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Home My WebLink About0000 LAKESIDE DRIVE - Health C� Lal��,c�� Jr . �.rn ,_ S`041 (71) No....--G - ..... Fps ............ THE COMMONWEALTH OF MASSACHUSETTS BOAR® F HEALTH ----......�/ ' ''1 ......0F........ ..... . I.................................................... ApplirFation for Dispnsal Works Tonstrurtion Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System a C ' .................... - �..__... .s ...........................•. . ...... L cation•Address or Lot No. - .. .... .... .......- ------- -- ---...------ Ad. ...---- Installer Address UType of Building Size Lot.......�®.� ......Sq. feet ,.� DwellingPNo. of Bedrooms.....................................Expansion Attic ( ) Garbage Grinder ( ) PL4Other—Type of Building No. of persons............................ Showers — Cafeteria a' Other fixtures .................................. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width....___.__------ Diameter................ Depth................ x Disposal Trench—No. .................... Width......I............. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------1----------- Diameter.__....../_........ Depth below inlet----6............ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 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-------_............... . R+' ------•-- ••------ -------------------------------------------------------------------•------•......--•-._.....---.................... Descriptionof Soil 1t --•--------••-----•-•----------------------------------------------------------------------------•---------------- U W ---•------------------------------•------------------------------------------------------••--------------------- a------------- � ---------- VNature of Re air r Alter t' s—Ans oer wh app cable--=------------ ------- ------------�.-_---.------..----_-. -____-•--___-_--.-..------. *A_A --- Agreement: - :/ The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu d by e bo rd of h th. ASig d ............ -f -�'�=-Y... ! Date Application Approved By----- Date Application Disapproved for the following reasons:-----• ------------------------------------------------------------------------------- ................................•----•••......•--------•-•••......-••--••...........-------•---------------••••-------•-••••--•-•----••--•-••---•-•-----•------•---------•--••-•-----------••......-•-- Date PermitNo.............................................•---------. Issued-....................................................... Date h } i No...----�./ ..... FEit ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - a OF........ .!!(..'-----•.......................•--.................... Appliration for Bi4os al Works Tonstratrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: f ..... - - ....... _......... .. ............................. Location-Address or Lot No. A v Owner �., Address ----..........._ ....._----• ,.ram... Instiller Address j 1 d Type of Building, Size Lot....:. .:... ...`:_....Sq. feet UDwelling;—No. of Bedrooms-__ ,*....................................Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures --------••-•-•-••------•-•------ • WDesign Flow............................................gallons per person per day. Total daily flow..........................:.................gallons. WSeptic Tank—Liquid capacity............gallons Length................Width................ Diameter................ Depth................ Disposal Trench—No -___.-- Width.................... Total Length............s_------ Total leaching area....................sq. ft. Seepage Pit No........I----------- Diameter....... ^ ..... Depth below inlet.... ............ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by........................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---- -- --------------------------------------••------•--------•----------------------------------------------------------- D Description of Soil........................}:___ !?` ... V .....-•----•--•--•------•••••-----••.......-•--•-•-••••---•---•......................•-••------•----.....•-•------------•-•--•--......... W ................ ....... ......_._.._....... .__. ._... .._.. ....__..__.._..... �+ / ---------- '�s ;iF U Nature of Repair or Alterati ns Ans er �-_ �' �....................f q Agreement: 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 been issued by the board of 11 Ith� t Sig , d , '._.._..!' ._..... .- •-•--.._. .--. Date Application Approved B ..... ... ...... Date Application Disapproved for the following reasons:............................................................................................................... ..........................................................••----•--•--•----•-•----....•••••----•-•--......-------------------•--------•-•---•--••------------•---•--•••-•----•-•----•------•-•---•----- Date PermitNo............................................•---......... Issued....................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD O,F HEALTH OF............J-3 a ............. .................................. �! Trr#ifiratr of ToutpliFntrr THIS ITO TIYThat the Individual Sewage Disposal System constructed ( ) or Repaired ( � by ...... _ -- �w�� I9staller, �c� 1 M f / `f{f at M..... .. �f �T rL✓ -��='Y° P- d- `' ' r " " u+`................ ', C3 ?!�!' has been installed in accordance with the provisions of T Tn—i f'5 of The State Sanitary Code as described m the application for Disposal Works Construction Permit Nod_� 2"lt...✓_e................. dated.._.1' _: THE ISSUANCE OF THIS CERTIFICATE SHAD NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............................. .•. Inspector.... • --------------•----- THE COMMONWEALTH OF MASSACHUSETTS }� � BOARD Off HEALTH 1 ...................OF......... PJ' ................................................ No.�2. 1� _ FEE.. •--................ Disposaal, r rin rrmit Permission is hereby grant . 1. ..... to Constructt//( ) or epair ( ) an Indivldu I' Je kage-,Disposal ystem at No...