HomeMy WebLinkAbout0034 LISA LANE - Health 3�1 L,'sc� e
Ii�yS
BDUSIFIELD SANITARY SERVICE
17 Burbank Street
Sandwich,Massachusetts
p 63
Name ee�'. `�7�r�� � _ S per Permit No� - 7 r
Location: .DC o •�is� ,C g�,� ./ f� �/�
i1Je S'7 7-a fi/e
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Builder?s-Name and Address �`grr�a
Date Permit Issued: - 1/- 7 7 `' ' ?;
Date Compliance Issued: �W- s- 77
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- THE COMMONWEALTH OF MASSACHUSETTS
BOARD ' HE LT
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Appliratinn -fur Uifipwial Works Tontitrnrtion rrmit
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Application is hereby`made for a Permit to Construct ) or Repair ( ) an Indivi ;acrj�System at: f
sA -------------------•--------------------- ------- �� ------------------------...
Lo ion-Address or Lot No.
Owne / Address
W ...._...... n......r �l�r----•--• ---•-------•- -----------•-•----------- � -----.----•-
v Installer Address
UType of Building Size Lot.. .. f _ __Sq. feet
Dwelling—No. of Bed
rooms----- ...'. ............................Expansion Attic (Al( Garbage Grinder (` )
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a Other—Type of Building, /_ X-- No. of persons______ .......... Showers ('�) — Cafeteria ( )
Q Other fixtures __ .404� 0do�`1��..._lC✓14 / --._
W Design Flow�y................... 1 °►.gallons per person per day. Total daily flow.._.__._........._..__._..._._._-_......._-.gallons.
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R; Septic Tank - Liquid capacityAAH__-gallons Length---------------- Width.-------- ------ Diameter---------------- Depth.--.----_.-.--.
W Disposal Trench—No. .................... Width___•---_-_-__.---_-- Total Length-_--__--_--__-__-. Total leaching area...._..._ _: sq ft.
x
Seepage Pit No.......I............ Diameter-------60......... Depth below - let--_- Total leachingarea
Z Other Distribution box ( ) Dosing tank ( ) �� ! �. /S'. - 'y'
Percolation Test Results Performed by-------------------------------------------------------------------------- Date---------------------------------------
,aa t Test Pit No. I................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
a -
wate�r-r----.--__-----__----.-.
------••---• - •--•;7....6
'...................1of SoiDescriptio .
'----- -��� -------------------------------------------------------------------------------------------------------------------------------------=----
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W9 -------------•--------------------------------------------------------- ------------•---------------
V Nature of Repairs or Alterations—Answer when applicable..----------------------------------------------------------------------------------------
------------------------------------------------------------------------- ---------------•----•-------------------------------------------------------------------------------------------------------
Agreement: -
The undersigned ag-ees 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.
ned %�
g •--•--- ---------•--- ----------• • F 1'977
ate
Application Approved By--- -- --- ----------------- G ..�/L- ?'.7
VDater
Application Disapproved for the following reasons----------------•------------ -----•--•-----------------------•--•--------------------------------------------
..........--•--•---•-•--•--------•-------------------------------•-.......---•-------.......--------'--'.-------••--•----------...•----.....---=---.........--------------•------••-----...------•......
Date
PermitNo......................--••-•---------------------------- Issued---------------------- .................................
Date
C-7 ' -No... � -••:- _ Flux..............................
..................
" THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
L77� �
j� '_ .._....OF......... .CG "....... .lGr/�C_p................................
Applirtttion -for Mripoottl orks Towstrortiou Vrrutit
Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Indivi h 1 WSwa�e D•sp sal
System at: /�l �j.l s
I-)
Location-Address or Lot No,
Address
w
Installer Address
UType of Building Size Lot__________________________Sq. feet i
Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
Q, Other—Type of Building .-____-.---__-___-_______ No. of persons____________________________ Showers ( ) — Cafeteria ( )
dOther fixtures -•-- --------------------------------------------------
w Design Flow............................................gallons per person per day_ Total daily flow--------------------------------------------gallons.
P4 Septic T,-nk—Liquid capacity------------gallons Length---------------- Width---------....... Diameter__.-_...__.-___ Depth..__-._--
xDisposal Trench—No..................... Width-------------------- Total Length-------------------- Total leaching area...............-----sq. ft.
3 Seepage Pit No--------------------- Diameter_-_.__-_..__________ Depth below inlet-_-__._____.________ Total leaching area.-.__.-_---.-__-_sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) -v�' J 11 �� �' 9
aPercolation Test Results Performed by-------------------------------------------------------------------------- Date_____-------.-----..------------_.------
Test Pit No. 1________________minutes per inch Depth of "Pest Pit-..---____-________- Depth to ground water.__--.--_-_---._._..---
-i - - ---:-- P -----------f--••- = i p - -
Test Pit No. 2_______________minutes er inch Depth of Test Pit-------------------- Depth to round water
D Description of Soil-- -._......0- .f ' 7..
cx., ---------------- --------------------------___---------- ----------------------- ------- ----- ---------- - - ---
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 of health.
,Signed '
f
Application Approved By ••-•- ------------
Date
Application Disapproved for the following reasons------------------------------•----------------•-•-----------•---•-------•--___---------------------------------
---••-•----------•-•---••-----------------•--•------••---------•••----•-------------•------------•-----------------------•-•----•------•-----------•-- -------------- --------------•-------------__----
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD Otq HEAL ,.
..........O F,;....... ..
Q.Trrt f rate of TOmplittnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( )
by ----- ------- ...........................----•-••--•• ---•---------•••-
/y // ,y / f,�[ st
at •Id3-� `T 75. �'`� i��i �/I �.� _ llllt_! /.- _!ie! --------___•----
has been installed in accordance with the provisions of i XI of The State Sanitary de as described in the
application for Disposal Works Constr1 .uction Permit N -.y_____�_3'__7_______________ dated.. -.2.0v---/�9{..77.
TH"E ISSUANCE OF THIS CERTIFICATE-SHALL NOT BE CONSTRUED AS GUARANTEE THAT THE
SYSTEM WILL-FUNCTION SATISFACTORY. '•. m4� !. :
• r i
DATE... ..- � --- -- ------ --- Ins�eetot r
.. ----- i ....................
q' THE COMMONWEALTH OF M.ASSACHU,SETTS
-BOARD OF HEALTH �-
�:
No. `a------• , FEE_.../✓'
�. . t� o.�ttl ork,� �oo��r�tr�t�it motif
Permission ran is hereby gted 3_ s. .._:__________________ ____________________________________________________________
`.to Cons at Repair ( t �' a widual Sewage�Dispos 1 System
at No. 2-- et ts. }�
Street /
as shown on the application for Disposal Works Construction Per t,No.___ _____'_ _.-___ ated-_--�1""_"' 1._. ___-___
s 1
• 714-41
oard of Health------------
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FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS -
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A143 0949
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N 4
APPROVED BY
SCALE: 4 DRAWN BY.
DATE �+ C REVISED ��f
DRAWING NUMBER