Loading...
HomeMy WebLinkAbout0073 FOX RUN - Health 73 Fox Run: Centerville A= 227-155 S M EAD No.2-153LOR UPC 12534 smsad oom • Vads In USA AM) ��� Im{aDYu w immsOiliElIllom �s IOFI vmw r i `No. �� —`� Fps..... . t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1©��'.................OF............ <! ................................... �3 ApplirFation for DhivaoFal Works Tonstrnr#iun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Y �.o OT --...-•-•- .... ......... $------------------------------r--------------------------------- ----- Afjl, »..._. I cat ads Lot No. �Ao��' 166 a3 Ai �09� ems," 3201 1 8"'` O ner ' Ad r ss w N_j&�a� bE EgSY2�s f i�a�A i UUM71CA OAc. UI ��ti a •-'-........ ..••-'--•-------------------------•'•'''-••• '---'---•------...........---•--•--- --..__._.........---......................¢.--------------•._.----------------•.---..-•-------- Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms---------3................... .Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building ............................ No. of ersons.....__.........._.......... Showers — yp g p ( ) Cafeteria ( ) a' Other fixtures •------•'--""-"-'--'-'-•-.... ' W Design Flow..........s ..........................gallons per person per ay. Total daily flow...... ......__._..............dons. WSeptic Tank—Liquid'capacity15gallons Length"...-.... Width.?'6_.._.. Diameter________________ Depth_....'.'.... i x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area___--__.._-gg.. sq. ft. Seepage Pit No-------J.......... Diameter....r�2_........ Depth below inlet-----4........... Total leaching area.AA......sq. ft. t Z Other Distribution box Dosing Lank ( ) r a Percolation Test Results Performed b ._....__....X�� .............................��� t..l�/C INS- �1J Yr� 1 Date ,.4 Test Pit No. ....minutes per inch Depth of Test Pit... `__....... Depth to ground water_4®N§-_.Zoe. >..(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ............ ..................... ................•-------._.g...... ........---------. ------•--------- O Description of Soil.......Q 2-'-- �UP3SQ t L.--'-'•. --•'-2 � . ..--- A a1>s x _ N V ---------------•----------- ------ ... UNature of Repairs or Alterations—Answer when applicable_____________________________•_.............................................-_................. ..•-'--'--------'--'-•-----•--------"---•--'•'•-•-'-'-'--•-•"----•••'••--•••"'...'-•.............'-'•"""'•-•'------------'•--'•'---•'-•......................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal Sy em I accordance with the provisions of iI'i U 5 of the State Sanitary Code— rsi_ ned further agrees of to face the system in o er tion until a Certificate of Compliance has b u t oa e Sign .............. ..... '' J~�241 Application Approved By...................................�£� :'.....h....--'-'-----•---•-------.....•--- ..... . `-='a l- � Date Application Disapproved for the following reasons:.............................................................................................................. » ----------------------------••-----•----•----------------•--•--------------.----••--------..-..-..--------•-•---•---------------------•-----•------•--------------•------•--------------•--•-----•------ Date PermitNo......................................................... Issued....................................................... Date Fms.....� .J" ::.... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH . .........................OF:..................................... Applira#ion"for Uiipau ial Works Tonstrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal -System at: ................--..............................•--------•----•----------•--•-.....--•-•-----••• -•--••....---.....•••-•-----------•••----•••••......-•--•-•-••••-••---•-•-.._...-----.......--••-- Location-Address or Lot No. ......................-----..._............................--------•-r........................... ................................................................................................. Owner Address w Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type 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 capacity............gallons Length................ Width................ Diameter-_-_.---______ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rl, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ----------------------------------------•------------------...------......------........................................--------------------•-•--•----..--.•. 0 Description of Soil.......................................................................................................................................................... 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 TITLE 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. Signed...................................................................................... ................................ q x " j� �1 Date f Application Approved BY _ul°"CL.............. Date Application Disapproved for the following reasons-------------------------------------------- ----------------- -----------•--------------••----•----•••••- -----------------------------•-------------------•-•---------.....--------...-----------------------------••---•--•---•--••-•-----------•••--•-••--•--••••----•••••----•-------••-------•-•••---•-•-••-- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS z BOARD OF HEALTH ..........................................OF..................................................................................... Tntifirate of Tomphanre THLSIS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.............. -•-------------------------------------------------------- -------------------•----•-------•---...-----------...........•.....-•----------------•--------- r_ Inser at---------L=:(--.....` ------. .....k►.r\....... +�has been installed in accordance with the provisions of TITLE 5 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 CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL F N �TjION SATISFACTORY. DATE..... - -sue✓ Inspector----------- - ------------ ITHE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -• ...........................................OF..............................................._..................................... _ -- No.. '...�...!` FEE..... ?......... Disposal Iforks Cans#rnrtion amit Permission is hereby granted.......... -------._ to Construct ( ' or Repair _ ) an Individual Sewage Dis osal System atNo...........L,2_74:=-----�--...-- - -------------------------------------------- Street as shown on the application for Disposal Works Construction , 't No`�_�'`�1.9--- Date .._ g __ _. 1 ^� Board of Health DATE ..��.f..l. ........................... FORM 1255 A. M. SULKIN, INC., BOSTON s:3v - R ;30 r Fr :: (L ; 30 - 2 :ov } 7A OA47-4 U c 6 Soc2 Cx,cL ►�a► >.i.i SIT, 22G Is-i: GZ Z I s - Us GPI 1135rO, 1,0 d.� PRER SULLIVAN 1ARD Na, 2973 ati' '� . CJ. No.24043 fir, Z• t 5•£�5 -�" Sub _ ( f<" /�/r/, •.,. 1 CL. 1000 AM, BOX 11 GAL, :, Y: 34r0 98.(c 9�,�. C.E2T/F/EO PLOT .rr. C11-41V 3 3' SGGL�As f�o� v _ pL.d11 .QE�E.2E.VO� j I GE,�ricy T�'.QT Ts/E_�1���-�iaC•� S�/aW.V �"�� /•vG. AiVv.fE'T�A�,� ,2EQv/,�'E�IENTS d� Th'� ,2EGisr�.ec�.GQ�✓o sl�,2riEya,P� TOX/it/ OF A�c„�ST,�BLE. Alzl A 114 C? '4"Z9•$j U u,�%�� T//!s,a[,e v /.S AloT ZrA.<60 GIv.4 AX M-"$7.Z,-'- -41 E�✓r-.Sv,2 C fI Y,4N0 T,�/•E o.�FS�� ✓`�l fyif/fjiE.e�dN.S.NdI/[-I>�/aT!�E USEp Ta E.s?xl.�L/S,Si LoT-LINES • 3�,294�F 1o2•o 100 g Y �71* 1 o , N ioi •S o a o2•0 /�� L9Acl-4 ; W-A • r� , OF Mf . A. 05 s �i�;• Saco�AR Ul No. 2� BAXTER w No.24W STS �� PLA, M IF-W L0CATI0N SEWAGE FERMI-T 9ov VILLAGE I N S T A LLER'S NAME & ADDRESS c i U I L D E R 0R OWNER . r•, DATE PERMIT ISSUED Au 9 i`� c-P� 5 � --- - -- - - DAT E C OMPLI A N C E I S S UU E D i tc? 0 r 10 I