HomeMy WebLinkAbout0135 CAPTAIN ELLIS LANE - Health (2) SJ C cz p-e c-
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No........�f�A..... r Fimic ,ll!....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O I-�E LT
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t'N�Se • Appliration -for 43hiposal Works Tonotrurtiou Vrroiit
i 3 S Application is her `made for a Permit to Construct (` ) or Repair ( ) an Individual Sewage Disposal
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ddress or Lo 0
..........". •.•..... -•...................... . .....••. .............. ...... . -••---: IC�!. 4 - •- •----------•--•----
Own Address
W '... 4t•c ................. .....• f---- 0�` --------•-•-
Installer Address
QType of Building Size Lot......... .................Sq. feet
U Dwelling—No. of Bedrooms .. --------------Expansion Attic ( ) z bage Grinder (we
ier=Type of Buildin C� _. o. of persons___________________________ Showers �6) — Cafeteria ( )
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Otherfixtures -- ------------------------------------------------------------------------------------------------------------------------------------------------
W Design Flow-----------s�: .......................gallons per person per day. Total daily flow.......... .Q..0.....................gallons.
WSeptic Tank—Liquid capacity/AP_�rallons Length-------_------- Width................ Diameter_._.-_--.__-_ Depth................
x Disposal Trench—No........... ........ Width........__......___. Total Length-------------------- Total leaching area....................sq. ft.
Seepage Pit No.._./.Qa iameter.................... Depth below. inlet__________-.--_----- Total leaching area.-__.-_._.__--_---sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) 6)h— f,2 V-7G
aPercolation Test Results Performed bY-------------------------------------------------------------------------- Date--------------------------- -----------
,� Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water...-----.----.-__-.-----
r3;4 Test Pit No. 2................minutes per inch Depth of Test Pit._---.---.._______-_ Depth to ground water------------------------
--------------------O ' � `o . �escrtonS & ' - 1 .=.A
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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 \I of the State Sanitary CO — The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been is ued by the alth.
Sign -- '``! -------------
Date� -
Application Approved B --- - - -------- -- ----- ,........ 1-Q ....
PP PP Y '`� l.e
Application Disapproved for the reasons:.-•------•-•------••----•--/--------------------------•-•---------•-----------------•----- Date---------•----
Date
Permit No. Issued ----•-••• --- -•••--....`
Date
�
07�
No......... '-- / ^ " Fwic ~�~=
THE COMMONWEALTH opmAssAo*ussTrs
. ���`��� ���� �� ��
, BOARD
----�/ .......OF .-------
Application is her y made for a Permit to Construct or Repair an Individual Sewage Disposal
'��wx .
Installer Address
Type of Building Size Lot----------------------------Sq.
Dwelling-No. of Bedrooms,/--------- _Expansion Grinder (
Cinpoau Trench No Width-------------------- Total Lcogtb -----_- Total leaching area-------------------sq. h.
Seepage Pit N bel 4rc ------------------sq. b.
Z urucr Dosoioozmo box ( / Dosing tank
'- Percolation Test Results Performed 6v......... ---------------------------------------------------------------- Date........................-.---'
Test Pit No l................niootesperinch Depth of Test Pit-.--_-... Depth to ground water -------
44 of
Ix
[) es t' f S i1____ ---- -------4
-_.-_----.---------'_-._-__---_--.-'--------'-_.___'-_.--------'---..-_--'
U Nature c6 Repairs orAltorn6ona--Auowcrw6eouonicable-------.--.-----._-.---------------
------------''---------'---'-'-----------------------'------------'-'-
Agrxco`roz:
The undersigned agrees to install the uforcdexcribcd Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Cod'- The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been is tied by the board-cpffFalth.
Date
---------------
Date
---.---.---'--_-'_---_-_'_.-----'--'--------------._-._-----_----_-----_---
~~`
PermitNo......................................................... Issued..................... ..................................
Date
THE COMMONWEALTH orwAssAo*ussrTs
BOARD .,PF HEA T
...........OF.....� ----------
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V��rtuforwu�� v�� ��11*4�pliaurr
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has been installed in accordance with the provisions of i eXI of The State Sanitary Code as described in the
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS AGUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE........................ Inspector....................................................................................
'
THE cowMowvvcAcr* or mAseAc*ussrrs
BOARD
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as shown on the for 7,1
runM 1255 xonnsaWARREN. INC.. pvoL/yxcns
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i CERTIFY THAT'-THIS Fi�W $Hc.�WS
�IE ACTUAL. OCA`tQ- N-OF` THE
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STFZUC*tU,R Cal ;T L.f i�f G AND
THAN if
r tONFOOM WIT H 'TH
,, PLAN, of A D
_LS 6 THE T"0dN
y
1744 t ,s MASS.
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OWNED :BY
�j p A!q �N Ot Aq�� J49-z5 r-- *Wli
FRANK CONERY 5 TRNI`ON S' .
g tat�t+c FRANK q HYANNIS, MASS, t 1
o � a LAIDGONERY REGI CA6
COHERY �V
'Ho 6232 Q ��No. 6573 Q �
SCALE t tit a rF r e 1,974
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