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Home My WebLink About0079 LAKE ELIZABETH DRIVE - Health 79 [eke e�rr�{, Dri ce�F FBI, THE COMMONWEALTH OF MASSACHUSETTS -,-BOARD OF HEALTH ..................OF............................................. ................................. Apptiralion for U44pasal Works Towitrurtion tIrrutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ............6e_A.+ ...................................... .................................................................................................. ......... Location-Address or Lot No. S32-10......C-0 ............................ ................................................................................................. Qw__r Address .................... ...... fr.q.h.................................. .................................................................................................t Installer Address U -2- Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.__..:....__ .......................Expansion Attic Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ .Showers Cafeteria ( ) Other fixtures ----------------------------------- ------------------------------------------------------------------------------------------------------------------- Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width........_._..___ Diameter__-_._.......... Depth_............... Disposal Trench—No..................... Width..............._.... Total Length.._................. Total leaching area....................sq. f t. Seepage Pit No..................... Diameter..........__.__..__. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit....._....._........ Depth to ground water------------------------ raq Test Pit No. 2................minutes per inch Depth of Test Pit.............___._.. Depth to ground water------------------------ P4 ...............................................................................................................................I----------------*-------------- 0 Description of Soil------................................................................................................................................................................. x U ....................................................................................................................................................................................................... .............................................................................................................. ..;;—--------- Cot 0 t-ZOVJ ------------ Nature of Repairs or Alterations—Answer when applicable...TJ-_h::J----------------:r------------- 0L -------- U -------_--P--------- --------------------- . .......... .................................................................................................... ... - ------------I------r---------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'T'11 5 of the State Sanitary Code—The dersigned fur �4er agrees not to place the system in, operation until a Certificate of Compliance has been is'ue by board of h blffi ...... ....... 16.... .. .... . ... ............ .....�vwmr t_ le...............7 Application Approved By........... . . . . ................. ...................................... _2.6_10.E3 Date Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................................................................................................................... � 11 Date PermitNo............................... Issued_....................................................... Date - cED Lj Fim.............................. ............... THE COMMONWEALTH OF MASSACHUSETTS .�OA R D O F-, H E A LT H ..:....................OF.................... ....................................................... Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ...............•--•---•-----•.......... ...... ...•......................................... ....................... — --- Location.-Addr ss or Lot No. Wit C� .CY'I .. ........................................... ..... Owner Address Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.......... '...........................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures .................................. Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Wy Septic.Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. �y Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Other Distribution box ( ) Dosing tank ( ) `-' Percolation Test Results Performed b a Y---------------------------------•--•-•---------------••-•---------------- Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.--.__--__:__-_______--- Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.--_____..___•__-_---- a ----------------------------•-------•--------•-•-----...------------............._..--------•-_-•---................................................. •------ "';0 Description of Soil......................................... x W •-------••---------•---------------------------•-•---•-••- •--•---•--•------•-----•--••----•----••----- --------------------- ;U Nature of Repairs or Alterations—Answer when applicable______. !_ 1. v t-...a.. �'_ ".. y Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with f lT/jl:^ the provisions of T I E 5 of the State Sanitary Code.,-.—, The undersigned fur- er agrees not to place the system in operation until a Certificate of Compliance has been iss7,ued by tl�e board of h h. e Signed................� J-...... ....._...................................... -•---- Application Approved By.......... _��..!......:.:...... ...... � - 2G Date Application Disapproved for the following reasons:_..----•----------------•---•----....._..-------------••---•--------------------••------•----•--------••-••..... --------------------••-----------------••---------------...-•--------------------•---------•--------.....------------.....--•---------------•--•-------•----•--•---•••-•------•----•-------------------- Date ':= C.' PermitNo......................................................... Issued....................................................... Dste THE COMMONWEALTH OF MASSACHUSETTS -- BOARD fQF HEALTH ..........................................OF..........~~�.................................................................... Trrtifiratr ,af Tomplianr THIS IS TO CERTIFY, That..•the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by--------------_----n� ' k�- 1 r1........_.._ ...... .•••------•-----•-•-••-••-•-••--------•.................•-•••-•-••-••--••.........-•-•-.._...•---•-------•-•-...------------•---•--------- Installer at. F 4 .... < 7 7/ ._.._r 1 y 1�! = ............................................................... . --- --------------•------••-•....._.._..._......--------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Cod �de�ril�e the application for Disposal Works Construction Permit No........ r°:_-__._Lf.�_._--'... dated_ -------......... ............................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....----•••.......`7._.".. .-.� ......................... Inspector................ .................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF—HEALTH �L c, ..... OF.................... No... ,r. .. ............... FEE.---.. .............. Disposal, orkii TlInstr ion rrutit Permission is hereby granted......... a+----: -'- 4+_^...._..----••. -----•--•----••-------•--••••------•---------------------••--.................••- to Construe �_) or Re air ( ) an Individual Sewage.Disposal Spy tat No . --.-•----•-------------•••--------•--.......-•--- ...- Street as shown on the application for Disposal Works Construction Permit Not:`.............. Dated.......... �......../ a U Board of Health DATE-------- Z ....:. ..............•------•-•-•.......... FORM 1255 HOBBS & WARREN, INC_ PUBLISHERS