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HomeMy WebLinkAbout0022 PAULA LANE - Health 22 PAULA LANE A= 019— 148 Cotuit r No. .� Fimn..THE COMMONWEALTH OF� SA;HU �S G77 FF'"'�1!�r'"'Ci //''11�L..... ii�-77 � -1 .......0 F.......... ... ... ........ .... _ g , . p\� App irnttnn for Bisposal Marks Tonstrurtion p a it Application is hereby made fora Permit to Construct ( o Repair ( ) an Individual Sewage Disposal, Sy tem ° Location.Addr s or Lot No. _a �ner Address W .f a ... `.......----•-. ......._ --------------------------------------------------- Installer' feet � . Address U Type of Building Size Lot..' 5 -.. q. Dwelling o. of Bedrooms................. ---------- ------------ Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixture . --------- -- Design Flow.............. ��.......... . gallons per person per day. Total daily flow.............. ...__:_..__gallons. WSeptic Tank Liquid capacitylgallons Length................ Width................ Diameter------- -------- Depth................ x Disposal Trench—No..................... Width... _. ota •........... _ Tota chi area.................... ft. Seepage Pit No....../........... Diameter/t2 _ eptl- o e ._.. .. al. ac ng area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) - f�C4ly Percolation Test Results Performed by--_------------------- ............................................. Date.---...-•---�............ aTest Pit No. 1.................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (� Test Pit No. 2..........:......minutes per inch Depth of Tes Pit.................... Depth to ground water........................ P4 •-------••-------------•----------------••......-•4a:�/ ODescription of Soil.............................................................. --------••-••••.....--------....-•••-•---•• -------------- 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 of Article XI of the State Sanitary Code— The undersign further . rees not to place the system in operation until a Certificate of Compliance has been issued by e b d f h Signe .-• . . ................ ...:.....: .. ......... ......•-- ................................ Date Application Approved BY ..... . ----� ...... • � ,Q/e D£te Application Disapproved for the following reasons------------------------------•-------••-------------------------------------------------•------••--••••--..---- ---------------------------------•--•-•---•••----------------•----•---•••-...................------•-•---......................................... Date Permit No-----------------------------------------•------- ------ Issued..... ..: Date 5 --�{----------•--•--.----- _-_ ._-.-._-- _..__-_--__-...-.................-_--_...---- --------- ------------------------------� No..S.Ygl.. FE$. THE COMMONWEALTH OF MASSACHUSETTS BOA R D O H I L H . .......... / Apliiiration for Digpmial Works C on/strur#ion Prrutit Application is hereby made for a Pernlit to Construct ( or Repair ( ) an Individual Sewage Disposal Sy tem01`t � .. �� .... d . ...... .... lr! ae!�. .. ' . Location-Addr s or Lot No. - ^ -••-••••.............•••••...........••... ---_.......... •.......... ner Address Installer Address Type of Build' Size S ...-.Sq. feet U Dwelling o. of Bedrooms.____ ... '.. _____Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ....._.. , No. of ersons_________________ Showers — a YP b -=-- - P -----'--- ( ) Cafeteria ( ) dOther fixture ----------------------•----•-•-•--------------------..._..---------------•----------------•---......................:................................. W Design Flow. ........... ...__ gallons per person per day. Total daily flow____.__........................ -gallons. WSeptic Tank T Liquid capacity ggallons Length................ Width__ ...... Diameter______ ._.:Depth................ x Disposal Trench No .................... •• -• .• __ � a�� .�rac n� area__. :_---s.q ft. Width.. � I ota o ch' area---- ' s ft. Seepage Pit No _:_ ._ __: Diameter _ epth o I e g q. Z Other Distribution box ( ) Dosing tank ( ) . :r j '-_ ,r e ' T_;fr. Percolation'Test Results Performed by _________________________________________ Date_...___._.:':........................... Test Pit No.. 1.... ..........minutes per inch . Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Tes Pit.................... Depth to ground water........................ a' .................................................. ....... .. ........................................... ODescription of Soil............................................................. ._..---•--•---•-••------•-- U W 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 Article XI of the State Sanitary,Code,,- The under ign furt ier ees not to place the system in operation until a Certificate of Compliance has been 14"-, b e b f he Signe •... ............... -- ----- . ••--• ................................ Date Application Approved:BY-- • --- . ..... . .. --- 1� Application Disapproved.for the following reasons:-------- may:. k r.•. •::R+(. a •......................................_______.______________..__.____...............__________..____.__..._.__._.________._.___.__.___._______.______._.______________.___ Date PermitNo......................................................... Issued....................................... ............... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF ZHEALT4-1 ............OF....... .. .. ::.. .... .. .., ......... _ ...a: THIS I T C TI hat . dividual Sewage Disposal System constructed ( ) or Repaired by.. Yr. ._ ._.. ...__. .... ...__ a+.. .. _._______. 4 has been instal ed in accordance with the provisions of Article' XI'of Tlila�te Sanitary CPC, : as des ib in the 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..................................................................................... k• THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALT �'` .......OF....... ....... ....................... No....S..` ........-• FEE.. , Din �t1 r tLixt rruti Permission 's ereby granted .. . ..----• ... to Cons ct ( ) air )'an I idual S a Di sai System [•. at No. tiG r...sd ... ._� -' •' -----....-- jr Street. as shown on the application for Disposal'_Norks Construction P t X Dated... z _ ....... r --- ._.. 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