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HomeMy WebLinkAbout0103 CARDINAL LANE - Health r) e. jti7 �rs'��nS M � Z`�S �7 L'of LOCATION SEWAGE PE �� IT NO. l®3 C4oeo���L Ggti� ,, � VILLAGE /4l-l2s TOivs Z!? I N S T A LLER'S , > NAME & ADDRESS / io Cam, &—c" 5-�— —7Z s7 y.4iro►y u t U I L D E It OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED POT °f L- N .-- ---....�.�`� F�$.....3U.--...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH To.cs,7..................o F.....��5t. Appliratiun for Disposal Works Tonutrnrtiun rumit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: �?.Q.tt.E.._ .. St1Z.b�/.J!►1,A -......L./.t/ ST--QA)S......ftd.44.f............1—.C.;r....7..V---....................... Location-Address or Lot No. J�..X� :.. .........X ---------------------------------------- �1_...__1 �ss. .............................................. Owner Address W ....... `--- ... ..«-•---------------- ----------- -•-------------........ ....---.-.------------------------- a Installer Address U Type of Building GG�� Size Lot.,25�.5�._..Sq. feet U Dwelling—No. of Bedrooms........... ..... F...........Expansion Attic fvb) Garbage Grinder (No) Other—Type T e of Building No. of persons............................ Showers � YP g ---------------------------• --------- --- ( ------------------------------------- Design ) Cafeteria ( ) Other fixtures .................................. -----------•-•-------•--- ----------Flow.........//.0........................gallons pei� iWay. Total daily flow...._.____-�30.................gallons. WSeptic Tank—Liquid'capacity/UoQ._gallons Length8.-'K"... Width_Y..2,d_" Diameter................ Depth 5"8.". x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......./............ Diameter....(9........... Depth below inlet....I<............ Total leaching area.o'ZDd....sq. ft. Z Other Distribution box (Vf Dosing tank ( ) '-' Percolation Test Results Performed Date- EZ3----.ast_1_.9..a.y. a Test Pit No. 1__4.7-_...minutes per inch Depth of Test Pit._1_%_�......... Depth to ground water.__N.c_V.& ._.- 0;4 Test Pit No. 2...L-Zn..minutes per inch Depth of Test Pita!A-_......____.. Depth to ground water..N_pw..S._._... a ...--•-•-•-•••-......•-----••--••--....-•--•-•---------------••---•--............--...--- ---- ----------....................----. ...... O Description of Soil----....-Q_-__3________GQ.rg _ . 9t- S.U_13-S�tlL�.-----..V .. l/6_lL.y vi4.n.E.�............. ------ 01 UNature of Repairs or Alterations—Answer when applicable.................... _ -.... Zf.s ,___.__.___::_.__......___.._.. -•----------------------------------•------•--•--------•-------------------......-----.............-•---•-------•-•---------------•--------••......----•----...._..........•-••••••---------------•--•-- Agreement: a The undersigned agrees to install 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 until a Certificate of Compliance has bee issued by the board of health. Si one... X' ....... ......... ............D..t............... a Application Approved By........�. A......................... ...- -/� 7-............ Date Application Disapproved for the following reasons-------------•-•---------------------------------------........-----------•-----...--........................... ..--•----•---•---------------------------••----•--•-- •-----...---•••------------....----------------•----.._.__...••------------•-----•-•-----•--•••-•---••---•---•-----••-•------•---•-••----.._..... Date PermitNo......................................................... Issued... z +-..(............................ Date 7P L �. � r 10. Fxs... 04....... THE COMMONWEALTH OF MASSACHUSETTS `�, BOARD OF HEALTH 14+�................OF..... .{I�1 ............................... Applir4tion-for Dispas ai Works T anstrur#uaat Permit Application is hereby made for a`Permit to Construct `or Repair ( ) an Individual Sewage Disposal System at: tV.At L..*---Ca/9I ..�1-PliA ----...4.+4 tt ...�.d dAi 3rows......t.4.1k,a s...........E.'a�" ....-Zl1.......... ........ Location•Address r Lot No. .. '4. V..l Z.:. .......................... .......... ...... ............ rt .....