HomeMy WebLinkAbout0020 RABBIT LANE - Health 20 Rabbit Lane
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LOCATION
pp SEWAGE PERMIT NO.
VILLAGE
I N S T A LLER'S NAME ADDRESS
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S U I L D E R OR OWNER
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C� 1.DATE PERMIT ISSUED
DATE COMPLIANCE` ISSUED
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THE COMMONWEALTH OF MASSACHUSETTS
2.u15 -212- BOARD OF HEALTH
.................
Appliratiou for Bigvii l 011
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Application is hereby made for a Permit to Construct ) or. Repair ( ) an Individual Sewage Disposal
System at:
.. .....- ................ ... .........................................
__... .----_- ..
ocation-A ress. �,yJ p��
............ . . . l.� G?� •.-.4�.•�/_••-•=- ... or Lot•No......----•---•-.-••---.._................
--._... _.. _........._
Owne _ Address
a ..... .............................. ... �..!..... —
Installer Address
UType of Building Size Lot_._/�.. (a. ._.__Sq. feet
0-4 Dwelling—No. of Bedrooms___________________ .....................Expansion Attic ( � Garbage Grinder x�l
Other—Type of Building i'02! No. of persons......... Showers —
a g ..._... ---- No. f P•- � (� Cafeteria ( )
d Other fixture ..._..... .n 'a`Q__ __ _
W Design Flow.............. .. ................:......gallons per person per day. Total daily flow____..._ ___....0.....................gallons.
WSeptic Tank—I_Iquld capacity:. gallons Length___.1 .._.. Width._..__._.__ Diameter________________ Depth__.
x Disposal Trench—No._._. G��Q..._ Width.................... Total Length.................... Total leaching area._a6_(b...sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( Dosin tank
`" Percolation Test Results Performed by �Depth
--- •.. ._......... Date••••-s/.rA....
a p ,f/ j_�_ Depth to ground water..__ ______
Test Pit No. 1_.��..._.__.minutes per inch Test Pit........ ,��1 _._
Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
............................................................ •••• _ .
0 Description of Soil---------Q -� ' .f: G _.._J. ..........................................................- - -
U �' -f�> sa L•.. ...........•------------•-•----------------------•-----•---•-•-- - ........_
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'1'1 U 5 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.
Signed � - �<`3,
77_-',� Datee
Application Approved BY • x
;j......._-_-• -••_ •_-••• -•------- ••-•
Application Disapproved for the following reasons:..........................................•_•_____•_____________________________________-__..___-•..__.._...._..
---------------------------------------------------------------------------------------------------------............._.......---•-------------------------..-••....------------•••-•...•••--••-......---
Date
Permit No........ _ 7. .c --------•-•------..._. Issued.............9 .................
Date
0 `J
NO................ ..... "° FEE............._...............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH �p
.......OF_............... /..? . .................
Allp iraation for Uiopuoaal Workii Ton,itrurtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: 7
................................................../..:1 .................................. ......._.....................------------... ...--------...---.=` .............--..
�•oration-Ad ress ......
" or Lot No.
........................ .....--••-.............-••-----.....•.
/7 OWn
..Address
7•
Installer Address
UType of Building Size Lot_._ C�__ ...�.....Sq. feet
., Dwelling—No. of Bedrooms__________ ___________________________Expansion Attic
Other—Type
(!✓�j� 1_/Garbage Grinder ;(/�)
p� of Buildin g ____.�/!��.______. No. of persons___..__..�_______________ Showers (,:;4 — Cafeteria ( )
a' Other fixtures ............ _......_
W Design Flow.............. ........................gallons per person per day. Total daily flow__----_. .______....____..._._gallon j
WSeptic Tank—Liquid capacity../. gallons Length.... Width...l5.---..--- Diameter................�_Depth......__...
x Disposal Trench—No._._./�% �_.. Width.................... Total Length.................... Total leaching area... R_.T.j. sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
z Other Distribution box (�'' Dosing-tank
Percolation Test Results Performed by4'`4" . c P_ T !,/-n _ ............. Date_______-ate 7��..___7�
'� minutes per inch Depth of Test Pit..._....gj- _ Depth to ground water-___-/--/---___....,� Test Pit No. 1..�:'.� •
l�
Gz, Test,Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 --- ........................................................ ------------------..:-----..............................................................
Description of Soil--------..1L.4 ...........-/ir>ta�,.:!....A --••----------------
v ...............•
•---•-•-•-•---•--••-•---------------------•-••--------•---••••---•-----------
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 TITLL 5 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.
Signed--- 1��...................................................e�� -I/ ", x, �/ �_....... ...
Application Approved Bte
te
7- �l Date
PP PP y---•---- — �I .:. f. �j
Application Disapproved for the following reasons:--••-.........................................................................................................
----•-----------•---------------•-----•-•---••-••---••-•----••--••-------•--•--•••-•-•••.....-------•-•--•--•----•------•-------•-----•-------------------••---....--------•---•-•••-•••--••-----•-•_-•.
Date
Permit No.......... ...................... Issued.......q j!! --e---. .......
Date
THE COMMONWEALTH OF MASSACHUSETTS
+J� BOARD OF HEALTH
....../en)_'I ...........OF.........../�r� :,. a /.r......................................
(9rrtifiraate of Tompliaanrr
THIS IS TO C TIFY, ]haj the Individual Sewage Disposal System constructed ( or Repaired ( )
- Installer
at --• ....... ._..--•--••--••-•--- - Y-7-----------------------------------
has been installed in accordance with the provisions of TITIF 5 of The State,Sanitary Code as described in the
application for Disposal Works Construction Permit No.._-461— 2.1.1.._........ dated........-1-''1..'0-3----•.------.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE....... ----•- ...... _........................................... Inspector...... F --- ----- ....
THE COMMONWEALTH OF- MASSACHUSETTS
BOARD OF HEALTH
. . ...............%�!�^ ........O F........ /h".ter aif t. .........................
No... ...� .t FEE......
Disposal Works Tomitnuttatt pamit
Permission is eby granted � = r ri ---------•----••-----•.........................•---........................
to Construct ( or Repair ( ) an Indi dual Sewage Disposal System
at No..- c; ---•� ...................••--.its. r,• _ .x-'---��...---•--------. •..............0
-
Street
as shown on the applicati n for Disposal Works Construction Permit No..................... Dated..........................................
Health
DATE..-
.' --••------•----•-•----•--------------------
✓ M. SULKIN, INC., BOSTON
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`' No. 366 .
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S�ONA4 EN
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EXISTING SPOT ELEVATION Ox0 '��� , ROBFRT CERTIFIED. PLOT PLAN
EXISTING CONTOUR --- () —.-- BRuC
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FINISHED SPOT ELEVATION
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FINISHED CONTOUR
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APPROVED # BOARD OF HEALTH "D 5� �
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DATE AGENT SCALE1 I �/� + DATES q A3 A3
LDREOGE ENG/NEER/NG CQ /N CLIINT d'4 514_ I CERTIFY'. THAT THE PROPOSED
EGISTERE REGISTERED J08 NO. � BUILDING SHOWN ON THIS PLAN ,
CIVIL LAND CONFORMS T4 THE ZONING 'LAW$
DR,IYl Mass
ENOIN ER 4 0F:.BARNS'TABL E 712 M AI N STREET CH, BY. £• _� 9 !3
H YA N N I S, MASS.. SHEET.1 OF 2- . OA E RED. LAND SURVEYOR
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