HomeMy WebLinkAbout0078 REBECCA LANE - Health (2) ecAl LP, - 7h c )/L .
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No..........77...... FEs....l..... ......®..
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THE COMMONWEALTH OF MASSACHUSETTS
BOARDOF HEA T
.
OF.
1
......... .............. .................... .
.........
Appliratiun -fur Uispuual Warkii mtrurtiun Prrutit
Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal
Sys
Z n 17". 5..........\ cation-A or Lot No. r
W = `� Owner `yr � C. �.�dres
---_____________ ..._......_...._.....'_.__ ____ ._ ..._"'.____'__'_."__ ..........._ _____.___._...._.._......_.__./"
Installer Address
U Type of Building Size feet
-, Dwelling—No. of Bedrooms.____......................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
d Other fixtures -e ----------
' ---------------_-----_--- ------------.............---------...---------......------------------------------------------
W Design Flow---------- ......................... allons per person per day. Total daily flow-------------
�-'_ '�0----__--.--.....gallons.
WSeptic Tank—Liquid capacitvf'�®__''gallons Length________________ Width...__........_.. Diameter_---- ..._ Depth................
x Disposal Trench—No............ ..... «�idtli __ ..--___-_-__- Total Len Total lea ng �rrn_
�1P_ _sq. ft.
----------- -----
Seepage Pit No--------G-.'.."__ l�ia e :_._____._ �LDepth b i��e ... 4_?o eac u g .............sq. ft.
Z Other Distribution box ( ) ( Dosing tank �.
Percolation Test Results Performed bY-----------------.................................................--•-•--. Date---------------------------------------
a
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water. ---------.....-------.
rzq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.--..--_--_--.__-_-
a' FI
.
R f
G _ �(
Description of Soil---------'� G' .._..K,1_° ` �1-Z ` . ... ..... --- ....b--- -------------------
U ------------------------�-----f----1-2------- ►a. ................................................. --.----------------------------._--.-------------
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 Article XI of the State Sanitary Code—The undersigned further agrees no to place the system in
operation until a Certificate of Compliance has been issued by he / and of hn ith.
Igne .
Date
Application Approved By------------- - - ---------Lt/J/�.....
�f Date
Application Disapproved for the following reasons:................................................................................................................
------•-•---•----------- -------------•-•---------------•-•----•-•---•----•-..-
Date
PermitrNo......................................................... Issued............................................ ate.......
Date
No...... Flnt..... .....................
_
` THE COMMONWEALTH OF MASSACHUSETTS
-� BOARD O� HE'A �TH,
//v/L�
�� +
l�6"t,4 �� t/Z✓
Appliratiun -fur 4%ipoiia1 Workii Tottutrurtiun Puniff
Application is hereby made for a Permit to Construct ( epair ( ) an Individual Sewage Disposal
System-at: i! _ ,•,�_
/i L'cation-Address or Lot No.
y r
Owner _Address _ r
Installer Address
UType of Building Size Lot.,�.2 ` !-.-- .. - /_Sq. feet
Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons...-_______---_-__-____-____ Showers ( ) — Cafeteria ( )
Other fixtures . `.' -----------_.__
W Design Flow.......�`. ..........................gallons per person per day. Total daily flow..._._.._._...-'.__0 O................gallon,.
WSeptic Tank—Liquid capacity Q_--gallons Length................ Width._..........._.. Diameter______..____--.- Depth................
x Disposal Trench—No_ ______ _____________ Width.��'_.�'----------- Total Lengpe.................. Total leachi/bg aredJ " ....sq. ft.
Seepage Pit No........� �Diameter�''' �' '""-Depth belies t� tal leac it ifie "-------------sq. ft.
Z Other Distribution box ( ) Dosing tank
a Percolation Test Results Performed by------- ---- ............................................................ Date------------------------------------._..
Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water...___.__.___._____.....
(Xq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_.._.....__--_______.._.
O „� ,� ----------- f.
Descri tion of Soil . --•- 'Z .t �a � r�`�--------------------
(xj �----- /..1_..'..... /'11.t ^tir 1 ems -- -----------------------•------- -----------�------
--------------------------------------------
W
x ---------------__--------------- ---------------------------------------------------------------------------------------------------------------------------------------- ..........................
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 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.
� igned `..�-�. �/ ...................... ..... /
�i ��• Date/
Application Approved By------__'� "�� .._.._. _' _ �__--4-m __//----
.... ....-rG__- _.... •-
Date
Application Disapproved for the following reasons----------------------------- -----------------------------------------------------------•------------------•--
-------•-------•--------------------•-----------------------------------.----------•------•------------. .----------------------------------------------•-------------------•--------------------.-----
Date
PermitNo................................................ ._.. Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD�OF HEALTH'
................. T.a'�� ..OF...;:. �......:�:L ., .. .......................
C�rrtifirate of f�ompiittnre
THIS IyS TO CERTIFY, That/the Individual Sewage Disposal System constructed s(%) or Repaired ( )
by �. .film- /t IX;; C>'
1
------------ - - --- ... ---
•--•- •------•---------------
has been installed in accordance with the provisions of A. 1lee XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No._ %--._�Y_7_7............. dated._..;/G___.!;_-_-_7-. -
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE--------• /"� --••--........:�-.
THE COMMONWEALTH OF MASSACHUSETTS
�,� ��I •— BOARD
,OF HEALTH'
No. 7 FEE..----------
�i��uuttd. Turku �unutr�trtiutt��rrmit
Permission is hereby granted_______�J - - - "__ ?. _.....__.___.a G• ..._._.........._..............................................................
to Construct ( �)o Repair ( , ) an Individual Sewage,Disposal System
f ..... ........................................,
Street /
as shown on the application for Disposal Works Construction Peg—nit N .. ___ram_. Dated-----Z-'_____- .....
f
_. �� .Pam!
/
DATE....--------------------�--------�P-------------------------------------- Board of Health
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
LOCATIOKI ' 5ENN& E PE MIT MO.
_ _ � �..�
VILLAGE •
11uST LLERS ►JL1MkE ADDRESS
DUI QER 5 tJ I�1�/t�E � VDRe5S
DATE PERMIT 155UED - �—
D ATE COMPLI &MCE ISSUED : 67 ��
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