HomeMy WebLinkAbout0016 ROSEWOOD LANE - Health 16 Rosewood Lane
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L &CAT10 a.— SEWA�E PERMIT /Nk,�
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VILLAGE
INSTAl L —A. ME & ADDRESS)
B B I'L D E R OR OWN ER
DATE PERMIT. ISSUED Ste -
DATE COMPLIANCE ISSUED
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No......... /._.... FE$......t. .. ...
THE COMMONWEALTH OF MASSACHUSETTS
`Y BOARD F HEALTH
............OF........ f��r. :Q` ,..f,/P--- --------------------
Appliratiun -fur Moposal Works Tomitrnrtinn rrnu
Application is hereb 'made for a Permit to Construct or Repair an Individual Sewage Disposal
PP Y �) P ( ) b P
System at:
0`'-----�......•-- f` ---------_--------_--
Loc ddress or Lot No:
------ ..... -- -----------------------------------------------------------------------------=
Owner Address
at. ----------•---
Installer Address
d Type of Building i Size Lot:. ._Sq. feet
awelli —No. of Bedrooms......:.....................................Expansion Attic ®)''"`: Garbage' Grinder V,6 )
____-____- No. of ersons____________________________:"Showers Cafeteria
p-, —Type of Building ----------------- persons �•S (,� ,),.. ( )
QOther fixtures ..................................................................................... ...................... --------------------------------------
W Design Flow................. .........................gallons per person per day. Total daily flow........' �... ............----gallons.
WSeptic Tank—Liquid capacitvlaallons Length________________ Width................ Diameter__.----......... Depth................
x Disposal Trench—No- ____________________ Width-------------------- Total Length___-_-__-_-_.---_--- Total leaching area--------------------sq. ft.
Seepage Pit No---------/-------- Diameter__X ._-_- Depth below inlet.................... Total leaching area-----------------_sq. ft.
z Other Distribution box (L} Dosing tank ( ) Q,6_ /0CJ)ft— y—S— "-1 7
�-' Percolation Test Results Performed by--------------------------------------------------------------------------- Date....................................
Test Pit No. I.........._-----minutes per inch Depth of "Pest Pit.................... Depth to ground water.._.______.---__.._...
fX4 Test Pit No. 2................minutes per inch Depth of 'Pest Pit.................... Depth to ground water__._„_- .__-_--__-. -
CY ......... p f�
x Description of Soil U °` !'s•.' - -U ce f' 2� �'�. i:.. -
----- y j cam'' .. r. . --�--- - --------------- ...
U ��
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 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 bby—the board of health .
Signe
Application Approved By.--••.. -------• ...� .--•---.. -- ------------------------
-----••-------•----•---- ------
��/ Date
Application Disapproved for the following reasons-------------------------✓----------------------------.--------------------------------------•----------------•--
....................................................... -••----------------•--------•--•----------------------•-•--•------------------...---•----•••------••--------------------------...---••--••------
Date
I
PermitNo......................................................... Issued........7.l--.... --F------•--•-•---•----•-•-••--
Date
No........................ Fas...... ,1� . .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
'J............OF .... P.
Applirdtiuri -fur Diipuuttl Works Cnuuitrurtiuu Vrrmit
Application is hereby 46ade for a Permit to Construct or Repair (. ) an Individual Sewage Disposal
System at:
i =
Loc n- 'ddress or Lot No.
I- G./- --- ¢ ------------------•-----...-------•-•---.....------.._..-------•--------•----•---••-•----•-••----
W Owner --. Address
t� r�f
................ --••- ! .............................-•--•---•---•--------- ---------------------------•-•---•-•--.......-----------.__....__._.._-•-----•--•----- •-•---
Installer Address
d Type of Building Size Lot_ __75P._Sq. feet
awelli —No. of Bedrooms--------------- ------------------------Expansion Attic �O) Garbage Grinder�D )
Q, Type of Building ____________________________ No. of persons............................ Showers ( );— Cafeteria ( )
a' Other fixtures -•---- ------------------------------------------
W Design Flow-----------------Jt _..__.__.____......gallons per person per day. Total daily flow._........... a..........-__.._......gallons.
WSeptic Tank—Liquid capacity/a allons Length________________ Width................ Diameter................ Depth.---_-_----.-.
x Disposal Trench—No. .................... Width.... ------------
: Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No........./........ Diameter_ -_- Depth below inlet_______ _________ Total leachin area..................sq. ft.
z Other Distribution box ( Dosing tank
Percolation Test Results Performed by--_----------_---- ----------------------------------------------------- Date---------------------------------------
`-1 'g,.� Test Pit No. l................mtnutes per Inch Depth of lest Pit.-.'----------------- Depth to around water------ -----------------
f� Test Pit No. 2......_.........minutes per inch Depth of Test Pit.................... Depth to ground water-_.-_._--_------___-_---
------------
1► r� -- -- . .................... f i 7 -
x Descri •op of. oil ..__ j" �. !'-' 4' - 4 •�L .
V ---------- ,- A'-- ------�--- .. �,w,. : --..... .... . � --------------------•-• •------- ---- --
W
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
U Nature of Repairs or Alterations Answer when applicable-------------._��.:.............:........:.:..............................._--_-.---------.--.
n.
`t,Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Artiri'e 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-
Signe ��" �� �� f _`2
i
�: -'..� I)/key
Application Approved By...... / .................. a_-- ••--•-_-•--- - ---------------- ----------------
Date
Application Disapproved for the following reasons_........_.......................................................................................................
Y
___________________ .....................
Date
ry
t
PermitNo. ------------------•---•----•-------_._.. Issued..-.--�----/- ------- .........................
Date
Jr".t sr` a j� THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA TH
'.'"/.:....::. O F.-.. .5'.......:✓�L"'..................................
Trrtif iratle of tompharur
THIS IS O CERTIFY, That he Individual Sewage Disposal System constructed � or Repaired ( )
b �-•.--- ��_ . c-------•---
by -----------
' Installer
lid s been installed in accordance with the provisions of A XI of The State Sanitary Code as described in the
_____....__ �_application for Disposal Works Construction Permit No. r�-�-------._.. dated----�-1 .3`.•..I 7-------------------•
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SY.:STEIVI WILL FUNCTION SATISFACTORY.
DATE Z •-/ 77............................................... Irspectoi !' -. t
E.. .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF. HEALTH
�! ......... .. ...O F..-.0/ ../`d? ................................... p-
No �? FEE ...............
DiXIV1315 _ '.Mu-r._ �c.Cut
urtu rrmit
yE Permission is hereby granted.__..
to Construct OX) `
or.R air ( ) a I•ndi i ual Sewa e Disposal Syft m F
g
at No._.. �� C � !' ! �.. . fpl�r. fl = err
Street
as shown on the application for Disposal Works Construction P it N _ Dated..... n?.............._
e g
DATE.......................------- il.... Board of Health?
FORM 1255 HOBBS'& WARREN. INC., PUBLISHERS -
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Name; Rans�crd ciaw3.
Jim Lockett I F,08 4756
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Name; Jim Lockett I cos�r�s Ians6475b
16 posewood LN 5h No
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