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HomeMy WebLinkAbout0077 CONTENT LANE - Health � 7 Nnf"+ zaAei(!04wf aqo- oqI L0 CAT HOW S t Yi A 0 E PERMIT NQ. VILLAGE 00 ! MST ALLER'S NAME & ADDRESS UILDIR ON OWNER A) eel 0ATL PERMIT ISSUED PAT E C OMPLI A N G E ISSUED J AC, �1 3� No._...... $... ... _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH • P.WQ...................OF.......1 / I 1 I. :...... Appliration for 11ispo-aal Works Tonstrur#iun Prrmi# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ... 0 I..I.. .._ Lc�'i•.v �________________ ________________________•-L..•.T----.7� ••.....-..•_-__•-_----_---_......•...___ Location•Add res - - or.. Lot No. ...... S�l.�_...... t t A ................................. - -•••-....-----•-•--•----•. .........-••••-•----••••••••-••..................... Owner Address a ��w ...,�,� .... . - ---------------•-•-------------------•• .......______.....___•--•-__......________....._______-_..........._......_....-__--_............. Installer Address Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) p' Other fixtures .-----•.............•---•--•••-• w Design Flow............. `7.......................gallons per person per day. Total daily flow_.._...33...._.........................gallons. WSeptic Tank—Liquid capacity............gallons Length..... --...... Width....__ _..... Diameter................ Depth...`C._...... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area_5'4.I$....:sty. ft. 3 Seepage Pit No......1.............. Diameter.....1R........... Depth below inlet......(Ct........... Total leaching area..................sq. ft. Z Other Distribution box (idj Dosing tank ( ) Percolation Test Results Performed by...................... .................•---- ........................ Date........................................ Test Pit No. 1..L ..._.minutes per inch Depth of Test Pit....�'?_._......._ Depth to ground water...Y1.0.1lf......... f= Test Pit No. 2..GZ_....minutes per inch Depth of Test Pit....1. ............ Depth to ground water....n.pk:lje_...._.._ x O Description of Soil........... ................... W U -•.....................•---------___-__-_-_-----•--- --------- _...... .------------------------------ .----------------------------------------------- ------•--------••--•-----••• ------- �l ....------•••-•-••-•---••••-••-•-•--•--•---•-••------------•--•--•-•-----•---•----•---••--•••---••--•••----•-•••---••-•-•••••••----•-••---•••.....................•------••--•-......•-•-•---•-•---•-••. 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 iI'U 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 b the oard of health. Signed..-_LA!- .......--r----0Lf_60-...... � Iq Ka Application Approved By.." `?!- ..... ---•-•--•••----•- ........................................ Date Application Disapproved for the following reasons----------------•-•......----------------•---•-•-•........_..---------------------------•--••-•--........•••---•- ........................................................................• •------.......----•------•._.....--•-----•---..................---•-.......--•-•----•---••--•-•---•--• ..._____.____ Date Permit No....... S..... ............................... Issued........................................................ Date • «•,� 14 LL No._............._.... ...... THE COMMONWEALTH OF MASSACHUSETTS P - BOARD OF HEALTH ...................OF....... Applun#ion for Bispaoal Works Tonstrnrtion Vamit Application-is,:hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address^ or Lot No. w Owner / L Address •-- tS�I_.---.. -!"/........................•-•-.------... . ........... Installer Address Type of Building { / Size Lot...........................Sq. feet Dwelling—No. of Bedrooms............ ............. .....:. Expansion Attic ( ) Garbage Grinder ( ) aP4 Other—Type T e of Building No. • 1 `> YP g --------�----•-•--••---..... of persons............................ Showers ( ) — Cafeteria ( ) QOther fixtures .•-•---"------•-'---------"•-----"--•..................••"--...-••--•......-"-••••••••• -••"-••... --......-..----......__•----_-••---- -""•" W Design Flow............. .......................gallons per person per day. Total daily flow......