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Home My WebLink About0051 QUEEN ANNE LANE - Health �� ,� � i i LO• CATION S WAGE PECIMIT 130• VILLAGE INSTA LL R'S M A M m ADDUESS i e IC , I3UILDEQ 0R GATE PERMIT ISSUED ?A�J DATE C0tiPLIANCE ISSUED �� • �� I ec� �4,.- 1�G3� �p� i15` 's ise�e��l ��if�� Q �� .��,� � �� a ,�3r � u' � c9\ �,\ � � . /OVA�A� ��P 10 APPF:0VAL O� VECT �- ARd�STAEI.E .. MMISSI®N THE COMMON ALTH OF MASSACHUSETTS BOAR® OF HEALTH ....T ...............oF....`.LJR.ZQ. 1 ........................... Applira#ion for Disposal Works Tonstrurtion nuti# Application is hereby made for a Permit to Construct (' ) or Repair ( ) an Individual Sewage Disposal System at: ....LOT..1.1s� .. ,.. . ............ _Crl.o:�----------------. .--.....---------------.....................------. Loca' Address (� Lot No. ...k .................................. ---. zs C&er --------•--•--------••---•----•.Address Installer Address Type of Building Size Lot... ,_ d _`Sq. felt U Dwelling—No. of Bedrooms___---_--5...............................Expansion Attic ( ) Garbage Grinder (% ) Other—Type of Building ............................ No. of persons.....__................ Showers (�) — Cafeteria ( ) a' Other fixtures - -----------------------------------------------------W Design Flow.........1.1_0..........................gallons per person per day. Total daily flow....3.16Q..............._............gallons. 1:4 Septic Tank—Liquid capactty1,59D.gallons Length__1.b........ Width.__ ........ Diameter-----a....._. Depth...8......... Disposal Trench—No. .................... Width.�._............... Total Length.................... Total leaching area..............------sq. ft. Seepage Pit No.: ---------------- Diameter................... Depth below inlet.................... Total leaching area.... .....sq. ft. Z Other Distribution box ( ) Dosin ank '-' Percolation Test Resu. Performed b 4vt4t .----. Date.....7' ............ ,a Test Pit No. 1________________minutes per inch Depth of Test Pit...I? ........... Depth to ground water.___�� Test Pit No. 2.....L......minutes per inch Depth of Test Pit....1 .......... Depth to ground water........................ O -------------------- ----- Description of Soil........ct.t cwl ___... V •-•----•--•-••---•. •--- .. _ - W ••--------------------------•------------•-----••••----------------••--•------------•----••----------------------------------------•-•-•-----•------•-••------•------•---•---•......----••......----•-•. UNature of Repairs or Alterations—Answer when applicable................................................................................................ " ----------------------------•------•------------------------------------------------..........-.....---•----•-•---------------------•-------•--------------------------•---•-••---------................ Agreement: The undersigned agrees to install the aforedescribed Ind ividua age Disposal System in accordance with the provisions of iITLL 5 of the State Sanitary Cod — The unde' igned f -her grees not to place the system in operation until a Certificated Compliance has been iss ed by rd of he .. I) Signed---•-• --•- Date Application Approved By........... ... % -.• 1l L ate Application Disapproved for the following reasons:_..----•------------------------------------•----------•--------...--------------------------------•--•--------- .................................•----•-----•----------------...-----------------•----•-•--•--------...--•-•---•••---.....•-----••-•--.........•-••---------•--•---------------••----•--............... Date PermitNo.......................................................... Issued...................Date- te............................... t , THE COMMONWEALTH OF MASSACHUSETTS } BOARD OF HEALTH ..................oF.... �?(�.hl`s....1 .,---------.................------ Applirtttion for Diiipagal Workii C mitrurtion rantit .Application is hereby made for a Permit to Construct ( / or Repair ( ) an Individual Sewage Disposal System at: Locah1Q'n-Address _ _ or\Lot No. i,,.,,•t y-.-! 6 �; v.,,i ��. I� C~ O. c�7'-`•c C-� .-..� ....... ....... ....:........L:.:.Y::..:._.._.........-_ ....---•...----.____________.__... .__.___ .. J_............................ ivner Address 1 a •---•-•--------- •-•-••--- ;A Installer f Address - .! d Type of Building �4 Size Lot.__ r_,.............. �n `• Sq. feet U .,.•. I �. Dwelling—No. of Bedrooms........,v?.