��e�..CX................................................... � II Owner Address M......... .... .............................. .....:........... ...................... Installer Address d Type of Building Size-Lot. .60.55_....Sq. feet U Dwelling—No. of`,B,edrooms.......... :-....Expansion.Attic Z44) Garbage Grinder fit"?) Other—Type of Building No. of persons............................ Showers a YP g ---------------------------• P ....------(--).— Cafeteria ( ---). d fixtures -- .............................. ..._.gallons ( r a W fDeslgn Flow....Other ��---•: :...... g p p I y. Total daily flow „ .. 'jO... -•--.-•--gallons. (� Septic Tank—Liquid ca itYlAP.O.. allons Len h:8._X.. _ Width!/.2 Q"' Diameter................ De th-S.Id.t.. x -Disposal Trench—No .................... Width.. .....Total Length.................... Total leaching area--_. -------sq..ft. Seepage Pit No......1'`----------- Diameter....9..I........ Depth below:inlet ..r r____.__,: Total leaching area.A.00....sq. ft. Z Other Distribution box (VI Dosing tank ( ) aPercolation Test Results Performed by t-4_.o. .Y.0 .. !1Q �aA.46S. Date��:a... Test Pit-IN'0.. L.�.. .:_...minutes per inch Depth of Test Pit./.........:... Depth to ground water &4A.'.,C..... fs, Test Pit No. 2...4. ...minutes per inch Depth of Test Pit_ ..........3. Depth to ground water__l !tl�3, F_..... .. Description of Soil ....__.± ::. �........�-�: . .. _ �- - - - - • _X --•-•- ..... (xj ...................... ............. _.---..... ............. yy W ... Ir .�._..� U Nature of Repairs or Alterations''—Answer when applicable................. .717.. ----------------------------••••.........•--••---:•-- ................-•------------...----------------------------------•---------•----•---------------------. . Agreement The undersigned agrees to install the aforedescribed Individual Sewa e.Disposal System in accordance with the provisions of TITLE E 5 of the State Sanitary Code— The undeisigned:4ur tier agrees not to place the system in operation until a Certificate of Compliance has ben issued by the board of hel lth. Si e ... .. �� � ................................ . D tg Application Approved By....... ' " ' "'�!+,�`- Z......-- Applieation Disapproved for the following reasons: :: ......................:........Date_____........_ ......................................•--•---------------••-----••-•.....-• •-•••------..•---•••• . -- ----• -• -••- ••••--• ••-- ..................... Date PermitNo °'.._... .- --• r ------------------ ,� Issued..............................._.............---------.. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ."` .0.bj.A)...................0F..... ..�'�d��# .�:�... .......................... �a-Trrtif iratr of Tompliaurt. :.:, THIS IS TO CERTIF'V,That the Individual Sewage Disposal System constructed ( ) or R� paired ( ) by ---------------------------•--••-••-............... . -- Installer at.... ........... _ '._4�_.C"' f.12. .1. ►_ _._.... J.�......-_..r_l d. J .......... has been installed in accordance with the provisions of 9-1* 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No _. +�+V................. da.ted......�'�-��:`._�.�............... THE ISSUANCE OF THIS CERTIFICATE $HALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......................... ..•..... ....................................... InsP k ector.......... r THE COMMONWEALTH OF MASSACHUSETTS ,. BOARD OF.,,,HEALTH .................. OF .. ��' t. . .a.. ..�. '. ,Q NO......................... FEE.= IRS Li's `* �1111iltrwtiatt Permit T4 /Permission is hereby granted !....................................... to - �... �.Construct.( or Repair ( ) an Individual Sewag Disposal System r at No..t°d 1 .._. '" ..... .... ...........Al_i-.------. .-----•. ! Street as shown on the application for Disposal Works Construction Permit . .... hated............. -. ... ......-...... • . ...................... �+ c DATE.....if--_..2-.(--+-•1.'..........................•--•-------•---- Board of Health FORM 1255 HOBBS a, WARREN, INC.. PUBLISHERS - TEST ' HOLES rE3 , a5 , /9 79 i EXISTING MAUL MURRAY- 1;tSPerTOR POLE LOT 74 o - ., LOA t�l A N 0 r , S UCiS.OrL c S l 50 'c a 4 I'Z, VERY COA X$s SAND CX I S T. / E 1 43' F©(JNQ E�t 1f• 9 D ` N Q b-)ATeR. 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