_ 3�'.Q.............._.,__._..._gallons. WSeptic Tank—Liquid'capacity............gallons Length__.._?_`.____ Width......4�_.... Diameter._._.. ......_. Depth___.4`_.....-- x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area_�.`�.�1:g....msq. f. Spa 3 Seepage Pit No....... .;......._.. Diameter....ln........... Depth below inlet......e.`......... Total leaching-area..................sq. ft. Z Other Distribution box (t/) Dosing tank ( ) Perc a .n Test Results Performed bY------------------"---"-"--"-"---._...--"•--•"-";•--......-•"-"--•"-"-_._. Date•-•"--. "•-'"--•-._.........._"•----••• � Test Pit No. 125: ......minutes per inch Depth of Test Pit....3........... Depth to ground water...f)AnP......... fs Test Pit No. 2. zc__.._minutes per inch. Depth of Test Pit__-J.3�........._ Depth to ground water.-.Y1oE! ._.__... x _ ......................................................... ODescription of Soil............ lC.......-•-� Ala(...__.."--•"-"-••"--"-•--•-"-•-'"••--""----•"•----•---••••••••-•......_-"--••---••----••.................................. -' -- ._- ----- . --------------------------•-- - -- ------------------ -----------•-------------------------------------•--------- ---------___-_._-••--------___...... 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 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 bv the board of health. Signed- .. G � _.-- ;a� .....__-- _...._._ .__.J_._._ ......•�,� — Application Approved te BY f t; '= ................ ........................................ Date Application Disapproved for .the following reasons:__...."........................:....""•-•---•----•••-"------•-"--------'•--••"-"----....._......._•••---........ --•--•...............................•---•-•----•--••-----------•"---•----...-•""--------.....-•------"----•-"---•-•"---•------"--"-------...---"------------•"-----.....-----"••---....-•-•..__.__..•-- ` Date PermitNo..."• Q ............................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................:...........OF........... .... ............................................................. Tertifiratr of Tontplianrr THIS' S TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by_ ..t .ra...........................--•""-.....••"- •••....---"•---•-••-"-• ...... .........•--...__....---- •------------ 1.. I ! •: l — Installer at_ r ' ------------------------------------------------------------------------------------------ has been installed in accordance with the provisions of TITL 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit ........ dated _--,_ 4........................... 1 I�, ' THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE. . f 1 :�.: Inspector..f �� _._--•-----------••---__...... ............................. �_; • r � r e .__..____---,._- THE COMMONWEALTH.;OF MASSACHUSETTS BOARD OF HEALTH No+ �+... :... .FM..! .........OF...... 1,., t ,o.V � !!. ....................... I. ................ 1411posal oL o nrtion Permission > hereby granted__.____._.' _ fit_ to 'Construct ( or Repair ( ) an Irx ividu Sewage Disposal System at No...... . D ------ fir' ,d�►✓F �^/ r Y� C'._.Ct -- .. ..... ................. ........................ street as shown on the application-for Disposal Works Construction Permit D'ated.._l� -. _._.... � �• q - Bu.n of flualfh - - DATE.. / ----•----------- -•-••- P _ r.rY��r�����.«.�.w�_+f.._...._..-...�«..•..+-....+s.••...._....._ ........_.._...„«.........«_r....�-..Y.o.w....,...+....�..,.,...x..Dirt....,,•.a.....w«.,...».w-...,..,........».,:«.._..........--....�.»....-................._...........«..+w_.,....._..,_...._.._�.._......«......».....«......_..�...r..._s..>......u.r.rr.:.rrw..._�.s..s..—....«.,_......,+.............•.«.. r� _ . 111 , 14 ---- -- } ---- -- ----- --- ---- ---- -- --------_ _---- _ _... ---_ ---- -- r - - - - - -- -- - ----- ---- - - _---- - - _ i � 1 �OTL I EyCTE-AJD RL. L f� PPL/GF-1 BL E i e X15 I r0Ur7 d fD r—o i O Al . E �? T, " /")AIVf-1OL COVE2S TO G'J/T/-l/A-/ —o -- o._--o--o — Proposed gr•ovnd crof� le !2` OF F=iw�s/--1 � T.� G �HL>E 6 y S C HE D. 40 PVC. 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