-`�'=•C��k..... !t-�s .�Jr --........__. . _1.�-�•: • - styea / as shown on the application for Disposal Works Construction Permit�No.....t.:............•D ,l(�._." 1'� �... --------------------•- B"oard of Health DATE r/ f = Z---------------------•---- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...... ..OF........ .Lm.R.l.-�:-./�.L.� ......... ........_.........-- Alip iratinn -for Uttip ial lVarkii Tutu# rnstion Vantit Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System a r' f'ocation•Address r� or Lot No. I •-- �--------/I�&_eKF ............. _-- --•----------------•--•_. ...._____.------------•----•-••----••••••-- Owner Address In Her Address Type of Building Size Lot......._--------------------Sq. feet U ,..� Dwelling—No. of Bedrooms------------------------------------_-------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building __-__--___________________ No. of persons--____________-__--_..___.__ Showers ( ) — Cafeteria ( ) a' Other _L flow Total daily per da person per gallons n Flow fixtures -_------•---------------------- - - ._--_-...- Design Flow p p py. y ____-________________________ ___ W 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 "Pest Pit.................... Depth to ground water....-_-.-_--_.__--_-.- fZA Test Pit No. 2----------------minutes per inch Depth of Test Pit-______-____.______- Depth to ground water__.__-_____-___.____.-.. 9 ••------------------ --------------------------•-----__•._.___-__.___.._--.__..-------•-•----••--•••......................................................... 0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------ x U .---------------------------------------•-••-----------•--------------•------•--•-•-----•-•--•••-....._..._._..... •---•--•------•••---••-•-•-•-----•------••---•---...--•--••---••--•-•-•-------------- -- --------------------- ------------------------------------------------------------------------------------------------------------ ----• ---- U Nature of Repairs or Alterations—Answer when applicable.-./ _________________ __l�---—----- - _ / ----------- --- ....................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue the bo o ealth. m y igne -•-- ----••. --••-•--------•-••----------------------••-- Date Application Approved By-- ,� 6, 1 - D ~to .... Application Disapproved for the following reasons:..._._ •-----•----------------------------••---•-----•-•----•-•-••••----•••••.._..._._._.. Date______.---•--- ........................................................ --•----•-•-•-------•----------..-----------•-•---------------------------------•-••----•• ..................................................... Date PermitNo......................................................... Issued........................................................ Date ----'------------------------------------------------ No.. -=/•%-_..... F� `.. .... .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _/d.&J.Aw'._.. ...........OF........ ,o.4.4 ,,64/��1.............. - .................... Xppliration -for Ii,ipviitti Works Tomitrurtiou Vrrra t Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System a --------- . -" cation.Address or Lot No. 4_2 ................................................. --------•-•-.1 `.. Owner Address In ller Address QType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) `-1 Other—Type of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ...................................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. USeptic 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 tank ( ) H-I Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water--.___-_-_---__-_--_-_ G% Test Pit No. Z_-•..............ninutes per inch Depth of Test Pit--____-__-.___--_• Depth to ground water........................ 04 ---------------------------------------- .............................................................................. .:------------------------------------- x --------------- U Nature of Repairs or Alterations—Answer when applicable._. - __. x:.� ---- .!/. t�....1`��►u!---------------�----- --------- ----- 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 b the bo o ealth. 1 igne •-• ................ ... f A lication Approved B-_ ---- _ Date Application Disapproved for the following reasons-----------------------------------•------------------------------•••••-••••-•---•---------•-•--••••......----- ------------•-•-- --------•--- . --------------------------- -----------•--•---•----•-•---•--•-•--•••-•••-•----•••••---•---------------••--•--•----- ................................ Permit No..'..'.-.•-•-•-. Issued... / r'= -�•--- Date .._.. .............•-- X..;, ---- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD . OF HEALTH +q ��J...}�....'..........0F........ .�.. ►,ry Trrtifiratr of Tones iaurr T1 IS IS O C TIF-Y, That Individual Sewage Disposal System constructed ( ) or Repaired by---- _,4_j 1• ....:. - rrAW Installerat-"----`' ----�--------�, �- f��`�- -�` ----- ----------------------- has been n accord<�nce with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.._......... ,c5--'............... dated....��_�. y .._._._._.___.._. THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CON UED A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............E . . ��--•-' --•---•--------------------- Inspector.-- ..................... %•-----------------------•------------------ 4 TWE COMMONWEALTH OF MASSACHUSETTS i,f.... BOARD OF HEALT :u ......... d..K n........0F........ ........................... No........ _`� ...... FEE_ ` War ii 11mitrurti , t Vrrmit Permission is hereby granted_____ = - -- -- -------------- -------- -- ----------------------------------- to Construct ( � or RepMr (, an I vidal Sequa p System at No..- J (E LL '" i jr�SE:1 f; / �E re t, as shown on the application for Disposal Works Construction Permit .-___-___._ _'..:._ � d__ - _ -_.7 --------- Q DATE--. r ,; .�------ ...--------- �---------------------------------------- � _ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS h �V I' -