HomeMy WebLinkAbout0450 RACE LANE - Health (2) -44
450 Race Lane C,Maistons Mills
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LOCATION SEW&(:C E PERMIT UO.
VILLAGE
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IWST&LLER*S ► l&NAE ADDRESS
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BUILDER 5 Q &"F- ADDRESS
DL-lkTE PERMIT ISSUED '--a
D ATE COMPLI &KiCE ISSUED : - - -
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No.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HE L�TH
Nj .......OF...... .. .. ..�.. - ......................
AvvUration -for Disvviial Works Tutw#rurtinni Vrruiff
Application is hereby made for a Permit to Construct ( r Repair ( ) an Individual Sewage Disposal
System at• e
-------------------- ------------------•--.•---- ---- ----------------------••----•-•---•----------
Coca;'o Address / or Lot No:
nor U - ® A
Installe_flk Address
d Type of Building Size Lot............................Sq. feet
U Dwelling No. of Bedrooms. _.._.Expansion Attic ( ) Garbage Grinder a Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ....................................................
W Design Flow-----r(7..............................gallons per person per day. Total daily flow____-3.00----------------------------gallons.
WSeptic Tank J-Liquid capacity-400.gallons Length_-_____-_____- Width------ Diameter................ Depth....--_-_.-----
x Disposal Trench—No. .................... Widtli.__._____._._ ._. T tal Length_._-___-_-__--_-_-_ Total leaching area..--.---_.__.-----_.sq. ft.
Seepage Pit No
--------r�........ Diameter..11�p'.._ e below, inl _______ . ___�. Total le�hit� rea.___.___._-_____sq. it.
z Other Distribution box ( ) �osing tank ( ) ;i �. ,r' �—
a Percolation Test Results Performed by-----------------_- •---•---•-----------•---------•-------------------- Date_-.-.----•----••--•---•---------------
Test Pit No. 1................minutes per inch Depth of "Pest Pit.-.__-:--___-______ Depth to ground water.-------.---------------
f� Test Pit No. 2................minutes per inch Depth of Test Pit._-___-------__-_- Depth to ground water-----------_-----------
G L J---- -- ---
Description of Soil-----------Q-� °� / �--•-`-- --l 'Z
V ...............•----------------------....------...._....._.....--•----• ---a/ ------------...............-•-•-----------•-----------......._.........--
W
V 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.
Sign __. _� -
Date
�e�� �/_
Application Approved By------� . = - ---------------- =l
Date
Application Disapproved for the following reasons------------------------- -----•------............._..-•----------------......---•--•-----------------.
-------------------------------------------------------------------------------------•--------------------------------------------------------------- --------------------------------------------------
Date
PermitNo......................................................... Issued........................................................
Date
No......................... FEE. 1l........ ..
THE COMMONWEALTH OF MASSACHUSETTS
{ BOARD F HE L . H
r
........ . ... . .. .........OF...... ,..416.4 . .. . - ----------------------------
App•liratiun -fur Ui,ipniitti Works (noni#rnr#ion Vrrnift
;k
Application is hereby made for a Permit to Construct (-/--ror Repair ( ) an Individual Sewage Disposal
System at:
f�U?....%�:.-``_�.- `%.!_...... _c.......t,��e---------------------------------•----.--......---•------------------------------
f Location-Address or Lot No.
Owner
a _.__._.•.� ,: y/WTI ��r'1..........I.n. . . . iJA(��,Of C�
_ •.............. ...... ....e�.... __.._....._._..._..._... .._.._.__.•_-__�___S. A _ _�
sta
ddress
Q Type of Building 0 Size Lot............................Sq. feet
0-4 U Dwelling)(-:-No. of Bedrooms-------Z----------------------------------Expansion Attic ( ) Garbage Grinder
aOther—Type of Building ............................ No. of persons..........._---------------- Showers ( ) — Cafeteria ( )
G4 Other fixtures --------------------------------
g g P P P Y Y gallons.
w Dest n Flow.__._?_�_______________________________gallons per person per day. Total daily flow__..%.�.�/._..___..____________. ..__....
WSeptic Tank L-Liquid capacity_h*0--gallons Length................ Width---------------- Diameter---------------- Depth---.-_--_-.-----
x Disposal Trench—No_____________________ Width------------- T taI Length------------.------- Total leaching area....................sq. ft.
1 ,. D
Seepage Pit No........ .......... Diameter.ff!2F_..=__i ep belo inl _____L___...._..... Total leaching area.._._...._.__._.sq. ft.
z Other Distribution box ( ) Dosing tank ( ) C - /1 • # �- a 4-7C
aPercolation Test Results Performed by-------------_ ..................................................... Date----------------------------------------
Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water....................
�L4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water...-.---.-----.---------
O �o Soil
U -------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------- t
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 not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
��i d_�_!'�-,F;• i �_ ------- I. .c�laJ1Gd------------
--------------------------------
Date
Application Approved BY--- . L. •. ..... 1 ..�..............7-ee-------
Date
Application Disapproved for the following reasons-------------------- --- ------ -------••-......-••----------••--.......................---•----------------
....................••-•..-•----•-•-•------------------------•-•••--•.....-------- ------------.•-------•--------------•--•------•-----------------------------------------------------------------•----
Date
PermitNo........................................................ Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD �DHEALTH............ .� ` 1..........O F............ .. 'l�14........................................
Trr#ifira#r of Tilutpliaurr
THI IS TO ERTIFY, That t end' idI Sewage ' .4posal System constructed4—o—r Repaired ( )
by= �kl = jh-{ r� �'--�---- it `y '---=- -----
�'�Insta}ler
has been installed/in accordance with the provisions of Ar old XI A The State Sanitary Code as described in the
application for Disposal Works Construction Permit No._E/-....l_:7,,1.............. dated-.__i�?'SU_'__-.-tom............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
D
DATE......... ----------------------- ..-b ........................... Inspector-- =-� .- - ---`--- ..............................
THE COMMONWEALTH OF MASSACHUSETTS
�4 BOARD F HEALTH
. . ..... l.................OF... . . .... ........................................ /
Now FEE/Z)...••---.------
�tti
Permission is hereby granted 1 = �J G`..... --- -----------•- �-----• ....----•---•-----
to Cons ruct ( or Repair( ) "apjIpdividual/�ewage'�is�osa Sy tem �
S r Street /
as shown on the application for Disposal Works Construction Per.,.- "o..... .....:....�D ed...4/: Jt ._ .. .G._........
oe
,,����tt��,TT i
Board of Health
DATE.- ..................................... -------------------------•
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
LOCATION 5EWO,C,E PERMIT UO.
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BUIL. 9ER 5 Q- &V AE ADDRESS
D1QTE PERMIT 15SUED f L - -
0 ATE COMPLI &MCE ISSUED : `L J
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0. DATE REVISIONS JOB NO. DRAWING NO.
t�0 U S t U b "IP C G 7) Y ;�2 a �., y s ~ V� I ; r `=�, DATE 7r
DRAWN BY
C)`-1T L'--12-'I L-L i��A( � .�� T Pa A 12�i:�� � ?'�L.f M A ��-r V
CHECKED BY