HomeMy WebLinkAbout0153 OLD JAIL LANE - Health i
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LOCATION A 1��� g SEWAGE PERMIT NO.
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VILLAGE
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INST_A LLER'S NAIVE 0 ADDRESS
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BUILDER OR OWNS
DATE PERMIT ISSUED ,
DATE COMPLIANCE ISSUED �/ �
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No(% � �:... B., FEB...............
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® .OF HEALTH
Q. .......0 F.......13. . .N...S. f...�L.�...............................
Appliratiou for Uhipwial Workii Tomitrurthitt Urrutit
AppliD10
by made for a Permit to Construct (tL4 or Repair ( ) an Individual Sewage Disposal
System at: _7F—OU2
4 ....�i4�! .1 A^j . f. . g� ---------------------------------------•---•-------•--• -•----•-----------.
Location-Address r or Lot No.
.r.
-RAY. i 2 14 . as�
f._ .......................
........ -• Owner ------•------------------------- .. . Y�
Address
�.e ............................... ..••--•-----.........................•. �---...------......- ......--••-^---••---
1.4 !!�
nstaller Address
Pq
Type of uilding Size Lot____3'.................Sq. feet
V Dwelling—No. of Bedrooms________________- ___-_______---_____.___Expansion Attic ( ) Garbage Grinder
Other—T e of Building ---------------------------- No. of persons___________________________ Showers — Cafeteria
P.' Other fixtures -------------------------------- -
---------••-------------------------------- -------
W Design Flow...............S_45......_......._......gallons per person per day. Total daily flow...........4.�O...................
WSeptic Tank—Liquid capacityISPILgallons Length................ Width................. Diameter................ Depth.............:.
x Disposal Trench—No- -----------------•- Width....................Total Length.................... Total leaching area....................sq. ft.
i
Seepage Pit No.Z.9'�--____.. Diameter/0............. Depth below inlet.... Total leaching area.!?®2....sq. ft.
Z Other Distribution box ( Dosing tank ( )
'-' Percolation Test Results Performed by------- ...... ............
,aa Test Pit No. 1__�_.L -_-_-minutes per inch Depth of Test Pit---13'--------- Depth to ground water---Ajon-.e'........
(T Test Pit No. 2__4Z------minutes per inch Depth of Test Pit--- Depth to ground water---&,QAet-------
-------------------
-----------------------------------------------------------•------- ----------------------------------------------------•--------
......
0 Description of Soil.A..... %�. LP�p2 U ��CC------ �:. �✓ A�� �✓1L!�[?1...._ R �
W ,/� �"',gl_ 2 � r�un�_t' / �rp
U U Nature-e€- }jai — .ns a he a o
a►
--------- lJold
Agreement: e�� 21 6d2G'/��p un. . �vf'✓ ,r C'dJ2s
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of i T T Lu p 5 of the State Sanitary ade—The undersi.�}ed furtl er agrees not to place the system in
operation until a Certificate of Compliance has bee i sue y�tsZ
o �ai lth.
_
S' ned ................................/
Da e j
Application Approved BY , ..._._-�`...�: �---------
Date
Application Disapproved for the following reaso s:----•••--------------------------•------------...-------=....................................................
.....................................................---------------------------............--------------•-•---•-•----------••----...-----•-----•-------------•---•----------•--••--•------•----•_..._
Date
Permit No......................................................... Issued_...
. ........................ .............
Date
•CQ
No.---.....- ........ FFm.............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF,`HEALTH
V N.'V_ ............OF....... 11 IV..5 7A 731
.. ..........................................................
Appliration fur Uhqpasal Works Tomitrurtion "amit
V
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System.at-
....... ...... ............................. ..
............... .......-;.V.... ......1�23Q.OK_Z�........ '0
..on
Loca on-Address./ or Lot No. ..............
.......... ........... ............................ o V A 2� ........................
Owner Address
............... .................................................................................................
