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HomeMy WebLinkAbout0391 LAKESIDE DRIVE - Health 391 Lakeside Drive , , , t; Mdrstons Mills �A = 102 -209 lfl�' ,�lr'� ; ► M i oC*. —�� — — — — — LOCAT_1.0-KI __ =5EW6,C;E_P_ERMIT _-U0. Cozy - -- - - _ --/-('.2 - - - - - - - - — :1.1`IS`C -ER�S:-►J�.NhE-�'ADDRE=SS 4 DATE-9-ER.M1T_1SSU_EDi_.� _ — - — DsATE_COMP_LhAt�ICE_I_SSU.ED_:_-�- ��.-'�_ �o�, �CJtfia-Z.� f ` i .{ ,, ... __ 4 Y" . .. � � '� 1 �� �.. �G� I C7 No....... Fes$... ...... . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. .................OF.......1_14&1�i w......... - ------...----------......................... liration -for Did oitti Works Tonitrnrtion Ppruid Application is herebymade for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal Sy)A em at lf( Oro s =-- ..........................' ` '�' d�<------.ry-------------...............�� _ ocatio Addre s No. z.�-•• C -��% '`= ....... ----j-�=-S�.r�-�-!-...... 7 I............. ' �. . Owner �� Address Installer Address _. d Type of Building Size Lot./�K.e.............Sq. feet Dwelling-KNo. of Bedrooms_______ ________________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures --------------------------------- W Design Flowq...___________________________gallons per person per day. Total daily flow___________•__:__-. �`.._.._...._-...gallons. WSeptic Tank—Liquid capacity-�S�___gallons Length................ Width...__........_.. Diameter__-.-------.-_-_ Depth--..___-__------ x Disposal Trench—No. .................... Width---------,.I ��_�otal Length.................... Total leaching area....................sq. ft. Seepage Pit No.......�...... Diameter___(.� _— �epth below i let.,,....... ... Total leaching area____._._________sq. ft. z Other Distribution box ( i.� Ma tank ( ) d � � '` jC- �- Percolation Test Results Performed by---------- ----------------------------------- -------•--•----•-•---•••••• Date.......................... --------- Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water--- -------------------- s L14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water__._---.____-_.-__---. a+ j r. ------------- . O Description of Soil--- � -��a i = < ��'" -=�---- - _ �X� ��f" // ,, l 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 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 issud by the boa d of health. Application Approved B � � �`�= dam - C:— .��t' l�r PP PP y---, � ----- t y -----_ ...... . --- / Date Application Disapproved for the following reasons---------------/_.__------------------_-------.-------.--------------------_----.---__-..--.-_--------------- •--••••-----••-••-•--•----•-----•-•----•---•-•-----••----------••---------•••••-••••......-•-•--••-•-- -------------- Date PermitNo......................................................... Issued........................................................ Date (7� No......................... z / Fas.. .................. THE COMMONWEALTH OF MASSACHUSETTS `- BOARD OF HEALTH ..._._........OF....... � . .... - AVVfirtttiun -fur Uhipiittl Morkii Tomitrurtiun Vrrui t Application is hereby made for a Permit to Construct (X ) or Repair ( } an Individual Sewage Disposal S...................................... stem at: o cs SiR ,� /+ ? �i9.r --Si>C 77�Pt lr f. -•...----•'�-- • -•-••.. ...........•••-••••.......... -- �Locati ,•Address of No. Owner Address -•---•--•- .................................. .................... .......................................... Installer Address UType of Building Size Lot.�...�................Sq. feet Dwelling!No. of Bedrooms------Y.................................Expansion Attic ( ) Garbage Grinder ( ) 4, Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) G-I Other fixtures ------------------------------ - J w Design Flow.__ _U--------------------------------gallons per person per day. Total daily flow__..._.........___�/CO......_..........gallons. WSeptic Tank✓Liquid capacity C.s�_�"__gallons Length---------------- Width_.............. Diameter................ Depth....----_-_---- x Disposal Trench—No. .................... Width-----------I. Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No......2......._.. Diameter.J./.D.0A..... Depth below inlet.................... Total leaching area------------------sq. ft. z Other Distribution box (✓) Dosing tank ( ) Q 6 /d C 1)24. — Jt y 7G Percolation Test Results Performed by------- ----------------------------.....-••---•-•-----•---._......------ Date....................................... �.l Test Pit No. 1----------------minutes per inch Depth of "Pest Pit--------_----------- Depth to ground water.-.--.-----..--.--_--_ 44 Test Pit No. 2......•.........minutes per inch Depth of Test Pit.................... Depth to ground water--._-.---_-----.--__-.-. -------- ---------- ---- -------- ............ ------ Description of Soil-- --- 2 - •- U --------7- /- � � � r 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 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 ofhealth. Signed (�r��l' �= -- -- I���''� " (� �a G.,.(�JC-e.✓� Date Application Approved B -- -• - ------------------------------------- -----..._. d.._. f ram. .. S Application Disapproved for the following reasons:---------_./._--•---••-------•-------•--•-----•------•-----•----------•------------------nac---------- -- -------------------•-•-------------------•-------•----•---•---------------------•-•----•-•-•--••-----------------••---------•---------------------------------------------------------------------.----- Date PermitNo......................................................... Issued........... ---•------- -------------•-••-•-----------•- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH ,1. ............OF......... ................ IT w.wrtifirtttr of T11m i ttnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by.. ... ------- Installe ...... ..T has been installed in accordance with the provisions of Arc X of The State Sanitary Code as described in the application for Disposal Works Construction Permit Nc --( 1 dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIO"AT1SFA CTORY. DATE....----- ` -----------•-••--•-•-- Inspector---..._.�_� C THE COMMONWEALTH OF MASSACHUSETTS BOARD �i O,Fj HEALTH ...........OF......... ..�................................-............................... FEE_ �i� tt ttl nrk� (flttnitrnrtinn Vamit Permission/iss hereby granted.............................................................................................................................................. to Constr,ct (�) or Rep •i ( ) an In 3vidual Sewa Dispos 1 System at No.- - - �..1��-�• � -1=....... sc as shown on the application for Disposal Works Construction P• it N .___ l fs ----- Dated__-_:S. `1.D_`....... ........ Board of Healti�z----- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS N f i 1. �7 W + Fb v*1DXTtc►y j OF OAK - ! L .7 c 4=,R 7—/ Y' -rv,4- ' THE /- ©7- .5 7 F-O U 1ti/1�AT,/t�Iti! 5/1�*D W''.'V A146-A''r, 15 /M G e-fv AP-,A .5 710 THE .Z Q.v/H Ss N Q /..Av✓.5 c�F' �y.E Tow'N OJc ' 6?Aele 6-rA8 c-E7. AIAR67'"oN5 M/�L 5 /e4 A='� �/ Sz R��/.57 .mac to ,GA,�✓.o .5u, e5}'r 5CAJ.E-:/" =30' 0A*rr- MAY 7/76 l3fiXT,1 5A: G N "C /�'vG, RE6/S715:'RC.La 4 A MO SUX�NE'ydk'$ ky + � U CD) 7 1 , b