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Home My WebLink About0050 FOX RUN - Health (2) F�,,o �ve_u_n . — -1 a`7 --IS 1 S M EAD KEEPING VOU ORGANIZED No. 10334 M 2-153L MADE IN USA GET ORGANIZED AT WEAD.COM ZZTT No... —� E:IBI ........................... THE COMMONWEALTH OF MASSACHUSETTS �`I ; 1 BOARD OF HEALTH -�s 9 1 Applira Lion for Uhipoii al Workii Towi rnrtion Frratit Syq Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal //''''�)/gyJ Location[p�dye�ssry �/►{ ` 1� or Lot No. d,./ Q�.......•_=°•--itt o eJC._l- _ mod.. Owner Address W Installer Address pp�� Type of Building Size Lot }}.. .. .......Sq. f t U Dwelling—No. of Bedrooms.............. Expansion Attic 1 o Gdrb Age Grinder aOther—Type of Building ............................ No. of persons............... Showers ( ) — Cafeteria ) QI Other fixtures ................................. W Design Flow......515-+5CK-------------gallons per person $er dqy. Total d�il ow......C--G-0.....................gallons. W Septic Tank—Liquid'capacitvl� h S allons Length .__. Width... -__ Diameter.------------ -. Depth_.5...8. x Disposal Trench—No. .................... Width_.... _._._.___..... Total Length........... Total leaching area._._......____...._.sq. ft. Seepage Pit No._..._'�..__ ___. Diameter......... De z below inlet.33..t�. . Total leaching area_..�.�...I ... ft. Z Other Distribution box Dos' �a k Percolation Test Results Performed bye_Z;.>U tnt t A?c. ,aa Test Pit No. 1----#4'2-._.minutes per inch Depth of Test Pit.....(Q......... Depth to ground water .. 44 Test Pit No. 2...o4Z.....minutes per inch Depth of Test Pit....10......... Depth to ground water________________________ r- �- •--- ........................f-------------t.------------------------------ �---a--..... Descriptaon of Soil � _ i '1 C��' ...... - -•---- U 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 r1'^ the provisions of TAIL A TLTi� 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-•-----•---•--•- ••------- ,a------------•-•----- •-•----•--••--•-•- ............Da.--------•--•.... Date Application Approved By........ .. ®.._.. .. Date Application Disapproved for the following reasons---- --------------------------------•--•-----------•------•-----•---------------------------------•-•........... .................................................... Date Permit No.----.ag-::..ly k,:::. Issued....................................................... !f Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......... ...............OF........ .Atii 'r ............................... Tntifirtttr of Toutpliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( V1 or Repaired ( ) by---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- at Installer has been installed in accordance with the provisions of TI IE' 5 of to Sanitary de s desc ' e . the application for Disposal Works Construction Permit No. �1-""- r �-- dated-.- -- ( ... ........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GU RANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 9 V j/ a- DATE............................................................................... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH 9.......... .p.W..0.........OF..---....... t?rnal5l- t .......................... No...� �.._._..# FEE.- Bhipoii al Workii Tnnitrudion rrnti# Permissionis ereby granted........................................................................................................................................ .... to Construct ( ) or Re air ( an Individual Sewage Disposal System at No............................ .. ........_p.m......TZt>/ .------- ----C-t�, ..... -V! ----------------------- •...... .......... Streeto.as shown on the application for Disposal Works Construction Permit N ._. _ ated.......................................... ------------------------•---------------------------------------------------------••-•---...---•--..---•- Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS THE COMMONWEALTH OF MASSACHUSETTS BOARD 0 F HEALTH Appliration for Disposal Works Tomitrurtion thrutit Sy �� 6��bv ouu6� �« u ��co�� to ( \A or Repair ( ) an Individual Sewage Disposal Application ' . �� - � Locati Owner Address ---'---------'----'-------------------------'--- -------------------'---......... .......-...