Installer Address
,1Type of Building Size Lot...3Z,�e.........sq-�
Dwelling—No. of Bedrooms.__._____. .............................Expansiod'Attic Garbage Grinder V-65T
A4 Other—_,Type of Building ............................ No. of persons.......Y................... Sho�rers Cafeteria
Other fixt ............................................................................................................................................
Ures --------
-5 2 Design ;.Flow____. ________________________________gallons per person perwday. Total daily flow............................................gallons.
ptic,.'Tank—Liquid capacity!PP..gallons Length______
I....... Width________________ Diameter__._.___.__.____ Depth________.___._..
W SeDisposal Trench No..................... Width y ................. Total Length Total leaching area....................sq. f t.
Seepage Pit No./4.9t:L Diam&e/ ............... Depth below inlet_ Total leaching area.P�!?.....sq. f t.
Other Distribution box Dosing tank
Z -------*)�)
Percolation Test Results Performed by......4P4J�A.7_>...../K 9! ............. Date..7�!
�4
Test Pit No. I minutes per inch Depth of Test Pit.. Depth to ground water...NO
Z2;------- . ----------
Test Pit No. 2...............minutes per inch Depth of Test Pit._._....____..______ Depth to ground water.-AVA4147......
0 ------------------5........... ....................T....;0*............***-----------------"------------7----------------------------------------------
Description of Soil... .0 -V8 ' 6 04 M-/ 4,-'- !r,014, OeS /............................................... .....5,4N-lb
I E;.... 4*./#f Z 00
W I I w- a- 5�"a'h', -------------V----I-------------/---/---- Neoi 0
U ........................... .........................................................................................._4......................................A-----Aneke
.............. ... .../V9 - ------- ----- A ........4�,
-------------- I I .u Nature sw r er L ...
a
............. . .. ...... ....
------------ ri
------------- ---------------11 Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T-7 T L- 57of the State Sanitary de e unde as* ed further agrees not to place the system in
operation until a Certificate of Compliance has bee i sue b o rd', f Ilieth.
.. .. ... ... .......... ..... ................ ...........I.....................
jeaT.0
Application Approved By-,�.. .... ...... 4............................... ........................... ..........
. 7
Date
d�following reasons:................................................................................................................
Application Disapproved for,
............%..................................7.........................................................................................................................................................
Date,
PermitNo......................................................... Issued_........................................................
Date
THE'`COMMONW EALTH OF MASSACHUSETTS
BOARD OF HEALTH
a VV
a - 0;r............................... OF............../V& .5,�,.!12? ..4.......................
T-pWrtifiratr of Toutphlaurr
THIS IS TO CERVFY,,iThatthe Individual Sewage Disposaf�g$#ystem constructed or Repaired
by........ lifyrw.AV 5r;1 f-r-If .......................................................
................... ............ ....................................
71 ........V!, 1*44V
taller
.0
.Za er
at................................................ ........ A....................... . .............................. ...............
_`9------------- ....... .......................
has been installed in accordance with the provisions of " f The State Sanitary Code as d bed 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 FUNCTIOI� �ATISFACTORY.
DATE.................7-\-F 14-1d
......�I�f-----------------
........................................-------------------- Inspector.:.. ........................................
THE COMMONWEALTH OF=MXSSACHUSETTS
___-I-,
BOARD OF11HEALTH
,.
le .........OF ........................................... 13.0
No......................... FEE....._..---.........:...
Uisjlaqr�
Permission is h b granted......- i ere y ..;j'A ...............................................................
. -.................
01
to Constry! o�,Repair an In' idual,Sewage Dflosal System
oe-, p - 4 r
at No........................................................................................... ...A.!.Je.z
Street
as shown on the,4pplication'for Disposal Works Construction Pe �-J
'Rnit X Dated_.____._____.__ ...
AOF� AV ................
....... .....
..................... oep------I....
�Board of I &th
DATE-.-- ........;R
.....................................
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
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