__.............................Expansion_Attic ( ) Garbage Grinder (k! ) aOther—Type of Building ____________________________ No. of persons.......:............... Showers ("' — Cafeteria ( ) Q' Other fixtures ---------------------•----.....•.. ---------------------------------------------------------- =; Design Flow............................................gallons per person per day. Total daily flow......................................._....gallons. f� Septic Tank—Liquid capacity_�OD_gallons Length._1_Ul........ Width...5-___-_--- Diameter________________ Depth................ W Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No.:.------------------Diameter------I.__._....._. Depth below inlet.................... Total leaching area---- -5.....sq. ft. Other Distribution box ( ) Dosing--tank ( _) ^ Z Percolation Test Resin Performed b °.c f.___ :_�_ t`' Y , - �7 t Date -/-� $7.....----•-. Test Pit No. I________________minutes per inch Depth 1_2 'of Test Pit.__ Gam__-_____-- Depth to ground water---- - 1e) (z Test Pit No. 2.....`L......minutes per inch Depth of Test Pit----l7. ....... Depth to ground water........................ ------------------ ----------- - ----- O Description of Soil_..---- 4-:�-- -------------------------------- - - - - - - - w ..................... - -----.. .-�-- ----------------------------- --------------------------------------------------------------=-------- ----------------------- ------------ -------------------------------------------------------------------------------- ------------------------------------------------------------•••-••••-••......... UNature of Repairs or Alterations—Answer when applicable............................................................................................... ----------- ----------------------------------------•-------------•--------------------------•-----------------------------------------------------------------------------------------•---•-----.----- Agreement: The undersigned. agrees to install the aforedescribed Individua age Disposal System in accordance with the provisions of iITLS 5 of the State Sanitary Cod The unde igned f her green not to place the system in operation until a Certificate of Compliance has been iss ed by rd of he 1 Signed..--•- -• - -- -- -------- - ---• ---- 7 Z� ��.. jp -- .-.D Application Approved By............................ . ..' Date Application Disapproved for the following reasons:............................................. ---------•----•---•-•••------------•......••-•-•-•-------•-•-••-- --------•-•-•-•--••--•-•••---------------••••--------•-•----••••-•••-------•-••••••-•-•••-•---•--••••---.................................--------------------------------------------- .............. Date Permit No....................................................... Issued-..................................................... - Date THE COMMONWEALTH OF MASSACHUSETTS ' BOARD OF HEALTH ..........................................OF..................................................................................... T-5rrtifirtttr of Tontplittnrr THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repairedby P ( ) ...................... ..... .•---------•-----•----•------•---•-••--•••-•-•-•-----------------------••-------•-•••----......-- at--•-----•----------•---•--------•-•---•-----•---•-••--••----•••------•----•--•---------•--•-•----•-•-------------••--••-•-----------••....----•----•-•--------•--•--••••----•-......--••-••-------- has been installed in accordance with the provisions of TWPiE yir i The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated....................t........................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. lL�e �� DATE..................................................=-.......................-..... Inspecto - ------ ---f-'�•-Z--•---Y-�' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a�?..elsS ..........................................OF...................................................................................... SS .�- No......................... FEEly for �ono�r>ltr#ion �rrmit __ i Permis_ sio er�yPgranted----•------� __. to Constr `r e ai n I al Sew ,Dispo sty atNo..........................................................................................--._ --I/••=---•---••• Street as shown on the application for Disposal Works Construc iea Permit N J...._.. Dated......................................... ---�-� ... .. c� Board of He DATE......................... - ..j1__ - ............... FORM 1255 HOBBS & WARREN. INC.. 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