------------- ��"�, A�� Type of Building Size Dwelling—No. of Bedro Garbage Grinder Other--Type of Building _-'.---_- ....... No. ofprrv000--.----_--- Showers ( ) -- Cafeteria (� ) Aq Other fixtures -.--.--.----.-----------.------------------_----.----------________ Design per person per day. Total daily flow....... .....gallons. 94 Septic Tank--Liquid capacityA7-ATX_`gallons I.coo8h'�l��-' Widt6':��. �.. Diamozer-.... ��-' Depth....- Disposal Trench--2Jo .................... Width.................. Total Total area. fc Other Distribution box Dosing.tank ~~ ] � � �� [��'�� _ �� z.�..�i�-��i��- -- � Pcncolutiou Test Results Performed by'�� '/.� c ' +- 'ate--- TestPit No. l.-' ��Lminutcs per inch Depth of Test'Pit-.-!L ........ bepth to A7000d water^w---w" L-wuuuu `�� cX4 Teat Pit No. 2....z-"Z=--oiootesper inch Depth of Test Pit-..! ........ Depth to ground water-------_- ........... --' v^'---------'-'- ---'-'r------r-- 0 of [� -.-.-_---.--_-.-_-~~---'�'~=--�=-----_------_.----_-------.-----------'.---------.---'--_.------- -_----------'_-------_--.__---.--___-.__-'-__-_.--'_.__-''---'-_------_____ U BatoreofRepairoorAlterutioo,--Anawerwbeo applicable------------------------------------------------------------------------------ ........-------- -----------'-''----' ------'------------------'----------'- � /^grcro eoc: � The undersigned agrees to install the uforedescribed Individual Sewage Disposal System in accordance with the of��l� �� d� S�� Co�— ��uodc�o�o��so� mo�c 8e ��m � � ^ ' . place � operation until a Certificate of Compliance has been issued by the board of health. Signed......... _________ ............ _ ______.. - � u"�_ �on�ut�oo Approved D]��'��'��'��'��'�.��--_ '�-��[�' '�' -----.-.----____.___ 6/ 11 um= Application Disapproved for the following reasons: .............................................................................................................. ...................................................... ------------- --------------------------------------- ----------------------------------- `--------------- Permit N | a�" | � - � � THE ooMwmwvvsALr* OF wASsAoHussrrs ' BOARD OF HEALTH ..........................................OF..................................................................................... ` Trrtifiratr of Toutpliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by-----------'---------'-------'----'-------'------------------------'------------'----'--'--'------ Installer ut..................................................................................................................................................................................................... has been installed in accordance with the provisions of � d in the ��i�ou � Di�� Wo�sCm�� P�� N-�� ..~.-��---'�--°'��---- ~^~..~^ .;+--.-__. THE ISSUANCE OF THUS CERTIFICATE SHALL NOT BE CONSTRUED AS A G ARANUTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. CATfL---------------------------------------' Inspector.................................................................................... ` THE COMMONWEALTH oFmAssAo*uasrrs BOARD OF HEALTH �_��' ele «�� ^ ��0u_� .--- / --------------� ---- -----------------------' FEs/�-~------- �� D�� rrmit n--~ —�-~-~- ~------'------ � Permission iohereby granted ---.----.-'-_.---------------_.------'-----.--_..-.----.-_-----.----- to Construct / \ or Repair ( ) an Individual Sewage Disposal System _ atIVo........................................................................................................ --' ----_-------.--------- ^�� as shown on the application for Disposal Works Construction Permit N d...-----..-..!. Dotcd.......................................... ---------------'---------------------------------- � Board of Health DATE............................................................................... � • r r' I '00 tiDl , -119 100.1 ` r -�� ,••{~--T' ,:,*. :h�*' -Pi TER ��; � lv.� �'•-- " 0. / I o A. o $ULLIVA 1 CiiiX`fcfl 7(,.'7 �y s A P.o. 2 ,,:3 ,gip V r1w / 10 a ;, o ..--- ....... OD r. ...., PVC 7i� ZG � •9 � 299 '" i 31 S f ' •ti i i I • '.F I ' J , , 27 4 E _.., �� (O v G load I IJ1j• .lb`a I NY I rjolo -r S • '� 3 :GAL 1�1V I u� lal 1� 21 I 2oA 8 20, tub L/O 1 5l 'T i L At :W'- II L TAB _.. G WAI*W CLEAW 20;5 � - ' � 11 , max Pu 1 v C f PaCFl Pro Pose_> S�PT-tG SyS I i 170 Sco/e_.. 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