HomeMy WebLinkAbout0022 JANICE LANE - Health (2) ��� J 3 ��� a�3
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THE COMMONWEALTH OF-MASSACHUSETTS
BOARD F HE
ALT
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Lcazzv.n...............OF..... .. . ..: .... .. ... ._... - --.............
.........
AvOrntion for Disposal Works Tousfrnrtinn Prrutit
Application is hereby made for a Permit to Construct ( j/�or Repair ( ) an Individual Sewage Disposal
ystem at:
�-......... n_.G-........................................ -------------------------.................................................
oration- ddress
/ /- or Lo
�. ,��y) OJwne� Add `ss ,,'p W �'" /��t�f J-.l-t/.:i_'_T'"\TSi __'_."".sGr_•. .� i�LL CL.♦� dI�Y e 14 Installer Address
UType of Building Size Lot.77 3.. -------Sq. feet
�-, Dwelling—No. of Bedrooms.__-_-_---- 4'.._ _.__..Expansion Attic oo Garbage Grinder ( )
aOther—Type of Building No. of persons_----- .................. Showers (A'O) — Cafeteria ( )
Other fixtures( 12 �t �I t 11A y---- ------------------_--------"•---•---••-----
W Design Flow............................................gallons per person per flay. Total daily, flpw____............._..__._____................gal�ony,
P; Septic Tank—Liquid capacity/Ma--gallons Length_. _... Width_._�_��'__ Diameter________________ Depth_��/-
---
W Disposal Trench—No....../............ Widthajz/ . Total Length... ----- Total leaching area---- __
Seepage Pit No..................... Diameter.................... Depth below inlet..........._........ Total leaching area_..__________._-__sq. ft.
z Other Distribution box ()<) Dosing tank ( )
aPercolation Test Results Performed by-------------------------------------------------------------------------- Date_---------------•-----------------------
Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water.__:____-___-_..____._..
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water___________----._______-
------ ------------------------------- ----••---------------- -------------------$, ---------•----------------
Description of Soil--------------IA - ��U��'--------------9 fP --���:_�'_..fl�l�S -----a------------------------
W
x ------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------------
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 boardd o. �th. of
Sign d 1� �� -•------------- `� L`--- 7
Dat
1�/e&A,7 Application Approved G �/ �' -=-" ................................................. ------------l� 7-23
Date
Application Disapproved for the following reasons- ------------------------------------------------------------•-•----------------------------------------------
.....------•---""-"••-----------""•--•-----------"----------•-------•••---"---"-----"-""---•---••-----------•--------•----•------"•----"--------- ----------•----------------- .
_ Date
PermitNo.------ ... ................................
Issued.......................................................
Date
.............. FER..............................
A THE COMMONWEALTH OF MASSACHUSETTS
X
BOARD QF HEfflTp
OF......K��.. . ..: - - I te-
.... ..................... ................................I......................
Appliration for Elispotial Rlorkti Tomitrurtion Verutit
Application is hereby made for a Permit to Construct ( k/ or Repair an Individual Sewage Disposal
System at: *-
's 14
...........................................................................4-------- --------------------"----------------*-------------------- -- ------- ✓--------
/)"o 1--kole 1�gation-4Lddress I:f
.......................... ....... 0'r 17-------
ner Addiy-lss
Z 1 0 oq? - ) *t7rf Aae?? ?:?...............V-- --------------------
......................................................!!_ ..W4............................... ......
Installer Address
Type of Building Size Lot_77,3.4.......Sq. feet
U
Dwelling—No. of Bedrooms-_ ........ .......6y......3......Expansion Attic Garbage Grinder
00
—Type of i .... Cafeteria Other Build ng .... No of ersons 3. .............W. hower
, ( t,
_C
a
2 Other fixtures --------------------------------------------------
Design Flow................................ --gallons per person per Aay. Total d 1) fliDw--------------------------------------------&.�jjon_%
W
Septic Tank—Liquid capacitAea.gallons Length-.;?.; ..... Width__- Diameter------.---_____ Depth-- ---44'
0,
Disposal Trench—No....../............. Width.-41-1/.. Total Length___...)30.. .... Total leaching are,_.Yb.0....sq. f t.
Seepage Pit No____________________ Diameter-___-___-_----_--_-. Depth below inlet..______-._..._._._. Total leaching area..................sq. ft.
Z Other Distribution box (X) Dosing tank ( )
Percolation Test Results Performed by..........................................................:............... Date........................................
Test Pit No. 1................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 water..._....._......_....._.
----- ----------------------------------------*--------------------/-------------P--------I----------------- ----------------------------
01 ------ �7.... A� '0
Description of Soil-----------------` ......;...... ................ ............................................t--------------------------------
U .........................................................................................................................................................................................................
W
Z --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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 beep,issued by thej2oard of`h�Oth.
���/LS /� :
... .. ...................Signe ........ ............... ...
11,o. Date
ApplicationApproved By.... .......................................................................................... -------------------
Date
Application Disapproved for the following reasonsIll............................................................................................................
.........................................................................................6...............................................................................................................
Date
PermitNo.------. 7.!) ---_------------_--- ------ Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.............0 F..............
................... ...... .............................................................
Q'Infifiratr of Toutpliatta
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired
by................ ,f- Z_4r . .............--------------- ..............................................._..........................................
at........... ......... ........... Installer
_X, e— , /� y
.. ................... --------- .
---------------been installed in accordance with the provisions of Article XI of The State Sanitary Code as describg,-' in the
application for Disposal Works Construction Permit No------------,92- -f�. ............. dated-----------!��- ------ ---ZZ-------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No........ ..................7e�, ......�OF.......................................................r........................... FEE........................
Permission is hereby granted............/�.......Z 7 �........................................ ..................1....................
to Construct or Repair an Individual Sewage Disposal System
at No........L�12:: Z.......Z............. y "S
Street
Zl- 7 - 23
as shown on the application for Disposal Works Construction Permit No.---_ .---7-----?._4----- Dated----------- ............................
...................................................I---------------------------------------------------
Board of Health <
DATE.......................................................:........................
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS