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HomeMy WebLinkAbout0289 LAKE SHORE DRIVE - Health � ,� T7 No......... F�s..... :s ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAN H /: /1a � ....... tJ /" Appliration for Disposal Works Tonstn.rtiun rumit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: �� 1 .. .. _..• E' ....d �Y e............................ ...................................../Gl✓S.._........ Lo n-Address or Lot - ... .. Owner ....... ------ ----------------------------------------------------- -------- ..... e......................................... Installer I Address d Type of Building Size Lot.27e_�k A---..Sq. feet U Dwelling—No. of Bedrooms........._r�.............. .Expansion Attic/yo Garbage Grinder is '4 Other—T e of Building No. of persons............................ Showers — Cafeteria P4 Other fixtures -----•---------------------------------------- ----- ---• w Design Flow.......��..........•..........gallons per person per day. Total daily flow.............. .:._.................gallons. WSeptic Tank—Liquid'capacityM�q..gallons Length.Za.`r.. Width....6..�.__ Diameter________________ Depth.... x Disposal Trench—No..................... Width.................... Total Length......_.... �..... Total leaching area....................sq. ft. Seepage Pit No....../............ Diameter...... .......... Depth below inlet.....dry....-.......Total leaching area.a.?.!....sq. ft. Z Other Distribution-box Dosing tank (XP Percolation Test Results Performed by..___._ r_.........r'±__ ✓.._----Z.. :2�............... Date......... a Test Pit No. I...&o.Z......minutes per inch Depth of Test Pi ....... .:..... Depth to ground water../.Yo..6,,, , � - Gi, Test Pit No. 2................minutes per inch Depth of Test Pit-------- Depth to ground water........................ u+ ----------- j 0 `Description of Soil............. Qst..�...... ......... G------•--------• ......------------.--•----. ---------- -----.......------ x U ow 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b4en issued by th of health. Si d ................. Date Application Approved By....'�,P� •• -----•••--- ............................... x Date Application Disapproved for the following reasons:----•---------••----•-••--------------------------------------•-------------•--•-••-•--••-•-•...•-•---........_ -------•.........................•-----------------------------•-•--•----------------------•---............----•---------------------------------------------------------•---------••--••-------...._.__. Date PermitNo....................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH :....... ........OF...............: '... ..................................... Trrtif irate of Tuntplianrr TH I/, T ERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by.. sti.: Inst /.x� — has been installed in accordance with the provisions of Tod-a5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._ ....��. ................ da.ted__... __`.t ". .........._..•._... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... 1'7 FEic.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL ....... ................OF......... ...... ............. ................ �vvftrafton for Disposal Works Toutitrurtion Vamit Ajp lication is hereby wi�a%e'Y for. a,Permit to Construct Kor Repair an Individual Sewage Disposal Syqtem.qt: N tilt e JAVIer....Pkl.y.e..................................... .................. ... .... ... .. .......... ......T7hy On-Address e " or Lot Ngl� e � 02 or L ....... ....................... ................................... ................................................................................................ Owner Address .................................................................................................. Installer 7 Address Type of Building Size.'Lot.......7,..A../Aw.Sq. feet oms.........S!�!............................Expansion Attic#0 Dwelling—No. of Bedrooms...._.... Garbage Grinder (Xcp P4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria P4Other, 6xtu es ................................................................................................. Design Flow------- gallons per person per day. Total y ......................... - - Y. - ------- -....q..gallons Length_r,(.!r... Width:_....,.._ Diameter________________ Depth::..-."..-- Disposal 6.­".... 9 Septic Tank—Liquid capacit/ ------ Disposal Trench—No. .................... Width -1-------------- Total Length...........,"I..... Total leaching area....................sq. ft. 3 Seepage Pit No....`1............ Diameter......!9'- Depth below inlet...:A.......... Total leaching area: V./....sq. f t. z Other DistributionDosing a box 19 t _Percolation Test Resulti, Performed by. ..._!_"__.. ......... ........ ... Date....... 1-.4 1� .. .....0................ Test Pit No. I...05t......minutes per inch Depth of Test Pi --------0-*....... Depth to ground water_............�"�._. Test Pit No. 2................minutes per inch Depth of Test Pit...__.........._.... Depth to ground water.....................__. i-------------- ------- ------------------------------------------------------------------------------------------- 0 Soil._ ........................ Description of S I-------------------------------------------------- ------------------------------------------------------------- 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 T IT 1Z- 5 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. Si jd*............................................................................... .......................... 60-.?-;YK o. ApplicationApproved By../e....................................................... ............................... ....................................... Date Application Disapproved for the following reasons:............................................................................................................... ........................................................................................................................................................................................................ Date PermitNo......................................................... y IssuedL...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH at a ..........................................OF........... ................. .................................................. Tatifirate of Tompliaurr FY, That the Individual Sewage Disposal System constructed �) or Repaired by.. ......... ... . ..... ..... .................. ... . . ..... .................................. a)�-----------------------------7-------*"-------*----------------------------------------------- ..........---_------------ -------------------------------------------------------- has•been installed in accordance with the provisions of f The State Sanitary 92dyz in the application for Disposal Works Construction Permit No......................................... dated-............................................... 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 C?V HEALTH . ............. ............. ......................0 ........................................................................... No......................... FEE........................ Map 5 tnodrat ion ,Vamit Per'miss* 1 hereby gryted -- ----- ....... ........................on s '/---------------- 'S. t to Con n In is ;6 -/- Y, AA"Qr RV V1 t�-' IV r A atNo............................................................................................................................................ ............................------------ Street . /'/"j A zr- as shown on the application for Disposal Works Constructionit No-------- Dated rml .................................. ...... T.... ............................ .................................. .................................... Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS VA s SyeA / Ly _ J��L�u- , A61- 41 Goo/� �y - J 4:oGA��, �. �.� ,� -�- -.�.�. .�,t ��. s F 14 s -5-/7 o w n 0 77 ')7 � o/ u.t i� Co^/s TIES 11 C �-t o 9 /� prove 6, ,�a•Y n ?t�,6 /� t C ? 4 9 79 ✓? r0 o 7-r7 ,�oa vcl of HP l r� z 2�h 1Ala. ho f / 7 C9)77S .7'f- J,4G J/�� La J� rat 11 /�R,�sS. Eli V/I�o77 ��E� I�4a..ale- e jlz 1 �,Q,4J1/, 4 i a V, } V j .0 Al a =-l--- ti I � 1 { o h -9 E PLA `!�' ow LA HO MASS iell k 4fOWNED BY { �F` r, •, ,�'O ,• �L(M OF Mks �a OF NK CONERY 5 TRENT(M ST, o� ,#' FRANK FRANK �, HYANNIS. MASS. OW S s c� !C/- .5 C Ale r 3"7 a �t .4 CONERY o CONERY raIVMD ZNQTH caR a LAND SUMtVOP L / No. 6573 No. 6232 40 90� GISTE c�� crsTf.P p' LE t tW �� 1R'. c 1 Z1,78 FSs70Na 4No su��'y .5724%