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HomeMy WebLinkAbout0026 OAK LANE - Health dt� Oak Lie uzP l 933 MAIIoT BEET #� O le alle ce A = 11.7 — _ i i P I Ad UPC 12134 No.210 53LGN '�srcc HAGTIN08,MN LOCATION SEWAGE PERMIT NO. VILLAGE e INSTALLER'S NAME i ADDRESS 8 U 1 L D E R OR OWNER DATE PERMIT ISSUED 7 S-S- DAT E COMPLIANCE ISSUED .�r 10` �gi �r i p° 9A9K F,1,r,:. EI_TFi DEFT. Town Office bh: �J. No. ......... South .5 ,1, ,1lh4k 02.664 Fang ............ THE COMMONWEALTH OF MASSACHUSETTS. BOARD OF HEALTH [`...... OF........................... vw . Appliratiott for lliopooal Works Tonstrudivit Prrutit Application is hereby made for a Permit to Construct.( ) or Repair ( ) an Individual Sewage Disposal System at: .......... .....p..Aa. ... .�, ,r-e:................ ............................... cam•-- ._.... -................... .. Location-Address ' or Lot No. L.. ........... :ft- _.... ,y__ n ................................ .................. .5.3 -...................................._. /) owner �ress w -------� ....... . Fy u�a: .►- .... s--N. "•-=� : ......A:4`®:.......... a ....-- Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.............................................Expansion Attic ( ). Garbage Grinder,( ) `PLILI Other—T e of Buildin .... No, of persons............................ Showers ( ) — Cafeteria04 ( ) d • Other fixtures ..............................................................----••-•...................................................... W Design Flow.......:.��' ..:................gallons per person per day. Total daily flow....:..?. ................gallons. R: Septic Tank—Liquid'capacity........_._.gallons Length................ Width..`......_...... Diameter................ Depth................ 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 tank ( ) 0-4 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........................ a' •--•----•------------------------------------------•-----..........---•--.....--•--•------------•---......................................................... Descriptionof Soil...............................•--.......•............----------•-......---------........................................................................................ W ......-•••----------------------••-- ------. ----•--•--------------------- ----_.......-----.....-----------------------------------------------------------------------------.......,------ ........._...................... UNature,of Repairs or Alterations—Answer when applicable......_ _Q- ........rj._L`]:w-0......A0.:5 ------------- .V-- -. G ..S..�-c�c!!`-�.:-'',----..........------ ......................................................... 5 Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of�ITL 5 of the State Sanitary.Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b d by th board of r Signed------. ............ ...... ........ .._..•. ...... ...r.?..`..G: Date Application Approved By................... -...... ................................... Date Application Disapproved for the f ollo ng reasons-------------------------•--•----...-•---••----•--•--•-••-----•------------.........-•--•--••--•-•............._ ....................................................=.............................................................................--------•---.:.---•----------.......-----------------•--•............. • Date PermitNo......................................................... Issued.:: :=::..t.....---- ............................... r Date A r V 51 T N�� -- t'rcIto r � �r I F�s.....�.�....._......_ 1 THE COMMONWEALTH OFASSACHUSETTS M BOARD OF HEALTH .............OF..... ` �f.'................................ Appliration for Disposal Workii Tonstrudiutn rrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ©47ewL►�-� .......... .o...... x,,- -- ` = -................. ...............................ram`?- - - ................................ Location-Address or Lot No. .............. - ` --...,� �!. .k_.� .. --• -----.-------_.-S:?�3::�- :!� ...... ............ ....--•--- . •. - - - r Owner Addr�es ............... � �i. L.�IJ�l�1... �f I iai Installer Address of TypeDwelling—No. of Bedrooms__...._ Size Lot............................Sq. feet � { U g— ...................................Expansion Attic ( ) .Garbage Grinder ( ) n Other—Type of Building ............................ No, of persons............................ Showers — Cafeteria 04 Other fixtures --------------- --•--•-•••••--•-•-••----•---•-......._....--•---. . •. d --•--------•-•--------•--- W Design Flow.........'�,� ...................gallons per person per day. Total daily flow.......71.�./0................gallons. WSeptic 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 tank ( ) .`" Percolation Test Results Performed bY--•------------•---• ..........................••----•-•............._.. Date....................................... aTest 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........................ 04 •----•...................................................•-••---............--•••••••--.........---•......................................................... 0 Description of Soil....................................................................................................................................................................... (xj -•-•-----------------•------- ---------------------- •------•- ------ ------•--•---------•-•-----•-----•-•--•-.......... •.. --------...........---•---••-••......•-•-• ---------------............................................................................. •-•---•. .....----•-•------------------•---- -------••--•.........._. U Nature of Repairs'or Alterations—Answer when applicable.......�.D f~ ... 1 0 t2>>........r5.4......lf`r'...�� ................. ( V,:: =i.,J ...=C -- C-K Cti.l?i ........................•.. ....----•-•--•--•-••--..................••••..... Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in"accordance with,,, the provisions of TITLZ 5 of the State Sanitary Code-.The undersigned further agrees not to place the system in operation until a Certificate of Compliance hass bbe_en issued by th board of health y Signed..... � : {`.^-r= "�`. .... .... Date Application A roved%B _._ ...::__..._ 2. Date Application Disapproved for the follo ng reasons:.............................................................................................................. .: ...--------------•-- --•--••--•-------•----------------...-------•-----------..._..--•---------..._..---..........----•-----•---------...__...---•----•----••-------•• - ......... Date _ PermitNo...................................................---- Issued....................................................... Date .. r... --_----p----- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF........... ..... ...... ........... Tro firate of Tumplittttre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) Installer }� j at... -_• t rS,lI1 i gar Al ,1?s !1 E t ; . has been installed in accordance with the provisions.of TITLE 5 of The State Sanitary Code as described in the application for.Disposal Works Construction' Permit No. .................' '........... , dated--.. ..........:::._.................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. r DATE...............:. .... / -._!_2 ,.���� -•••------------------------ Inspector.... 1lrttf�4+.�ry.��ti, ��.�. •--------. ...._... ...:.... K" THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH F_ = _ t -n C b S VO -? ..> .6 g1x 'Y FEE.. .................. 14upoli 1Work u lutrur#iun rtrmi# ( ) yPg ( ) 1 � g P'.... .y.... Permission is hereby ranted_...... to Construct or Re � an In Iv al � . ...e= s oral stem /l at No r ,•_ �- �- tStreet r r t as shown on the application for Disposal Works Construction Permit No...._. r.... ted.._ ..... L - .. Board of ealth DATE........ ... /.. }