HomeMy WebLinkAbout0114 CARRIAGE LANE - Health 114 Carriage Lane
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THE COMMONWEALTH OF MASSACHUSETTS
BARD F HEALTH
_.. .. ...........OF...... ..
Applirattun for Difiposat i9orko Tonstrnrtinn Prrutit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
st at: ,
_______ ate
- ation-Address or Lot No.
- - ••V---------------•------------- ----•--•-----------• -•------••---•••-•••--.._......-•---...-----•-•
Own Address
'er --------------------------------- ------------•-----------•----..._._... ---•--•------------ -•--
� Installer Address try✓
UType of Building Size Lot___3&7��-............Sq. feet
Dwelling�No. of Bedrooms.__ __----------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Buildg ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures
-------------------------------------------------------------------------------------------------------------W Design Flow__ _____________________ ____ allons per person per day. Total daily flow._...___�_ _________gallons.
WSeptic Tank Liquid capacit' ____ allons Length................ `��idth.........__.-__ Diameter___._________._ Depth__.___________.
x Disposal Trench—No.____________________ Width_______:____________ Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.______:_/___.___.__ Diameter_ 0`'cl"�.. Depth below inlet____________________ Total leaching area_,��_ -'.sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date----------------------------------------
0_� Test.Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
(14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water___-.________________-_-
--------------------------- ----- -_:---------- --------- ---•-- --------•- -------- ------
O Description of Soil................... •••--•---=-•.
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 aI of the State Sanitary Code—The unders' ned further agrees not to place the system in
operation until a Certificate of Compliance has be by the boo r kohealth
. '
igned-- - •••. •-• --- •--_------
_ Date /
7-
Application Approved BY -• ------.-- r .....
--- •2 -{ 2
Application Disapproved for the following reasons------------ ---------------------------------------------------...................................------------
----------------•---------------•---•----------•--•--------------------••-------•••••--•--
Date
•` Permit-No........................................................ Issued.-P(4__
Date
--- - �_ -. .����W��. ����__�_•_•_ __ -..--_•___-___--_-- ---------------I
FEs...f
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OE HEALTH
__OF.....i).°
AvArttt on for Disposal Works Tomitrurtion Vermit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
Syst at
..,�.-----------------------------------------------------------------
f Location-Address or Lot No.
ak
Add
rm
--A- ------------------ .
nst Her ,v
Address •°� 6r
Type of Building Size Lot_- -,S"-- Sq. feet
:M . - -----------
.-� Dwelling�To. of Bedrooms------_ ____________________-----------Expansion Attic ( ) Garb ge Grinder ( )
aOther=Type of Building --------------------------- No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures ---------------------------------------------------------------------------------------------------------•-------------------------------------------
W Design Flow....................... '' ;:._., allons per person per day. Total daily flow........ _ _-___--_--gallons.
WSeptic Tank�Liquid capacity *'*allons Length................ Width--.-_-----..-_-- Diameter__---.-....____ Depth-------------
W
x Disposal Trench—No. .....................Width..................... Total Length.................... Total leaching area--------------------sq. ft.
�. Seepage Pit No........I........... 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...._--________--_---.-.
fs, Test Pit No. 2-..............minutes per inch Depth of Test Pit.................... Depth to ground water_-______--.--_--__-_----
I -------------------- • --- .----- /
O Description of Soil........................................ ! •-
x
$ t'fir:; -x {
w
-------------------------------------- -----------------------------------------------------------------•----------------•-•--•--•-••----------------•-----------•----•---------------------------.....
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 under gned further agrees not to place the system in
operation until a Certificate of Compliance has b i t, d by the bead4 health. -
Slgned � t • "---------- ---................... -------------------------------
" Date
Application Approved By...... - .. -�' ' --
Date
Application Disapproved for the following reasons:........................................... ............................................................
•--------••--------••-------------•----------------•-----•--------•---------•-----------.:.---•--••----••--•--•--•---•-----•-----------------------•---------------•-------•----•-----------------------
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH.
k"ertif iratr of Toutphatta
THIS IS TO by k CERTIFY„That the Individu (I�Sewage Disposal System constructed "") or Repaired ( )
-.............................
I t� jy}[y Ins alley �''*y r
............... »..`_.. .� _ Y .__ '• -�_..! '____ ._. ` .__q: `"_._._._.._._.__...
at -
- ---- -- ---- ---- -----------
has been installed in accordance with the provisions of Article XI of The State Sanitary Code as desc�ed in the
14
�, �.
application for Disposal Works Construction Permit No._.._�____.�.......................... dated.. . ':..____. ::: .......-.........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT TIME
SYSTEM WILL FUNCTION SATISFACTORY.
DATE...................................................-------••-----------•------- Inspector---------------------------------------............................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
! 1 l I I
1. ........ .......................OF....' .: p F ._..........._........... 1
Nw. ...a FEE...... ...........
�i���a��tl �r�� C�,atc�trrti�tt e�ittit
Permission is hereby granted..............". _ !� .- .
.................. ......
to Construct or Repair ) an Individual Sewage Dispos;.) Syst&
at No.-• >1
1 6 Street
as shown on the application for Disposal Works Construction P I Nod ___. _ .. Dated----- - .-- .>•.-
..
a Health
DATE.. --- -- r
FORM 1255 HO BS & WARREN. INC.: PUBLISHERS