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HomeMy WebLinkAbout0068 CAPTAIN ALDEN'S LANE - HEALTHr N0..- •- .- ,.3 Fps:.'2s .... THE COMMONWEALTH OF MASSACHUSETTS BOA F ' OF HEALTH ! ..............0F.......Z3..t4.JR.N-_-Z-.T.." _8 , pplirtt#iun fur Bispatial Works Tonti#rur#iun Prr�ti# Application is hereby made for a Permit to Construct (LI or Repair ( ) an Individual Sewage Disposal 00....stem at: .. — ... ............ .--• ----- .--- •............................. oc n Add s - or Lot No. r wne � O Address ............................. 1 � -----...--------.....------------ ..... ..�11��: ------------------- Installer Address UType of Building Size Lot.�-r224rO---------Sq. feet Dwelling—No. of Bedrooms...........................:................Expansion Attic ( ©) Garbage Grinder (1ve)) �'4 Other—Type T e of Building ......._. No. of persons............................ Showers YP g ------------------- P ( ) — Cafeteria ( ) 04 Other fixtures ........................................... ! R.try spa --� W Design Flow_.__...../ .......................gallons per por n per day. Total daily flow........_.-t_-,. b.o..................gallons. WSeptic Tank—Liquid capacity jam?gallons Length ..",9r.-"_. Width.`<?0.4. Diameter................ Depth,. Disposal Trench—.No..................... Width.................... Total Length..................... Total leaching area....................sq. ft. Seepage Pit No.........e!�___-__-- Diameter.................... Depth below inlet......`...__.. otal aching area_.P5Z ..sq. ft. Other Distribution box (� Dosing tank ( ) d �-=� Percolation Test Results Performed by_.A W N-!A1_>-..A.:.A._K 664,&t ....&S Date....AN-o-u:....IT�__/$ Test Pit No. I---4._!r.minutes per inch Depth of Test Pit.✓_-r._..... Depth to ground water..d.tc��t.�=....__. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 •---•-----------------------------------------•--•---------•--.......----------....--•-•--•----.........--•---•------•-----••-•---------..............---•--. O Description of Soil------... ..-AK.".....-C—jet. t_'&f----AA)Z>-•----..SL?2 _S,0,44�.......................................................... v ..................•---•••-•----•-•--...... '`- -1` f."_../��'AA 1 1 .--------5A.tic . W --------------------------------------------------•------------------------------------•-•----------------•------• I.---------•--------•--••••--------•--•---•----•-..._............---••-••-•-----..... U Nature of Repairs or Alter io s—Answer when applicable_________ ______ _ __.__---------------------------------------------- ..__..-----__. - -•---------------- ----------------- b. � ----------------------------------------.••......_.....-•-. Agreement �� The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in'accordance with the provisions of iITL p 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. Sied---- .-•................................................: Application Approved By........ -__- _.24 Dat 7 t r Date Application Disapproved for the following reasons:.....................................-•----•-----.......-----•--...------------•--....------•----•--- --------------------------•--•---•-•----••---• ---------------•-••--------------•--------.......-•------•----------•---•----•-•----••----------•••---------•-----•--..................................Date Permit No..................... ...................•---------------. Issued.----- ---_•'� �` 2 Date No.&2 �!:. V FEE...........::..............._7.J. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ra.w.N...............OF...... . . .. . .. ................................ ,���1utt#i�an •fur �i��u��al larks C�nn,�Ixttr#i�an .ernti# Application is hereby made for a Permit to Construct O or Repair ( ) an Individual Sewage Disposal System at: f1f .....fit.,' Z?.46.;:I YL. .... f -=.. ? /�U:L - 'j-t T '�- . . ........... - ............................... � L cation A r ? •� r Lot•No.L1 ._... --.. ... ............................................... .............................................. --- /..... --•---/-. -------- �/�i"j�t�Ai/less S Installer Address d Type of Building Size Lot Z_._ �-f�-.........Sq. feet Dwelling—No. of Bedrooms....:r_�...................................Expansion Attic 1+0 ) Garbage Grinder evo) Other—T e of Building .. No. of persons............................ Showers — Cafeteria Pa Other fixtures d ................................... W -Design Flow.........ZZ0.......................gallons per per• perday. Total daily flow........_ �r.0...................gallons. WSeptic Tank—Liquid capacity/ ._gallons Length ..c!1r__..'_.. Width.!V' o`... Diameter________________ Depth. »-''y-.:.. .x Disposal Trench—No..................... Width..._................ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....__.-l._______.. Diameter.._. ........ Depth below inlet.............. Total leaching area. - ..sq. ft. Z Other Distribution box Dosing tank ( ) b ,/! 1,57 %%z�� Percolation Test Results Performed by.X�QN Atth--A:--.1 .. Date..._1+���!• 1.4 Test Pit No. I.. •.A-~..minutes per inch Depth of Test Pit e!�.n........... Depth to ground water...N.Qiu,r....... 44 Test Pit No. 2................minutes per inch - Depth of Test Pit.................... Depth to ground water........................ ;4 •..-•-- -- - ------------------------------------------------------•.......----•-•--.........---••---•---..............-••-•--••...........---...... O Description of Soil------...0_`_.«A! ."------�&4N.......1QdVJZ>.......saa5�ov' ------------------------------------------ V ------------------ �' = �'` r' ../ 1_�G!1 a41a.? W VNature 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 TiT .._ y g g p y of the State Sanitary Code—The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issued by the board of health. Signed..........................................................- --------------------•---•- ................................ Date Application Approved By.........-_«_:.._.r�� �! ���.!/.a!<ys.::_. !/. cfi=........ �>.. v .................... Date Application Disapproved for the following reasons:................71..._........_..._..__.._..._.................._...__................_...._...._.._....._ •------•------•------•.................•--..........------------•---------------••--•---•--•-------••-••----------------•----------......_..----•---•--------------------------........................ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS ram_ BOARD OF HEALTH . . ......................OF...... /!%'� ........... ............................................................... (Inr#if irtt#r of Toutpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) x, i r Inst at :.�� ` j i FJ---fi(..... ........--•--- flr/` ,�2 " has been installed in accordance with the provisions of TI'TLr. j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated....-__�._` ._:_-... .....___.._._. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........ c(. ................................... Inspector.-------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7� ........OF......... ..................... No.......... ..`/1..... FEE........................ R11110sat Ivor p Tun#rttr#ion ramit Permission is hereby granted.....:....... l�:Ul._.% 1� ......... ..... to Construct (j,�'o r Repair,(,, an I �fivj&al Sew4ke Disposal System / = .:_ ,.:. •' Street as shown on the application r Disposal Works Construction Permit No............... .......Dated.........`!/.^......._....... ...... (� 9 DATE................................._...-----=-••--/-••........................... Board of Health ` FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS t_ 9. NO a T tq .a. 1'�' P ,�►„� �z x L C T. zip �.t i; . / . .7760 V �T Q'f6 if :G' m"�G r 1�C?1t 1�1 la fV f V2.. 4 Fl �j F /..,, r ;. . 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