HomeMy WebLinkAbout0063 CONTENT LANE - Health (�3 .Cow-R.oac9
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Sever Permit No. .f
Name A`i1'� :a�✓� � � y�L�'/' � O'S�b O��
Location it z � n
Installer's Tiame and Address
176
Duilder°s name and Address _ k _j— /3
Date Permit Issued
Date Compliance Issued.
7
No..•.......1 /S' Fim.......... ................
THE COMMONWEALTH OF'MASSY%-CHUSETTS
BOARD OF HEALTH_
...Tow. /)..... --- .OF...........i9' ' .`�. .C6. ----------- --------
Appliraatioaa -for M_gpmal Works Cnowitrurtion Vrrufil
Application is hereby made for a Permit to Construct (K) or Repair ( ) an Individual Sewage Disposal
System at:
Q!q.N__U� T---------e . ki/4
-----------
on-
p Loti C�'
of Lot No.
.... �. �Al .f� (nA_(......A41..0�.......-•-•---- � /!Q �._5p� /+�T ,�6/�e� �
res
a N C1�/�V�'40 Y ®wnel [ •YXITf�N � d (Y �77_--•--- ------
r
Installer Address
Type of Building Size Lot...z z,c_4_0®_.Sq. feet
U Dwelling—No. of Bedrooms................_----------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons..-_____-_______-_-_-.-.._ Showers ( ) — Cafeteria ( )
a' Other fixtures ......................................................
W Design Flow........
5...........................gallons per person ter day. Total doily flow------330-._.._-____--_--.._----..gallons
WSeptic Tank—Liquid capacity-100gallons Length__'-_G_. Width. .'./.o._._ Diameter_-.__...__. Depth_?.-4.-.
x Disposal Trench—No_ __________________ WidtliF................... Total Length---------I .......1 Total leaching area-------------.------sq. ft.
Seepage Pit No..........I--------- Diameter.._ Depth below inlet--- ..... _.... Total leaching area .�_.sq. ft.
z Other Distribution box Dosing tank
Percolation Test Results Performed by._...W.. 14--.--lG/AQ,-4`Y�.................. Date_ _
a Z
Test Pit No. 1________________mmutes per inch Depth of Pest Pit.._�._�_____.. Depth to ground waterpJ&1!'�.:'��3 !� /
rs, Test Pit No. 2..._...2-....minutes per inch Depth of Test Pit--- Depth to ground water--� _.C......
Description of Soil -�'---�------- ®4 (��. f11 r �. j `�� /vet...
W
VNature of Repairs or Alterations—Answer when applicable..._.._.........................................................................................
------------------------------------------------------------------- ------------•------------------------------------------------------------------------ ----------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions ofji-i-f.Le_ Jof the StateEN�1l_��Code—The undersigned further agrees not to place the system in
—� �r
operation until a Certificate of Complianc—e has b i ued th and e
Signe .. -- -- ••• . •••... -• ----------------•-- ------------------------•-
D to
Application Approved By -• -- •-• -'-•- •"-- . • -- ' �V— -----
-
• Application Disapproved for the following reasons:------------------------------------------------------------------------------------------------------- __..__._
---•-----•--------------'---•-----------------------------•----------------'•'-----•--•------•-----------------•-•••----•--...-•-••••. •--------•'•-----------•--------•-'--•-•-•'--•'-------'----••-'-
C Date
PermitNo......................................................... Issued......r.... .....................= -- ....------
Date
Vd
THE COMMONWEALTH OF'MASSACHUSETTS
BOARD OF HEALTH_ r
L..o.�/l &).... - .OF........... je1V�-U-L�,,
Appliration -for Di_gpoii tl 10orkii Towi#rurtion Prrutil
Application is hereby made for a Permit to Construct ( () or Repair ( } an Individual Sewage Disposal
System at:
Loc ion_Address. o Lot No.
C)2.A4Alj A lJ Q rie�T� /f/f / , ) ress e_ '!
O
� Installer Address
�. Type of Building Size Lot_._.______.,r. /_9______Sq. feet
U Dwelling—No. of Bedrooms----------- _..............................Expansion Attic ( ) Garbage Grinder ( )
0.1 Other—Type of Building --------•------------------- No. of persons............................ Showers
( ) — Cafeteria ( )
a
w Desi n Flow________________...........................gallons per person er day. Total daily flow_____.33.0_____.________-__-____-gallons.
Other Mures _____
R; Septic Tank—Liquid capacity. + ��
1 � q 1 �o�0.gallons Length__ _`.__ Width-4.-�.0._.. Diameter_,___"''_'.___. Depth-----------
Disposal ' ..
Trench—No____________________ Widtli _ Total Length.................... Total leaching area____-_______--______sq. tt
Seepage Pit NO----------I......... Diameter__. Depth below inlet__. O. Total leaching area---Z�.7..sq- ft.
z Other Distribution box Dosing tank � n
Percolation Test Results Performed by..___W/-_:_-_Kn.._ _�C1.6!lf�__ __________________ Date__/`'l p-, 7.3,__�_�80
// '
Test Pit No. 1_______ ______minutes per inch Depth of Test Pit__-�_�..__._. Depth to ground water..1.0/!E'_'?-evy4 /��
fi Test Pit No. 2.........�-_...minutesper inch Depth of Test Pit... .5!t �.__. Depth to ground water-_Ad_r-_C-AjcourrfL'�c` ,
O „-------------I—---------------- - - --- - J/
� ------ ;;------------
Description of Soil____Q __ B._.____ '�-41 --- Gl....a IJ _: f2!__.-->---_- ----"---f_`� ----- C�/v`.�r_......
x -1� ���►-.0----------------------- -
c.,
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�j tjr�S of the State�EEn-sil r. Code—The undersigned further agrees not to place the system in
Ze
operation until a Certificate of Compliance has be i ued bff th rd e t
Signe __
/y - -
Date
Application Approved B -.. l '" u - --"
C
Date- G
Application Disapproved for the following reasons_________________________________________________________________________________________________________________
Date
PermitNo__.................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF EALTH
J11, 'kt✓✓�.......OF.................. .. ...:: ..-......:..-........-..--..
01rdifiratr of 01.11,Untpliattre
THISIS qTO CERTIFY, Tt thvidual Sewage Disposal System constructed (�r Repaired ( )
by........ --------------------------------------- --------------------------------•-------------------------------
... Inst Iler
has been installed in accordance with the provisions of :Artie XI of The State Sanitary Code as described j*n the
application for Disposal Works Construction Permit No.___,d-,O/ ..1 __� ._-.__.__. dated-... v_"_ _ - 0 _�...______..
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
f r t��---•-•-----•-------•--•___._.._ Inspector---_ ���_ 11 //�'{
DATE -._�..:1 ..... /
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF ALTH
No.........12-�.L...... FEE `S l�
Bin.Vinittl Morkii Tlon4rurtion rr of
Permission is hereby granted................. = , "` ' ' ---------------------------------------- ..............................
to Constru t,j or Repai ( an Individ. al Sewage Disposal System
at.No. ------------------------------------------------------
street
as shown on the application for Disposal Works Construction Permit Nq�--___'.:___;/----- Dated----1lt'_'_ __ _'_ .G
-••-•
----------------------------------
���� ,
J /7 /` �v Board of Health
DATE----•--------./_l:_...-�---------------------------------------------------<-
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
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WAITER c>\/J-N\E.
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o SMITH, JR.
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