application is hereby made for a Permit to Construct (K or Repair ( ) an Individual Sewage Disposal System at: 1.�011. Location.Add or• too. .t.C.kAFL ..... ..Za..c.d---�' �N!4----------•........... ..��.Pt�LN. ..... t. � .. .N. t2�,L... ..... y�./ p g `,i...... a 0 R °S�!1:.Y ner�S��18�.Ck..dws.`A. _.}..1._^�''S�..._`".'O Y�reI&......P!-- _..�!- J.ld.171 � Ins ller Address d Type of Building Size Lot_.,�l � ....._.Sq. feet Dwelling—No. of Bedrooms........... ...........................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers — Cafeteria a Other fixtures ------------------------------------- - W Design Flow............ ..-,_.............._...gallons per person per day. Total daily flow........ 30......................gallons. p q P Y ga g -A a----. Diameter................ Depth.... ----•-. W Septic Tank—Liquid Li uid ca acit � . l��hns Length TotalLength ldth___. xDisposal Trench—No _......... ........ Total leaching area-------------------.sq. ft. Seepage Pit No....... Diameter:......:....:..... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box.:( G Dosing tank ( ) aPercolation Test Results' Performed by-----� .. 16J ......... Date.......:........ ' a Test Pit-No. l.....��-. minutes per inch Depth of Test Pit.:................. Depth to ground water..... ._-.- (i, Test Pit No. 2_..__d—._._minutes per inch Depth of Test Pit--------------- Depth to ground water-__ �:. Pi__ Description of Soil----------4 =' =.�Q ��4Dt3�c5.i ------------------------O-----a--------` 5 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---•--•-••............-- UNature 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 i171 L 5 of the State Sanitary Code—Tlie undersigned f rther agrees not to place the system in operation until a Certificate of Compliance has be' d by t ar of ealth. ... -- -- 2M Date Application Approved By........ ...................... ...•• Date Application Disapproved for the following reasons:-•-•----------•---------•-••-------------•----------•-••---•------------------------•------•---•-----•-••_...._ ....-•--•--------------------------•--•-•-•----------•--•---------•----••--•--•-••---••--......•-••-•--••--•--••--•--••-•-••----•-••..--•--•.------•--------•----------- -------------------------­--- Date PermitNo......................................................... Issued.•- -----------------------•-------------------•-- Date No ............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD, OF HEALTH ........... (::�U_ j..........OF...... ... .� Via, 1 .� ...... ......... ). Appliration.for Dhip al Workii Tonstrurtinn Famit Application is hereby made,for a Permit to Construct (K or Repair ( ) an Individual Sewage Disposal System at: �p p� Location---Adds _( / -or t"R1/o - Sp sm � w1 N Owner _ Addres --c�c��:<_--..,���.......P. .... - = � l � Inst Her Address .. Type of Building Size Lot_.__.__1_ _ ------Sq. feet Dwelling—No. of Bedrooms............ ...........................Expansion Attic ( ) Garbage Grinder, (, ) Other—Type of Building No. of persons............................ Showers — Cafeteria dOther fixtures -----------_--_.............. W Design Flow........... ' '=1 ...............gallons per person per day. Total daily flow........a30......................gallons. 'Septic Tank—Liquid capaci"ty).4=.gallons Length... Width---:2...... Diameter................ Depth.....2_........ W Disposal Trench.—No. ------I............ 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----- e�. _ t` .___. � e.......... Date_. ...._!±_)..... Test Pit No. 1.....r--_-_minutes per inch Depth of Test Pit...........:........ Depth to ground water----- ' . . .... f=, ~" minutes per inch Depth of Test Pit................... Depth to ground water____-_....-.._.__."io Test Pit No. 2__._...2-=... __ �..... +• ,D . -----------------=------- -----Soil i V ........................................... I. 11 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 iITLi: p 5 of the State Sanitary Code— The undersigned f rther agrees not to place the system in operation until a Certificate of Compliance hasoilby t ar of ealth. -Si e - -----------•-•-•- ................................ Date ry Application Approved By-••-•-• ,r _ Date Application Disapproved for the following reasons::................................................................................................................ ...............................••--•-•-•-••--•-•••......-•-----•-••••••-----•---••.........••----•-••--•••••-••-••••••••••-•--•••-------------•••-••-•••-•••-•-••••-•--•-----•----•••-•-•••---•= ` Date Permit No.--•--......----•---------------•--- -_.. Issued l--••------- -- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............. t9.U. 3AJ.....OF....... '.h a ! !' :9,r`� -..................... Trdifira of Trrmpliattrr THIS I O CERTIFY; That the Ind v;duMl ' wage Disposal System struc.ted ( < or Repaired ( ) by................. •. _ --- _ - Insaller at. ---------------------------- has been installed in accordance;with the provisions of T e ` of The State Sanitary Code as describe d in the application for Disposal Works Construction Pernim No.._ `1)`,_. ........... dated....._�.. �_ ��r'....:........ THE ISSUANCE OF�THIS CERTIFICATE,SHALL NOT,BE CQNSTRUED AS A GUARANTEE THAT THE SYSTEh+II WILL FUNCTION SATISFACTORY " DATE... ... :,_._=:.. .. ......:.....:.•-- --•........., . .. Inspector-•••- • ---`-- . ----� •--•-•-- l THE COMMONWEALTH OF MASSACHUSETTS N r BOARD OF HEALTH 0 � ..OF.........�.;3" 1.�> �..+ ..........N0.i)�Vl ........... FEE.................•-•••. irnrkii nm ion rrntit Permission is ereby granted...... ----•- ------ I....... '= .................................................... to Constructor epair ( ) an Individua Sewage Disposal System at No. ��__< ...... �V ls'3� .I`y.... /�?-f ------------------------- --•-- Street I as shown on sal Works Construction Pe No___ ____ ______ Dated.__ ._. .C. .' �. ���'�' e application PP or Disposal �^ - - - ( r /" Board of Health DATE........ ----•-------•----•--------------•---------------------........... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS } fi"' , .� a } ,.�.: a� .""ri,,;a°,T?, �'' '.R�a .•.{ a x - u?e43ar-.:.-� .�,-. 0 t ��'�...r.. 'P h.:-.' -.. ,. f 'N}• t9 -1', : .4...., v' N 1�y . ;x- gz,a�; �i?'wEY��T�`a�+�.mai.:.'�:'� %5„'. t.r`�'� 'a .,�-'•� .-ra` ?§:.. yrss 'F: g»:x _ I.ov ti'ZorJ rc ;� Q �r Al 3 c, y.ls-r a A0,, • l - d j"' � � ZM ✓v I � j f,4H T {{{ tiles"--s ley et 1 � �o��. z� � 3 PI� P�rGrF� �1 e/FT u►J�.eSs aT�FF�l�11SE (.1oTC'D; C.ASNe�— _-44 5. 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