HomeMy WebLinkAbout0065 HORSESHOE LANE - Health (2) L.a4le,
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App,
N0.0 ........... ..........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF ,,HEAL_TJH,
"�.k......... ..L...................
.......OF.........4..a4"
Appliration for Uispwial Works Toustrurtion 11amit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at:
14 -02 ............... zo ..... -----
----- ---------7----------------- ---
No.
te,".424-4-V............................... .................................................................................................
o"'(3 V Address
........... .........
Installer Address
Type of Build Size Lot............................Sq. feet
U
Dwelling No. of Bedrooms............................................Expansion Attic Garbage Grinder
'_l
04 Other—Type of Building ............................ No. of persons____________________________ Showers Cafeteria
Otherfixtures .....................................................................................................................................................
Design Flow______________________ _______________ 2— 6� .
_gallons per person per day. Total daily flow.......?�................................gallons.
04, Septic Tank—Liquid capacity............gallons Length________________ Width................ Diameter__.-___-.____-:_ Depth_._________.....
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 ( ) —
Percolation Test Results Performed by........................................................................... Date_________........._.....__...__..._.....
Test Pit No. I................minutes per inch Depth of Test Pit__.............._... Depth to ground water...___.._..____._......"
GX4 Test Pit No. 2................minutes per inch Depth of Test Pit.____._.___________. Depth to ground water...___......__._..__....
P4 ........... ................................................................................................................................................
0 Description of Soil.........................................................................................................................................I..............................
----------------------------*-------------------------------*----------*-------------------------------------------------*-------------------*--------------------------------------------
-----------------------------------------------------------------------------------------------------
U Nature of Rep Alt AnAWer jw applical Rep or Alterations—
... ...........
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TlTIZ- 5 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.
S, ................................................... ................................
19 .? Date
Application Approved By....... --—-----7..... .. .....
Application Disapproved for the following reasons:..........................1P ------------------------------------- .....................Date.............................. . ......
........................................................................................................................................................................................................
Date
PermitNo.......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD�DF HEALTH
........... ...........OF.... . ... . ............... .......(9rdifiratr of Tautplitturr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ;"-5or Repaired
by ...I.,....... ......I--------------- ........................... ......... .. ................
--------------
tat er
at. ....... F� - -- ----------------aZ4��4 .. . .................:.....i & -�nce VIthe provisions of T 5 of The State Sanitary Code as described in the
has been installed in acco:�r
application for Disposal Works Construction Permit No ..?. ........ ....... dated_.... .............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector.....................I..............................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD ?F HEALTH
.......... . ..............OF....... .
No..................a... FEE........................
Disposal Works T'llmitrudion "pantit
Permission is hereby grante .... ....
I , ___ ....................................................................................Z.................................
to Construe Repai ;�`an Individual Sew;d e Dispos�V.System
at . ......�Ia4.A,VW........../ s.?.......... ..........
Street
as shown on the application for Disposal Works Construction Pet ...No.14 Dated...... ......
.......... ------ ---------------
I ��rd o Health
DATE................................................................................
FORMPUBLISHERS 12 55 HOBBS &
N04. .................. FEi3... ..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD
............f 71.......OF....... ..........................
.Xppliraffou for Disposal Works Tonstrurtion Prrutit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
V-L ................(
System at:
---------------.......pLQca/tion ........kdr"e�s�s
or
& ............................... .............................................. --------------- ..........................ol;ZT Address
.......... .........
Installer Address
Type of
U Buildin a Size Lot ------------------------
Sq. feet
do
Dwelling JK-No. of Bedrooms............................................Expansion Attic Garbage Grinder
Other—Type of Building ............................ No. of persons............................ Showers Cafeteria
Pa
Other fixtures ......................................................................................................................................................
Design Flow.�....................6.0!*_3S....................gallons per person per day. Total daily flow__._.. zw-----a-----_*.7 .. ..Wgallons.
---- ---*....... ..Septic Tank—Liquid capacity............gallons Length................ Width..............._ Diameter________-___-__ Depth.............._.
Disposal Trench—No...................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.............._..... Depth below inlet.................... Total leaching area..................sq. f t.
Z Other Distribution box Dosing tank
'-q Percolation Test Results Performed by.......................................................................... Date........................................
1.4
Test Pit No. I................minutes per inch Depth of Test Pit..........._.._._... Depth to ground water......._...._._......__.
0-4
pl� Test Pit No. 2................minutes per inch Depth of Test Pit..__._......_..._... Depth to ground water.___._..................
..........*------------------------*------*............ .......... -------------------•---*............------------------- ----------
0 Description of Soil.......................................................................................................................................................................
-----------------*------------------------*-------------------------------------------------**-----------------------------------------------*-------------------------------................................................
An applicable_..-.__ .....cale.�.. _ _AW
U Nature of R irs or Alterations—A Wer 3 ...... ......................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TLITA IE 5 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.
'd Sig ....................................................
--------- ..................*.........
70 4;%;7 Date
7
'-Application Approved By.
Date
Application Disapproved for the following reasons:...........................�/............................................................................................
.
......................................................................................................................................................................................................
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARDHEA TH......... . 4.... . .................. ...........................
..........
Trrtifiratr of Tompliatta
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired
......................... . ...............
------------
at .... ------- ......... ............
by................e---------I------------------ - .........
has been installed in accordance Vtlfrthe provisions of T' 5 of The State Sanitary Code as described in the
T 9 /0 - dated_' ..............
application for Disposal Works Construction Permit No .. ...... -V
0. L....... ...
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD QF HEALTH
7 ?
..........OF......494*..!�.................................................... FEE........................
.......IT-2-
...........
Disposal Works 0-PaInstrudion "an fit
Permission is hereby grante ... ......... ..............
---------------------------------- ..... .................... ... ..................................
to Construgg (k Repa an Individual Sewp(ge Dispos9rSystem,1:4
auk
at ........ ........
41, /I - ......................
V Street
as shown on the application for Disposal Works Construction PerfhZit No -11 e Dated...._`wez.e�_Z_�K.......
No.......
.........................
..�dd Health
DATE-----..........................................................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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