HomeMy WebLinkAbout0024 SILVER LANE - Health 0 0
No.._ Fixx ........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..............OF......6.
A4",il4Z-4-te----------------------------------
for Rapofial Works Towitrurtion Prrinit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System-at:
V. .............. ....... Z4.........e�a�. ............. ........ ................................................
Locition-Aress .......... j...
......................
e, Address
—----......... .. ----- ........................
Installer Address
ul 44 0 5-
Type of Buildi Size Lot_-,. q. feet
U . --!�............S Dwelling-ONo. of Bedrooms--------------------------------------------Expansion Attic GarYage Grinder
P-4 Other—Type of Building ---------------------------- No. of persons---__-_----_---------------- Showers Cafeteria
Pa
Other fixtures ---------------------------------------------------------------------------------------------
Design Flow........................�_ .____-gallons...per...person----per day. Total daily flow-___.___....t --- -----------------gallons.
04 Septic Tank-4Liquid capacity gallons Length________________ Width----------.---._ Diameter_..-.-..---.---_ Depth----------------
Disposal Trench—No..................... Width_-____--_---``. IL th. ...... Total leaching area--------------------sq. ft.
Seepage Pit No.....I............. Diameter../d , .4,e^e 0614�et....................... Total leaching ft.
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date--------------------------------------..
Test Pit No. 1................minutes per inch Depth of Test Pit.-.._.____---------_ Depth to ground water------------------------
(_T4 Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water------...-..-..------__-
( ......................... ... .............. ..........................................................................................................
. .4g��. ,---------------------------------------------------------------------------------------------------------
0 Description of Soil.....................................�r
X
U ......................................................................................................................................................................................................
W
�ii ........................................................................................................................................................................................................
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 C? e The undersigned further agrees not to place the system in
_ss__u
operation until a Certificate of Compliance has bee blyt e boa f health
Sipe . ... ...... ------ ................................
Dat
e
Application Approved By---------- ------
Date
Application Disapproved for the following reasons:.................................................................................................................
.........................................................................................................................................................................................................
Date
Permit No.......................................................... Issued.---.— 7-3.................
Date
---------------------- ------------- ------------------------------------------------------------
No.--- ---•-•• Fix:... ;t . M
t
THE COMMONWEALTH OF MASSACHUSETTS
BOARD -.OF HEALTH
8... ...............0 F.....
... =----------------------------
Appliratinn for BifiVusal Works Tonstrurtinn Plernfit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
.........A. 4............... =J-I.....3..........................
4tion-A dies or Lot No.
4a>+---•--•---------•--- •-
Owner Address fi
� Installers wdress
U Type of Buildi Size Lot..f..d, �i,7 it)__Sq. feet
Dwelling 4$ No. of Bedrooms................ ................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............... No. of persons............................ Showers — Cafeteria
aOther fixtures ......................................................
w Design Flow..........................tgallons per person per day. Total daily flow......... .-.... gallons.
WSeptic Tank-4 Liquid capacity/ 1tr)-gallons Length---------------- Width----------...-_- Diameter---------------- Depth--...........--.
x Disposal Trench—No..................... Width------------------- tal Length. .___._____._____- Total leaching area-_____._-----_--___sq. ft.
3 Seepage Pit No.....I.............. Diameter./ et `�l�g __...__...... Total leaching area__ _,0-4.,..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_--______:_-__._--------
fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------:__:_:__-_---
ODescription of Soil................................... v--------------------------------------------------------------------------- .............................
x
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 bee•`issl ued by t e board of health.
Sined-_ --------------------------------
Date- - s.+B=--#- --- - - --'-- � -----•
APPlication APProved By..
Application Disapproved for the following reasons------------------ -------7---------------------------------------------------------''''. n•'......--•-----'
.........................................................................................................................................................................................................
Date
Permit No. - Issued " . ----------------
Dat
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............O F..... .. ..............................
CIrdiliratr of Tontplittnre
THIS IS TO CERTIFY, That the Individual Sewage. ' posal System constructed (101501 or Repaired ( )
by....................................................................... -------
- - --------- -
1- 1-46A4aller-
at... --- '"'.. w
has been installed in accordance with t e provisions of rticle XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No------ "______________________ dated---'-.- ���� /ETHATJ_ __..._.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE:CONSTRUE® AS �► GI7e4RANT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE �d ,f -------•---•------------- Inspector.... - ........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD. OF HEALTH
.............OF.. . ............................ 12
.
-
-pa at Mark T ntitrurtiun Prrmit
Permission is hereby granted................................... ----------------------------•-------•---------------
to Construct ( ' or Repair ( ) an Individual Sewage Dispos, System
at No._.. - -----------
/Ilkas shown on the application for Disposal Works Construction Permit No./- ___. Dated _ _. ........
Board . 21th
s
DATE_a'--- ------------------------------
- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ..