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HomeMy WebLinkAbout0050 EDLEN LANE - Health So edlen (j)., 40"I"s -1 11 � i / Asa LOCATION - - SEWAGE PERMIT NO. /-a% / JAJ i IVO .S/J<sl C ;PIT 7 7 d INSTA LLER'S NAME a ADDRESS a /;,"C"c r ;7' 6u/T e� /did get/i C, B U I'L D E R OR OWNER DATE PERMIT ISSUED . '77 D A T E CO-MPLIANCE ISSUED .- `� ,`1 d 0q a� itsA vim , No........................ Fim.............................. THE COMMONWEALTH OP MASSACHUSETTS BOARD OF HEAWLTH .........OF..... -- --------------------------------- ..........Appliration -for Bhipwial Varks Tomitrurtion Prrutit Application is hereby' t�d . r a Permit to Construct (&)"o`r Repair an Individual Sewage Disposal ,Aer System at: _Z —60 C " ,,, ) PA...................... ................ ------------------------------------------- qo� canon_4ddress Lot.No. .. . . ... . ... ...... �r.............................................. Owner Address ..................... . ..................................................... ................................................................................................. RlO Installer Address Type of Building Size Lot...IZF,122_6......Sq. feet Dwelling—No. of Bedrooms.........2...............................Expansion Attic Garbage Grinder (,be-) per, Other—Type of Building ---------------------------- No. of persons............................ Showers Cafeteria ---?--------------------------------------------- Other fixtures .------------------------------------------------------_--------------------- ------------_---- Design Flow........... ---_------_-----------gallons per person per day. Total daily flow...... --------------------gallons. Septic Tank—Liquid capacity/00?gallons Length................ Width...._........... Diameter_......._.—... Depth---------------- Disposal Trench—No- -------------------- Widtl Total Length-._--__--_-_____.-_ Total leaching area............ -.sq. ft. I --------------- -- - ------ Seepage Pit Nq1,&W6A*1.. Diamete below inlet-----------........ Total leachiiigarea__�A s(l. it. Other Distribution box Dosing tank 77 Percolation Test Results Performed by . . ................................................... Date--- ----------- Test Pit No. 1----------------minutes per inch Depth of Test Pit-.-.___--_-_--__---. Depth to ground water...--_.--_--.---.-----. (� Test Pit No. 2................minutes per inch Depth of Test Pit.--_-_----_----_____ Depth to ground water--.-. --_----------.--. --------------- ------- .......... --- .... --_---------2---------------------- 0 1 .Description of Soil--------- --- --- ------ - ---- - -------------- ------ Z - .................................0------------------------------------------------ - -------------- .........�._ ------------------I------------- ---------------------------------------------------------------------------------------------------------------- ....................... ------------------------------ U Nature of Repairs or Alterations—Answer when applicable.................. -------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- .................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System ii-f-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. SVigne -1,4� 'g� W//np �� 'Z/� ---—----------- 7-- ...... Date.............. .... Application Approved By------- -;; ! . ...... Date Application Disapproved for the following reasons:--------------------------------------------------------------------- ........................................... ............................................................................................................................................................................ --------------------------- Date Permit No. Issued. ........................ Date ---------------------------------------------- No.__ _. d FE$.......�.................... v THE COMMONWEALTH OF MASSACHUSETTS w ' BOARD OF HEALTH - vt.�. t i Applirtttioo -for Di,gVoiitt1 Works Totuarortion Vrruift Application 4§ hereby made for a Permit to Construct (4640or Repair ( ) an Individual Sewage Disposal System at: r cation• dress Al or Lot No. Owner Address a .................. t... . Installer-••------------•--•---------------------- ----------------------------------------- Addreess--- 's--- � Q Type of Building Size Lot...14Po_90_____Sq. feet U Dwelling—No. of Bedrooms-------: :-=----------------------------Expansion Attic ( ) Garbage Grinder (140 aOther—Type of Building ____________________________ No. of persons.....:...................... Showers ( ) — Cafeteria ( ) dOther fixtures ' ----- ------------------------•.•-••-- ---- _------------------------ w Design Blow..___ .__ gallons per person per day. Total daily flow__ __________________gallon. WSeptic Tank—Liquid capacity 00gallons Length---------------- Width_.......-.-._._ Diameter--------------- _:_ Depth................ x Disposal Trench—No. .................... W tdtl _. Total Length_________-______-._. Total leaching area.__._ ..__-__sq. ft. Seepage Pit Nq __ Diameter__ - below inlet........ .......... Total leaching area.- sq. ft. Z Other Distribution box ( ). Dosing tank 77 '-' Percolation Test Results Performed by.___. l- - . ..................................................• Date___f�«►/:------------------------ Test - a� a; Pit No. 1----------------minutes per inch Depth of Test Pit...__-_______.______ Depth to ground water....-.__-.___.____---_ (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water._.__.__._______.___.--- - -- - r O Description of Soil x1.;� ----- � ° ^>P _f:_ w �-"----� •---------- ------------------------------- ----------------- ------• ------------ UNature of Repairs or Alterations- Answer when applicable...-------_------------------------_--------------------------------............................. ---== ----------------- •-----r=:-----^-- -'.------=--•------ ------`------------------------•----•-----..------ 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.' ne ale t Application Approved B _:- -=---- -- �.� ..............�e �-�----- PP PP Y � l Application Disapproved for the followzn reasons..'._-.-..'.-__.. . ......:.......-•-• _-•-- -----_---_-.•--_---------------------•--•-..------Dace ------ .. r --' - '-----=---------•--•-•- ------------- - t Y Date PermitNo------------------ ------ -----............:_. Issued.- .......-•---••-- -- -----•................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF, ,HEALTHF. r / ........ of Ir Qwrf rttt of f� nt littorr THIS ISR C TIFY, That the Individual Sewage Disposal System constructed / or Repaired ( ) by---•••--•- --.. ....`� , Installer !r ..... . at.... --�-- ---- —= ---- r .� , 'e' /„ " � '' has been installed in accordance.with the provisions of Ar is I of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.. ..... _ .............. dated:_.__j_: _•'�_ .W_ ........ k� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE - ...... --... Inspector----•-------------•--••-•----•--------•--•-•-•.:•-•-------•---------••---•-•--•----- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r ? .F..:(:2. "��'�. O F.. -. ,#t�!i'!',f ............... ............ .. i No......................... FEE.-- �i ortt atrrotit Permission is hereby granted < ---------•-----------------------------------------------••------------•-•------ .---------_----- to Const uct O'"or Repair ) an In vidua] Sewage DisDpsal System al ....... Street as shown on the application for Disposal Works Construction Pepajt No________________ Dated___1 :'�._ 't" _ +--------------------- 't DATE_ v ` ............................ Board of Health FORM 1255 HOBBS & WARREN. 11YIE. PUBLISHERS S" �` �`f Law a 11 b �C 3 = 33 U G.P•b. A -lG 7-41,"K. _ SSCII 1570 7o T 4-95 6.P.D. U ice' t OOb 'GAL- . le Nee . `'F�cl�L�PlT List✓ (moo GAL-. Lll r "' P �tT WaLL AZG--A. = (So lr� S� �c 2.S 3 75 G.P.L . � �•� /� SID To-r,&L "7-)G- ,16KJ = 4215 'T-oT&L IDAl L2,( C 2GDL&.TI0Q t>l&Tl✓ o2 1] Pr b. 99 p Tot' T"N t, = o o.o �� - 77 _ �Pp� c. jv $O A .SO I L 4'Pp& a! 1 W. 64L. 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