The URL can be used to link to this page

Home My WebLink About0095 ANCHOR LANE - Health rq n c h �o7�-- u - � -7 i T Fss. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH ..................OF...... ............ ...................................... Appliration for Uiip.as al Works Tonstrnr#inn Vamit Application is hereby made for a Permit to Construct X) or Repair ( ) an Individual Sewage Disposal System at: L 4a //ice ...� ...._/. .mot........-•------. ..... -•--.... --•- ,� .._.._... Loc :n A t No. •-- " --- j........... ..... .__.....• ..............._...._..._....__ Own dress W -------------- ......... �----- - ----------•...•--.........---------.......-•-..... a Installer Address Pa Type of Building Size feet Dwelling—No. of Bedrooms _...______ d___ ________________•Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building _ _ _._____. _._ !N o. of persons....... .............. Showers ( ) — Cafeteria ( ) aOther fi to s ••--•----------------------•------•-••----•----•----••------------------------••---------------------•--------••-•-----------------------------•-•-•- d Design Flow......... -----------•-----.---•---gallons per person per day. Total daily flow.......7. 0.W g g P P Pi Y• A N Y is �)---------------------•--dons. WSeptic Tank—Liquid capacity/4 .gallons Length_.._ ..._. Width..,.�.__.. Diameter________________ Depth................ Disposal Trench—No..................... Width.................... Total Length..___.__......._.... Total leaching area................. .sq. ft. x � . � q. Seepage Pit No....../----------- Diameter...._�j.......... Depth below inlet.___7..�.... Total leaching area. ... _..__s ft. Z Other Distribution box ( /) Dosing to ( ) Percolation Test Results Performed by..... •- � � ......... Date...... ,tea Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water..VA..i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--VP... Q+' --•--•-------•-•----------------•-•-••----•------------------------------------••---•--•..................................................................... 0 Description of Soil........ ..... x U ------ -�------..........`........................................................................................................ W ---------------------_-- -----------------------------------------------------------------••-••----------•--......-----------------•---•-•••--•-•--------------•--••--••......--•-•-------------.... 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 TITLE; 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 and f health. / Signed.... ...... .11MZ_� �p A Date c Application Approved By........................l� l �E t.l.�/G ............ A.' 7-f Date Application Disapproved for the following reasons:----•----------------------•------------------------------------------------------------------ --------------•-- --------------•----•---...-------•-•--------•----------------------------------------------•-•--•----••-.-•-----------•-------•-•-•-------------------•-•----•----------••--------------•--••--•••-_.... Date PermitNo........................................................ Issued......f ® S...-`... .............. r • No.._... �,f.... ................... THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH ..................0F...... ......•' ................. , pplirFation for Disposal Works Tonstrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .........�.'............__�F :.?._... n Aaa-'------.....f � ; ........................ .....•------..... ..-------•-----•----------................................................... Locatio re'ss or,�Lot No. ...................... ......... ----------• ............. / Owner• ddress .. � � - •. Installer Address f= Type of Building Size Lot..: �( G'..........Sq. feet U Dwelling—No. of Bedrooms.._......._...........................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons Showers C-� yP g --��i�h�.�.�s?'<' P �'•-------•------- ( ) — Cafeteria ( ) Otherfixtures ------- -----------------.....•-••--•••--•••••-•---•--.------------•-•----••-••---•-•----------••-------•-•••-•-------..._...----------...........--•• W Design Flow........... `2.........................gallons per person per day. Total daily flow.......15-3 ___..................gallons. WSeptic Tank—Liquid capacity/ .gallons Length..1///"._ Width__ ...�/."._ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....../----------- Diameter...._!c_�--_•-__• Depth below inlet....7�-�?..... Total leaching area.., ('_�sq. ft. Z Other Distribution box (j ) Dosing to ( ) '-' Percolation Test Results Performed by..... k�! ' .._ _ l ?..._....___ Dater ° = ? ----• a . . . aTest Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water_+R`4_.. �✓ f? Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water._4-2i�.... ______...._ P4 .........................................=................................................................................................................... D Description of Soil...... <:. UU .....------•---•--••-•----•-•-•.......�' '�-�='--..... ----------------------------------------------------------------------------------------------------------------- W ---•-----•---------------•-•---•---•--•-•--•--•----•-------•------...----............•------•---•-•------•--•-•--•---------------••---------•-•---------••--••---•-------•-•--•---•••......------•-----. 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 TITLij 5 of the State Sanitary Code— The undersigned faTluler agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed_._. _r. �4 `== Date Application Approved By------ .... C---- .. -•• *' Q ` --•-f a wy Date Application Disapproved for the f ollowang reasons:.. ---------------- .......................................... ••-•------•-----------------------------------------------•--------------•---•------...-----••--•-------•---...---•------------------••------•-----•-•----•---••--•.................................... Date PermitNo......................................................... Issued....................................................... Date a.. V, 4,yr THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. OF.:......v . ... ......... (9rrtifiratr of ToutpliFana THIS IS TO GERTIFY, T,hat the Individual Sewage Disposal System constructed X) or Repaired ( ) by , `�� (.t� --------------------------- ..... ---------------- --- t at . --•-•...--•-•---•••--•-•--•--•••--•-...----•-------------------- ----•-. --- has been installed in accordance with the provisions of T— 0 The State Sanitary Code as described in the application for�Disposal Wor'siConstruction Permit No. .............._.j'_______________ dated-..... ;?P ........ THE ISSIJXINE 'OF THIS CEREtCATE SHALL NOT BE CONSTRUE® AS A GBJA NTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..... 0 d2 S .............................. Inspector. ...-f C-.--_... n f 1 r THE COMMONWEALTH OF MASSACHUSETTS �f BOARD OF HEALTH j� �.. ..OFL..rj F �*,- ......J-�_ . N ..................... _................................. EE..�... ......... f' . Disposal nrko Tnno�tm-ifi f mit ,Permission.Is hereby granted.... r..................................................... /�'' ........-----•.................................•-•------- to Construct O or Repair ( ) an Individual Sewage Disposal-System at No.... , - •. A ?" .... ... / vG- 1.------.....---•--•-•---------.. ---•-•. Street q as shown on the application for Disposal Works Construction Per ,NO....... .................................. r•..'• fQ Board of Health R , DATE...fl-............................ -•-•----•-•-------•---•---------------• r- FORM 1255 HOBS W WARREN, INC., PUBLISHERS , LOCATION SEWAGE PERMIT NO. /o T la.f �/vc110? Z f Al&- 7 '7 S 7, V I L L A G E coa�ir�Z iyav��vG On�vc INSTA LLER'S NAME i ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED e DAT E COMPLIANCE ISSUED � �� V �1 d �/ST/?iljUl7vN �. /3aX N zr A' LaT /Gg" ,¢/vC/fad L�Nt� ' fr kz Jr T �► d Llri's,ry3fsi I ;—)JNISH 6-VADF 6 ��rvcSH C+1PAP� >w�Nrt'►e �i?TAZ7G� - ..,~~�1 U R Ti4 To p Or r-d V H sf. ,1 ---- .. - GNtMNCrj, I Al 4 � .L'• � r 5........_-T...., ____-' ..j /� 4+n/E.tif A4ElflE]7 F/IL.L � -- i � (o eFG6 � _. � %. #}.-,(��. •_-. :..:_�. __. ,-__._: yam, c. r fLlr✓ 6 r' I i �� C�ul�Nh"e7 S`7ee✓� ..� �_ 1Q61 N l .'Gf t7 Cr O.VG • D (S 4 X , � O Q.. J ,.5EPT1 C TANK A N C s�,oQS E A i ° c o e l ' a Q c a ,No• of ,dFa�Roa1►*.�► : ''-t ., GAG. OCAO py LOT 106 w �� '! rt A IZ MA, r -5OVY 1 0 : Sa- G;.P► l E.a.�cH��c„ 10* �' coo arc. ` �* � •fit ,--�- 9twtr+c rit.st -T�Or ,, ya 7 r oAv- - •.w. at�ae►v 4y r P4uL Nt ujei-AV — 6M� h�4-c?l , f M-4✓ e4, /9 79 •9+�EaC. .dlTL:' �,,��,J/�,fit �! r +CA04E': 'i t�.�+1 .�• r.+v�.��: Z $7'P • �`,, e- Z J,4,0 relic/ ,mac��J ,'1ti, Pb U'efic 3-,e—r zaws 40K i 3 5� �� 1f � � • �' 4_, l�lr..,.,,'� •,.` tJa'Ft�`/+:..fir�_� �'� ��u,`,�_��f} � ,-�,'�' '' vr rF S?t •tf �4, ~Q'Uri�y )' J 1 a