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HomeMy WebLinkAbout0168 RACE LANE - Health 168 Race Lane A= 150-.006—002 1 Marstons Mills G No_ff�... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................OF........... .9 D 'd Appl ration for Disposal Works Tonstrurtiinn Prrmit 1 Application is hereby made for a Permit to Construct (XC or Repair ( ) an Individual Sewage Disposal System at: Location-Add or Lot No -- - ---• Owner ...................._..._ Address a . .... . . ..................••........-----••-•--------_.._. ....... ........................................= ....-•-•--...----•-----------•-•-••-........ Installer Address Type of Building Size Lot............................Sq. feet �-, Dwelling—No. of Bedrooms------- ----------------------------- .,.Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Buildin a Other—Type g ............................ No. of persons............................. Showers ( ) — Cafeteria ( ) d Other fixtures . -----------------------•--•----•----------•-•-•-----..----.-----•--•----------------------------------------------------------- ••---•---•-----•-----. Design Flow...........:!R5..........................•gallons per person per day. Total daily flow....... .........................gallons. CA W Septic Tank Liquid ca.pacityI. .__gallons Length.�5--_�e 0.___ Width.. ..�...... Diameter................ Depth...`l'_Q 11 _..... Disposal Trench—No................ .•Width............... Total Length Total leaching area....................sq. ft. 3 Seepage Pit No..--,- /--__-__.- Diameter..../..O_.. ...... Depth below inlet..... Total leaching area. Z Other bution box aPercolation T1T Test Results Performed byln ?!`'-_. F.._(Q 1 ............................. Date..�� __ � ....._.___._...._.. Test Pit No. 1� '._..minutes per inch Depth of Test Pit.1l`P�._:_.__.. Depth to ground water-----Sze ---- 44 Test Pit No. 2.<. -..minutes per inch Depth of Test Pit../YY.......... Depth to ground water_._/1Q-t�...�._ x _ ----------------- ............................................... }- O Description of Soil.....-•----......� _I�:Y� - U .............. ---....... ---•-••----------------_-----...... --...... •-•------------------------------------------------------ -• -- .......... W UNature of Repairs or Alterations—Answer when applicable.................................................................................I..._._....._.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI'12, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has issued he board of health. Signe ----- ----- ------ ..................................... •--------..._........ ate p Application Approved By....-- .. -:-•- --- - --- -----•......... --... ................. ......../r2)-_ Date Application Disapproved for the following reasons:........................ •••••......---••••-----••....•-•••.....•••--••----•••••-------------•-----••--•....•-- ---------••---------•---••.................•-•--•--•--------------....------•-•------•----•-•----...-.--.-------------------------------------------------------------------------------:............... C>V Date PermitNo--------0.1--- ---------------------------------. IssuecL....................................................... Date i w No.-- ... .� Fss... ; a ......_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................OF....... .1`� 'A -....... ...................... Appltratiun for Disposal Works Tonstrurtiun Frrmit Application is hereby made for a Permit..to Construct' ( ).. or Repair ( ) an Individual Sewage Disposal System at: .' . Location.-Address ....................... ................... ^....... -• or Lot No..................-•................. Owner ..._. W .._..: .... ,../- ... . ... ..... Ad..ress...... .................................. �_• a1�=• t'I / .J' //:f t'I;�:..: -.-_--.--•-- -- .......................•------- _...- .........-----................-........... Installer Address Type of Building V Size Lot................ ..........Sq. feet aI Dwelling No. of Bedrooms.... ��................0... .....Ex Expansion Attic g— •--••---- p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ............................................ ------------------•-----. -----.-.......---.....------------.._...... Design Flow.............�V-5.........................gallons per person per day. Total daily flow-----.._ 3CP...........................gallons. ----... p f 1 W Septic Tank—Liquld capacity) .._gallons Lengthy_<....... Wldth.. _. ...... Diameter................ Depth..`�� ��.._. x Disposal Trench—No. .................... Width.... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No......../.____--_-- Diameter..../0........... Depth below inlet.... `..__.__. Total leachingareas`?z�.,=sq:-ft Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.�`i+ Nl� .. : ti _. G.............................. ' a - ,.a Test Pit -No. 1�.` _...minutes per inch Depth of Test Pit.������J... Depth to ground water...��'t-� Li. Test Pit No. 2..!5 _ -..minutes per inch Depth of Test Pit (/Y............. Depth to ground water.-_�! P+ ..................................................•...... ------------- •......- •......---•----------. ---•- .. Z - .....O Description of Soil................ -•-------•--------••---....------....---.-.....--------------•--------.........-...-•-•--. W ---------------------- ---------------- .......------------ -------- ---------------------------------- --_-------------------- ------------------------ .... ---------- -----•------- x ---•---------•------------------•-•---••----•-•--•-•-••----•---••-•---•--------•••••---•-----•.............•... ---••---••----------•---•-•------•--•-------............-----......-----•-••---•-••..0.. U Nature of Repairs or Alterations—Answer when applicable......................................................................................0........ .............................................................. ............................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with ,the provisions of iITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has issue the board of health. \ t Signed ,� •- - . .... �l Application Approved By---t•--.-X_Iz4 nwfll •_I�! ....: ate Date_ Application Disapproved for the following reasons----------------•------•-/� '/ -----------------------------------•---•-----------•----------.......------•-------.-...------...----....--•----••--------•--•------•-----------•-•-••••-•-•--------•-•----•----•----••-•--•------ Date J PermitNo-------- -a--------------•--•----------------------- Issued........................................................ Date ------------------ ---� _---_.—. ----------------------- — THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... !l.!..n1...............OF............ /7 4,(a-4; Ala. ............................................................... C�rr�ifirtt�.e of faunt�rlittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (.,, or Repaired ( ) by-..........Y /�?. _�_l....................... Install r . -- - �r - ------•---• -•--•----------•-•---•------•--•---•--••----------------•--......................... has been installed in accordance with the provisions of TIT oe State Sanitary Col a +describe n the application for Disposal Works Construction Permit No.__..._lck_ I/ .._..._. dated_...-_.j�?Z�_/_�__.�.......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........... ....... ..................................... Inspector. ----------------------------------------••-•---••---.----- THE COMMONWEALTH OF MASSACHUSETTS �- BOARD—OAF HEALTH ..............�.......OF..........�!�/�/J��-f - ........................... t No..�,..... FEE.--- J Disposal nr409igjnstrnrtiun rruti# Permissionis hereby granted------..i ......---•--..... ' - ------ ----------•----------...............................................-........ to Construct ( L`) or Repair ( ) an Individual Sewage Disposal System atNo----= ........................•----------------- --------- --------------------------- Street as shown on the application for Disposal Works Construction Permit No-----___-__-_______ Dated.......................................... - ........... '--�-------------------------------------------------•--- --_--_-- Board of Health DATE........................................................................ 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