HomeMy WebLinkAbout0024 GORHAM LANE - Health &o�hiq-rn I--�-r�e-
(try.e.'rv,i 11-e-
q3- rya-
No...... ff 17 Y&E... . ..................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH [ o_
' or - . .......... OF_ - -------------._..._.
Appliration -for Ii,4 rrsal Worko Towitrurtion Vrrmit
Application is hereby made for a Permit to Construct (//) or Repair ( ) an Individual Sewage Disposal
System at: _
----------•-------•-----------------------•--......------•-- --•-------
Lo ' n-Address , Lo No. —/
r_' Owner . Address /. Ld. /
--
Installer Address ////
UType of Building Size Lot_/16_.000-------Sq. feet
Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic {Vq Garbage Grinder (
aOther—Type of Building ---------------------------- No. of persons_---_._--------._..._.- Showers ( ) — Cafeteria ( )
a' Other fixtures ------------------------------
g -.- -------------•.--gallons per person per day. Total daily flow-------------------------------------------.gallons.
W Desi n Flow............... �?
WSeptic Tank—Liquid capacit.----gallons Length---------------- Width---------------- Diameter---------------- Depth................
x Disposal Trench—No. ,Width-------------------- Total Length-------------------- Total leaching area--------------------sq. ft.
Seepage Pit No..IPAQ . iameter.................... Depth below i let-.-.-n. ____-. -. Total leachin- area..-----------
. .sc f .
z Other Distribution box ( ) Dosing tank ) ' /'�-- 71.10—/ 7 y
Percolation Test Results Performed by. -_ . -..`".-./1�...���.-/.-K!�r��ate..-.. -./- ..._7�....
Test Pit No. 1----------------minutes per inch Depth of T .t Pit.................... Depth to ground water...--------._.....__..
f=, Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water.............-..-._._..-
9 ----- ---- ---------------------- ---------- ------•------------------------------------------
0 Description of Soil................... . - . t om.....
-- ---------- --- ---- ---
It
__
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
h operation until a Certificate of Compliance has been issu "the board o hea t
,- .,
igned- --- -------- -- - ---- --- ------- ----
Vate A lication A roved B
Application Disapproved for the following reasons:.-------------------------------- -----------•-------------•-•-•---...........................................
---•----•----•--•-----------------------------------•---------------•--•---------------•-•-------------------------•----------------------------- •-------- ------- ..........................
Date
PermitNo......................................................... Issued-------'� -- ---••--••-----•- .............
Date
Q
r
No..... -.9G._.. Flzs.../0................
THE'COMMONWEALTH OF MASSACHUSETTS
'-BOARD Of t-6EALTH
OF..........
a.................
` Appliration -for Bifipofial ,Works Tomitrurtion 13rrmit
Application is hereby made for a Permit to Construct ( r Repair ( . ) an Individual Sewage Disposal
System at � �
- - --t' �r--- ------ Z ................................................
L6 n Address or Lot No
ope
Owner Address
---------------------- --- - -- - -----=--
Installer Address
Type of Building Size LotA &I.6-2__Sq. feet
Dwelling—No. of Bedrooms.......................................Expansion Attic Garbage Grinder
Other—Type of Building ............................ No. of persons.--__•--._._______----___.-- Showers ( ) — Cafeteria ( )
PI g
d Other fixtures A
W Design Flow..............4770-_--____-__--___-_gallons per person per day. Total daily flow--------------------------------------------gallons.• 1j"
WSeptic Tank—Liquid capacity/O6pgallons Length---------------- Width................ Diameter-----.....------ Depth...__..__.... s
x Disposal Trench—No._____. .._ idth-------------------- Total Length-------------------- Total leaching area............ ft.
Seepage Pit No../O_4 iameter.................... Depth below i et...... �.. Total le chin are l:._ so
z Other Distribution box ( ) Dosing to k ) G: �'C-w 71. OV 7 � ,.
'-' Percolation Test Results Performed by. , _ _ .__---. . . ate.:.:. _. ,r .. :._
.-I
Test Pit No. 1................minutes per inch Dept
h of T t Pit.................... Depth to ground water_:.--- __-.._---..._.
C14 Test Pit'No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.-.---- .-_----------.
x ;
----- ---- -------------•--------------------- - --- ... .. ...................................
Description ofroil------------------�-_.__ � '` l .._.��
U --------------@ 0_1 x c •► _c�'. �
x ---------------------- ------------------------------- �'----------------------- -
U Nature of Repairs or Alterations—Answer when applica.ble.----------------------------------------------------------------------------------------------
----------------------------------------------------------------- -•-•-•-•--.........................--------------------------------------------------------------------------------------------------
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 agr s not to place the system in
operation until a Certificate of Compliance has been issuedybi4he board of e
Igned-- ---- ..---- - •--- °_
-
- .. - ate D
Application Approved B
Application Disapproved for the following reasons:.............................. --•------•--------•--------.......•-----•...._................---•----•-•-
--••---•---•-----------------------------------------------------------•-----•--......••-------------•••.•---------•------•---------••-------------------------------------•--•-----•--------------------
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALf}
...7-`
..........
. F.....-... .. .. ...................
�rrtifirate of f�umptianr �,..
T. IS C h' he Individual. Sewage Disposal System constructed ( ) or Repaired ( )
jInstaller
..
has been installed in accordance with the provisions of Article XI of The State Sanitary Cod as described in the
application for Disposal Works Construction Permit No.....a.z.� G'................... dated-.-:t//.0/.7-�_...........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT.TIME
SYSTEM WILL FUNCTION SATISFACTORY.
DATE......=.......... -•-•-•----•-•------•---------•-----••------•--•-------------- Inspector....................................................................................
THE COMMONWE_kLT}i5OF MASSACHUSETTS
BOARD OF HEALTH
7 7.to.-1-d);t.. .....O F........ .. pC . .............. �/�-
No•--•-- --<•---------.. FEE. .
-digs Vamit
1.Permission y granted....... +_ , ':.
to Con5tridt or Repa ) a Individual Sewag Disposal Syst
7
at No �� 1 . ..... � i -i+ --------------------------_---
as shown on the application for Disposal Works Construction rmit No____ _______ _ _ Dated..... i ,�
.....�......
Board Health -• ^W.
DATE. d
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
OC TION SEW&CIE PERMIT UO.
VILL-AGE�
INST R S IJ IJl ADDRESS
BUILDER 5 Q &V AE ADDRESS
-27
DATE PERMIT 155UED '- � 1JO
--
DATE COMPLI &MCE ISSUED : °3
J
R,� I
i
_�- 1
b J
a \ I
fi
� �
i*49
i i
k, i � I � � �
i
1
ti
1 � I
i I I I
I I � � I II{
I I � I
. ` I � � i I I
i I � i
� � �
i i I l i ( i
i I � � � I I I � i � �
i � � �
i I
� ! ! I i � I � � i � � � � � � �
l i � 1
� � �
o i � �
j. . i
-- --- _ _ _ _ — _ _ . _ — _ _� I
I
� I � � � �
I I ! � � � j i I � � � ! I I
r