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HomeMy WebLinkAbout0024 GORHAM LANE - Health (2) -�d d-4-Ao-v, r `�3 _ i q1 r -1 $0� N I o .... Fivml. `���. ....... THE COMMONWEALTH OF MASSACHUSETTS F H B®AR® E L / .....14..... .... ..4 V...JL.! ...OF. ......... . ............................. Appliration for Disposal Works (foul union. Punfit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal 4 System at: Z_ Al e,, ................ . .... ................................ .................................................................................................. Loc1..n-.A dr s t N... ................................... .... . . .................................... Owner Address Installer Address Type of Building Size ....Sq. feet U Dwelling—No. of Bedrooms........ ..............................Expansion Attic Garbage Grinder 4 P4 Other—Type of Building ............................ No. of persons.....4................... Showers Cafeteria P-1 Other fixtures ---------------------------------------------------------- ------------------------------------------------------------------------------------------ Design Flow......_172n....... . ......**-------gallons per person per day. Total daily flow----------- ....................gallons. W 7 y6e> —e 9 Septic Tank—Liquid capacity............gallons Length....4......... Width_........_ Diameter................ Depth._.._.........._ Disposal Trench—No. =7==:..... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.A6O®_ iameter.................... Depth below inlet e........... Total leaching area..................sq. ft. Other Distribution box Dosing tank Percolation Test Results Performed by----................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.......__._.__..._...__. Test Pit No. 2................minutes per inch Depth of Test Pit.................._. Depth to ground water......_._.........._.... P4 I' A - 0 --- ....id---- ,fel%a.............- 6 — " t I.- A..;- --------- ��44-_Lz - ___-) .4- ------------- ...... -----------------------------------------�-/ ...it...... Description of Soil. -j�......... ....... U .....................3- ... ...................................................... ................................................................................................................................................. 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 furth agrees not to place the system in operation until a Certificate of Compliance has been is tie by the boar _9f Sign ...... ............7. ..................... .......... ................................ Date Application.Approved BY-----..... ...... -.�1 �/ Date AppliC',Ltion Disapproved for the following reasons:................................................................................................................ ..................................................................................................................................................... .......... ...7..................................... ... Date PermitNo--------------------------------------....----._......_.. Issued------- ........ ................ . ..... Date ------------------ ---------------------- -- No....... - " Fps l .. ...... THE COMMONWEALTH OF MASSACHUSETTS BM®ARD , E LRT'H Appliration for Uhipagal Works Cnomitrurti n Urrutit Application is hereby made for a Permit to Construct (. ) or Repair ( ) an Individual Sewage Disposal System at lo.-A . .:... ..................................................... Locat n-Adds o Lot No ► jr, Owner Address W /r Installer Address Pq U Type of Building Size; Lot...A __ddQ .Sq. feet Expansion Attic�-, DwellingNo. of Bedrooms_._______ .................................No. of persons Garbage Grinder Other—Type of Building P ..___. ( ) a yp g _____________________ ___ p �„_ Showers ( ) — Cafeteria ( ) Other fixtures ---------------- W Design Flow..... p......... .... _gallons per person per day. Total daily flow________ CQ___P_:._________________gallons. 6a - ,► WSeptic Tank—Liquid capacity.'�_______gallons Length___J____-.... Width. .... Diameter________________ Depth....._.......... x Disposal Trench—No._ `_______ Width_----------------- Total Length.................... Total leaching area............_._....._sq. ft Seepage Pit No 1 ..-•. p '�________ Total leaching area...................sq. ft. ©� �.. lameter_______________ Depth below inlet..__". Z Other Distribution box ( ) Dosing tank ( ) d h# PCIAyt- IX-,10-' a Percolation Test Results Performed by.......................................................................... Date......................................... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_---------------------- r-14 Test Pit No. 2.................minutes per inch Depth of Test Pit.................... Depth to ground water........................ - . - �s ----- w: Description of Soil : +r J �1 4�4 +d. x • f 494 w , UNature of Repairs or Alterations—Answer when applicable----.''______.....................................____________________________:___-___.._........ .Agreement: >. �.•• - ., , -- ------- - ---................ The undersigrie'd agrees to install .,the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the.State Sanitary Code- The undersigned furth agrees not to place the system in •operation until a Certificate of Compliance has been issue by the b ar Signe -- ` ...... ................................ Date Application Approved B � _-................. Date Application Disapproved for the following reasons::.. .....:. ....____. _________ _..______.________._.. _____._ _________. ..................... .....-----•.............•----.....-------------------•---•....--•-•-•------------__-•-••-- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD HEAL-i'-H s .............OF..... (t�rdifir tr of T11h liattrp ,�_X . T IS I TO IFY at the Individual Sewage Disposal System constructed \or Repaired ( ) b .... _ _ ---------------•----------_.___---------- Installer rI ----....................................................... has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construct O.P`Permit No------ a _-q_______________a_ dated_- _2-, /'4-____,?' ,.____,____ THE 115SUANCE. OE-THIS CERTIFICATE SHALL NOT BE CONS d6 AS A R N E THAT THE SYSTEMVlll. F1JNC ONSA7'ISF� TORY. DATE........... v .................... Inspector....... ........... I.......... ..---............................ THE COMMONWEALTH OF MASSACHUSETTS BOARDfF HEA § H ._ ......... � . "}.....: OF... . ......................... ..... . No. ; FEE ---_-__.. II �e �kti�' 1' i�rk� ft0k, •riot Pr�tttf I . . .� Permiss••ion is hereby granted.--_ • ........ to Constr 1�' 'or Rep ( ) a Individual Sewage D spo yst r at No... .-: -{• -•• A*- V --- ` ---_-- Street d•" as shown on the application for Disposal Works Construction P it N __ ____ ___.__ Dated__,�_41_".___.3z.'_`...la = -------------------- � A oard ofea DATE_......-•---._......••-=•..............................:.................•-•- - t FORM 1255 HOBBS & WARREN, -INC.. PUBLISHERS: - - - - - A r A co Vol of a