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Home My WebLink About0110 CLIFTON LANE - Health (3) i � o c�,� �a-ne ce.��¢-�-Qz - a�^'1-ao� f ,.k No....... o� 9 C9 F�> ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I-ro !..V a. ........__.......... OF........... .... . ................. ApVtiration for Dispotial Workii To nstrurthin rrmfit Application is hereby made for a Permit to Construct (/or Repair ( ) an Individual Sewage Disposal _ Sy em at: ��G lW 6, .. . H -. ..... :.... .. �..r..�� ..:N :r l .� ..........----•---.--•-...--.... Locat o •Address or Lo N ........ .... ................... .. n Ad ress W ................................ ......................................................................... Installer Address d Type of Building Size Lot..�..3'j ........Sq. feet U Dwelling—No. of Bedrooms.. ....A ..........Expansio Attic (X) Garbage Grinder ( ') aOther Other—Type of Building ._a ..�P o. of persons...... �Showers ( ) — Cafeteria ( ) fixtures -----•--- ---•---------------•-----------•-----------•------••---•--•------..........__.. W Design Flow.........6�0..........................gallons per rson per day. Total daily flow.........3.A.Q....:------------------gallons. WSeptic Tank—Liquid capacity/ 0!2.gallons Length................ Width-------------.__ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....f.(.60.j!diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.._-.___-_._____--_-. Depth to ground water........................ fZq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... 9 -•------------------•-•------••------••----•--....----------•--•------•----------•-----•-•-••--•----........................................................ ODescription of Soil....................... '�v�..........................................................-_..................... x •---•-•••--•---••-•------•-••---•-----------•---......•...y�f�9(l4e G °--------•---------------------------------••----------------- W x ---••----------------------------------------•-----•----------------------...._.....--------•-------......._....-----------------------------------------------•---••----------------------------------- U Nat-.ire of Repairs or Alterations—Answer when applicable................................................................................................ ---•-----------------------------------------------------------••--•--•-••---•-•-•------••••------•--•-•-------•----------------------------•--•----•---------•---•-••••----•-••-•-•---...........---•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance witli '1 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)Den issued by the board of health. /� Signed- -......I.......----r}G�'G�1 -/ �D._--•-----•---....----- %............... ' 7 +' Date Application Approved By........ A. . ...... •----------------------------------------------••-- ............. Date Application Disapproved for Hie following r sons:............................................................................................................... .........................................-......................................................................................................................................---•-•---•-•----•--•---- Date PermitNo.---J_1_3....................................... Issued........................................................ Date -""---------� r� r f. ' ,. err No. = - ---.. Fg ......... THE COP-lMON WEALTH OF MASSACHUSETTS BOARD OF HEALTH .................. OF............ a,... ..... -.. App irativrt for 15hipagal Iforks Toustrurtion PavAit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: cation. d ss or Lot ...... .. ........ .. ... ..... ............................ ...... ..........�............. ......�Qp . to/� Address e� �, . --s4..... ... .......I...................... ...................••••-••..................Address......................................-•.............. nstaller �U Type of Building Size Lot........ 0,.; ...Sq. feet F-I Dwelling—No. of Bedroom _.T...... . ...............................Expansion Attic ( �O Garbage Grinder (.\K) pa, Other=Type of Budding ( ) ( ).. ._ I�'o. �_.e��Scl ns....___ _:.:._. Showers �' — Cafeteria - a Other fixtures .. ` (�3� �--•------- W Design Flow........ ::::.....................:.....gallons per personay. Total daily flow-------- ...................gallons. 0� Septic Tank—Liquid capacity.j_ Z2 ?..gallons Length................ Width..............._ Diameter.-_..-.__-_-_-__ Depth................ xDisposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit ................. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution. box (" ) Dosing tank ( ) Percolation Test Results Performed bY.......................................................................... Date........................................ aTest Pit No. LI..............minutes per inch Depth of Test Pit.................... Depth to ground water........................ G%1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---------------------------------------------------------------------•---------•--------------................... •------------------- .--.-------------------- O Description of Soil--•----•._...--•---....!-4z= U ................•-•-----......--•--•-•--.._...__...._...........•�...dr;tgi1? •.._... -••--.............-•--••.............•---•------------- --------------------------------------------- ---•----.------•--:...............---•-•-•--•--••••---._............--------------....•--------•-----•---------- - ......-•..................=......... 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 NI 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 boar health. Signed--- -- - •-- -- ----- CL.---• •--------------------------------------- ✓Il-�! _.�a,..[.. Z Date Application Approved By... -................................................ -------------- u Application Disapproved for th'e f ollOwa�ly re soKS:-------------------------------------------••-•...............................-••--•......_Date ............• ........................•--•--••-•-------------------------••-••......._...--•---•••-•••••..........•••----•-•-----------•......---•-----•------•---------•-•••--••-•-•-•••.....--••--•-----......•••-- Date PermitNo... ...... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS .BOARD OF HEALTH ". z......... OF........ .............................. ( iifif irate of (lumplianrr THLS WSI CERTIFY Th y}e Individual Se«-age Disposal System constructed ( or Repaired ( ) ..........V' GIs --------------------------.--------._.................................................................................. Installer r. n ,r r r Ott t ! ,ti. a J :; - -------------------� ------=----------<-- ---------------------- has been installed in accordance with the provisions of Article N:I of The State Sanitary Cod, as described in the application for Disposal Works Construction Permit No......................................... dated---.---_-./�-�_0__'_-72__. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GiUARANTEE THAT THE SYSTEM. WIL FUNCTION SATISFACTORY. DATE•-•-Xrj�- --Z=`-� --------.................................. Inspector.----- . *. ` �,/ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No Z.r.. _...... FEE.1 --------- Permission is hereby granted-• ••. =` 7 '•-••-••......•-•--.......... to Construct l ),or Repair ( ) an"'Thdividual Sewage Disposal System atNo..... -x-.. ....._... ........... . ... ......................................................... • Street as shown on the application for.Disposal Works Construction Pei No.. p_�. _..- Dated......1 r r /„� Bard of Health DATE...... . A ------- •.........................:,z FOP.tA 1255`H..? 3Bs V.WARREN, INC.. FUVGLISY.ERS s