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HomeMy WebLinkAbout0044 NEWPORT LANE - Health (,C)co lo ci 24 E P RT ANE OS E L A=166--__027 �i 5 M EAD KEEPING YOU ORGANIZED No. 12134 2-153LGN SUSTAINABLE MIN.RECYCLED FORESTRY tP9TLATIVE CONTENT 10°h ZTX cartm9d fiber Sourcing POST-CONSUMER yr n t,sfigrogram.org snal go MADE IN USA GET ORGANIZED AT SMIRAD.COM ACJ 7V 16 adz 1 c�-(e5-"' v4o' LOCATION MG E PERMIT NO. T FILL A C L L�, I N S T A LLER'S NAME SOD .1ESS 9 U i L 0 E R 0 OWN[ OA;TE COM PL6 .1NCE ISSUED �` " �":.' ' l`fit 3�$Lip � �®�� t ;a a,. �• ;.r } R-�' t �I�I .. J,� , �, `� r No. ....... � FEs... � THE COMMONWEALTH OF MASSACHUSETTS B®�eR® E HEALTH . .....0 F... ----_--••-•-•--------- Appliraiiou for Uhipao al Works Tonotrurtiurt ranfit Application i hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal S st at: ....... . .•• • ..... ............. ............................ jiaw. -�- -- ca ion mr o ^•� ............................................... Ow res Installer Address g �,1/"�-----Sq. feet Type of Building Size Lot. Dwelling—No. of Bedrooms.....___..`,,...........................Expansion Attic Garbage Grinder (UQJ Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Oth r fj ctures --------------- --------------- . W Design Flow........ ................................gallons per person per day. Total daily flow-----J.jZ._.......................gallons. W Septic Tank—Liquid capacity............gallons Length.......... .... Width-----........... Diameter---_............ Depth................ x 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 ( ) Dosing t (0-4 Percolation Test Results Performed by... .. .__ Date/1-1 F'5 aTest Pit No. I................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........................ Ra' ............•• ------------------------- ----- •--••--•------. .................................................................................. _ O Description of Soil....6= -....._.. / _ ) - fi 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 TIT11 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation ti1�a,VCeificate of Compliance has been issued by the board of health. _ ned----------- -• -- ......�/----•- ---- to p 'cation Approved BY ....................................................... o— � Date Application Disapproved for the following reasons:..............................................................................------------------------•-••---- .............•---•-•••••--•-•---•----•-•-•••-•••-•-•...••-----..........••••••••------••••-•-•--••-••--...............•-•-••---•--------•-•-•-•••-•--•----------------•-•••-------... ----..._..•-•- Date PermitNo.......................................................- Issued....----------------------------•--•--................ Date No. --'� COS Fss.. .. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...................... , ppliratiun for Disposal Works Toustrur#iun ranfit s�r x 'Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual''Sewage Disposal System at ` f ....> ._........:. •-- .,met /:` 'r.!�� e�.,,_,� - 1 .. ! ! � .......................... �Focation= ddress r 1 or IBotiNo. Ow I Address• ' '1 ... .. a ..:✓ e%!I✓mod.. _ (l /i i ✓f 02 -• Installer Address Type of Building Size Lot__/7.//1"1_ ____Sq. feet Dwelling—No. of Bedrooms____._____,___________________________Expansion Attic s Garbage Grinder (/l� a44 Other—T e of Building No. of ersons____________________________ Showers YP g --------•-----------•------- P ( ) — Cafeteria ( ) Othgg7r fixtures ......................... -•--•- - W Design Flow______ .�__ ..............................gallons per person per day. Total daily flow.........)._,3 .......................gallons. WSeptic Tank—Liquid'capacity____.__.____gallons Length................ Width................ Diameter................ Depth................ xDisposal 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 ( ) Dosing tan ( ) '—' Percolation Test Results Performed by.____. s!.' _.. __ ,_:5 .............. Date / �.= W Test Pit No. 1..........._....minutes per inch Depth of Test Pit............. 'Deptth to ground water........................ (T4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ _ - ---••••••• .........................................................................................................•. Description of Soil. __....._ a_. A. U W VNature of Repairs or Alterations-Answer when applicable............................................................................................... -•------------------------•-•---•---•-------------•-----•--------------•-------------•--•-••-----------._:_.....------------•----------::---------------------•----•--•-------•--•..._..------...----•• Agreement: The undersigned agrees, to ms'all the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation ntil�,Cer'ificate of Compliance has been issued by the board of health. V. r.;,. nej�.-:Pplication Approved By.__ a . !`r --% ��� `D ---•-•--------------------- Date Application Disapproved for the following reasons---------------------•--•---••---------------•---•--••••-•••--_....-••-•-•--••••----•--..._...-•-•-------•---•--- ---•---•--•.............•----..._.....:_..._..__...-•=•--••----•-•-••-•-•-----•-•--------._._...••-----...__..••••-----•----••-------•-•••---••••--•-................................................... Date PermitNo......................................................... Issued-----................................................ Date THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH . ........ .......OF..... ........................ C9rdifiratr of Tuntphnnrr THI,S IS TO CERTIFY That the Individual Sewage Disposal System constructed ( "'7 or Repaired by..... ( ) '.r��,t ...� _._.__.. ._.._._..--••--•-._.._.----••. •------------------------------•-----.....--•------ ---------•---.._....•---•.....---- ..�'` Install has been. :k installed in accordance with the provisions off TITLE 5 of The State Sanitary Code as described in the application'for Disposal Works Construction Permit No.. i"` ._e?$�"`........... dated................................................ ' THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WI L F.U. CTION SATISFACTORY. DATE...-•--- ?;�_ :.�? t . �_ Inspector.. ....* ---- ----- ------ ................................ i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 5 � A ........ C i..I ..........OF...r `i1/tt.. ?. l No `r ., - ...._ FEE ............ MoVII n1 Works Tunstrtt.rtiun ramit Permissionis hereby granted.............................................................................................................................................. to Construcl _ orb Repair ( ) an Individual Sewage Disposal System at No....- •4 ���1­ �'�, � Street as shown on the application for Disposal Works Construction P rmit No .'Zm ated O ............. e — - .. a- ....................................................._ 2 - Board of Health DATE..........J..-•-C -------------••--••---._...--- FORM 1255 A. M. SULKIN, INC., BOSTON pES/G/l/ OA17-4 S/1145L E F.4/y/L Y 3 46Eo.2aoAl `g A/o CAeeBAGE OA/LY FLOW - //,0 X 3 = 330 G.P.O. �f / O/S�S,4L f'�r.-•USE /,01�0 6'1.1�. . � 7. 54 dLL ,4,eE4 �� /moo s,�: X Z•S = 3�j-G.�o. 1\ � ��, �� �.. yoT4.0 UE.s'/bit/ -- �}Z.S G P o. � cur Q^J l OES/G�t/ �.E,P-COL•QT/o�V.P..4r�'.'. �1 � i, �y '....��_-..� �\ I - �C/,!.`.'' �f : �; 1� � ...� ,ref ,(:ri,'.(',f���\� i:, � � �� � '�t'•:��..� � �Q� �1. 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