HomeMy WebLinkAbout0035 PRUDENCE LANE - Health 35 PRU®ENCE W. I' z
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LOCATION 35 Prudence Lane SEWAGE
VILLAGE ASSESSOR'S MAP & LOT N/A
Inspectors 508-775-3338
NAME PHONE NO. J.P.Macomber & Son Inc.
SEPTIC TANK CAPACITY 1-1000
LEACHING FACILITY:(type) 6 ' x 7 ' leach p i t `Y(size) 10 0 0
,s
NO. OF BEDROOMS N/A PRIVATE WELL OR PUBLIC WATER P.W
Inspected it,`,_
1/1-1/94
Report
DATE
®• Connor-
VARIANCE GRANTED: Yes No XXXXXXXXXXXXXXXXXXXX
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No.. .. ...1.-.1... Fmk....'?.....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH ,S_"�
......................OF........ ------.._...-------------------------------
Appliration -for Utspofittl Eorkfi Tonfitrurtion Vrrmit
Application is hereby made for a Permit to Construct (Y or Repair ( ) an Individual .Sewage Disposal
System at• .
---------------eot.:. -----
Location•Address or Lot No.
Owner . Address
a �_ t �D4c Jam' ........................ ....
Installer Address
U Type of Building Size Lot.. 1. ®®______-_-_-S feet
Dwelling t—/No. of Bedrooms._. _ r-e.�-_._______::______._.Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ---------------------------- No. of persons.___---_--:--______-_--_-- Showers ( ) — Cafeteria ( )
a Other fixtures ------------------------------ -
W Design Flow.. .......
®________________ .gallons per person per day. Total daily flow------------ ®....________.__._._..gallons.
WSeptic Tank Liquid capacity. gallons Length________________ Width_.____._-.._.-._ lliameter____..-._.-____. Depth..--------------
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No........ }QQ_Q..�q_1.. +4P!�..' Total leaching area._l Q sg�1,. _ft.
z Other Distribution box ( ) Dosing tank
' � 6 `
aPercolation Test Results Performed !�a_`S_AA,A_... Date._9.h."1._173----_r�__RUI. C
Test Pit No. 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water-----------Ms)_=.Y'Fk
Test Pit No. 2................minutes per inch Depth of Test,Pit_.__._.............. Depth,to ground water------------------------
----------- ........ --------•--••••-•••-----•••••-----------------------------•----•••••......................................................... t
O Description of Soil-----1---1-1. .'.. -----C_'1.)0.�'� `1 �.��_�... _� _.=_. 0.... � ....... - TM.
x
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 undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Sig ... �1 �-�.1. _l_ .
Date
Application Approved BY•- �(54' >�:' ' f . -... 1� �--
Application Disapproved for the following reasons:-----•-------------------•-•-•--------------..............------.......-•----................._...._..........--
........................................................................................................................................................--------.------------•-•-------------------------
Date
PermitNo......................................................... Issued....................... ........................
Date -,,,
J
No...._.. ..1... 1 -- Fu$.... ...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH -
TOW..Q_ ---- ------------OF........9. s- .s .: ..........................................
Apphra#ioo -for 43itipooai Eorkfi Tomitrur#ion Vami#
Application is hereby. made for a Permit to Construct (Vj or Repair ( ) an Individual; Sewage Disposal
System at, .. / C
Location.Address or Lot No.
�4?4�' G.r......Se`PLAL` ---•.................................
Owner Address
.._
Installer Address
d Type of Building Size Lot_-a_i.t_4_0.0.........Sq. feet
Dwelling 'ZNo. of Bedrooms....3�\rA_T-------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type' of Building ___________ _____________ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures------------------------------- -
W Design Flow........._`°S O_________________________gallons per person per day. Total daily flow...............2-QQ---------------....gallons.
WSeptic Tank—Liquid capacitvAf=0-gallons Length.................Width.-_--.._--__.. Diameter____....__"____- Depth-------.........
x Disposal Trench—No..................... Width-------------------- Total Length.................... Total leaching area....................sq• ft.
� Seepage Pit No.......!------------- � �N._�...__ Total leaching area_-s�.Z Other Distribution box ( ) Dosing tank ( )
o
a Percolation Test Results Performed ........ Date---
Test Pit No. 1----------------minutes per inch Depth of Test Pit..------------------ Depth to ground water.........1yVSJ_ '.r A,I
0-4
(Xq Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water_-._._.____-___.____.---
04 ---------•------ --------- ---------------•-•-------------•----•-------------------- -- ---------------------------------------------------------------
D Description of Soil---- 1 + ..... Z_�--- �-A-NA r
x
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 Article \I 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 board of health.
Signe� la - --------•------------------ -------- Date
Application Approved By- - - --------
Date
Application Disapproved for the following reasons:................................................................................................................
.................................••----------------------------••---------••-••---------------•--•---.-- •........_-------•---------"--•-.....__....----•------"----•---------------------------
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS ( 57
BOARD OF`2 HEALT1-1-•-/,Z._.
C�............................O F............... .. .... ... ...
Ter#if irate of�Tlim tionrr
S TO CE�_RTIF�-p 1iat the Individual-Sew ;,e Disposal System constructed ( ) or Repaired ( )
f �I Installer i
has been installed in accordance with the provisions of Article 'I of_ �ie/State Sanitary C�e,ds described .in the
application for Disposal Works Construction Permit No............ �.___-____;�..___-____ dated..... .-__f...................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE......................... .........----------------------------------------- Inspector------------------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
_ f --- BOARD OFdr�'HEALTH "
�J/J/f ff e�"L F/f OF ...�..... ....................................G! ... -
No. ---•• FEE -----w-
�i� >Q tt1i ork� boo #ru tio$ rrmi#
Permission ' h eby granted.___-____G"_-_rI___---_- r __
to Constru&-(,.fWi op/kepIair an Indiv'Aidu 1 Sewage Disposal,System
-- ; .. /
at No. c'
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-
as shown on the application for Disposal Works Construction_Permit-No-----Z_1-------/_ �Dated t_;. ---4_j_.F!t?. -----------
-----•---•-••(-----------------------------------------------------------------------------------------
-
Board of Health �../
DATE............................. -------------------------------------------------
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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