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Home My WebLink About0333 GLENEAGLE DRIVE - Health (2) 33 ten eat. Q�►- i��,-� CGS-, N SMEAD KEEPING YOU ORGAN17ED No. 10334 2-153L MADE IN USA GET ORGANIZED AT WEAD.COM r No. .�7. .......... Fimic-_.'2................... THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH rT � `1 �. fl/L...............OF......... .. ..-1. u.. Appliration for ]Niivoiial orkii Toustriition.. `prgit l Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at /J�(_J sY---- ---------- Locat' Address o t No. r/ Owner, .. ZX _:.......--- ..-•--•.....................................Address..-•---•........................•.. ... Installer Address d Type;of Buildm Size Lot............................Sq. feet Dwelling y No..of Bedrooms____._=' :. .__......Expansion Attic ( ) Garbage Grinder" ( ) �.. • aOther—•Type of Building _____________'`___.'_______ No. of persons............................ Showers ( ) — Cafeteria ( ) Q'` Other. fixtures . ` --------•-- --••--•----------------------------••-......---------=•_• -------- W Design Flow.................. b __gallons per person per day. Total daily flow.., Gl----'7..................gallons. WSeptic Tank�—Liquid capacit/.-___ gallons Length..............::Width---------------- Diameter................. Depth................ x Disposal Trench—Nd..................... Width...... __._: _ .. yof "iet____P, _.. _________ Total leaching area.. sq. ft. Seepage�it—No./,... Diameter(_-:_ ell pthl >S ...._.... Total leaching area _ . ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Pate---------------------------------------- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water____-___-_______-_____ 44 Test Pit No. 2................minutes per inch Depth ofk- P4t Pit............... _. Depth to ground water____-_-__.._._-__-___._. --------•- ODescription of Soil-------------------- - -.. - ----------------------------------------------------------------- x 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 the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has iss ed by the board o e th Signed .. A •------- ------------------•--- ................................ Date Application Approved BY, = ---------- .2 Application Disapproved for the following reasons: --•- ...... -••- D e --•-----•----•---•--•-------••------------------•••------------•-•-------•--------.....-•-•--------•---------------------------------------------------------------------------------------------------- Date PermitNo.....1.7.7........................................ Issued........................................................ Date z THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ! OF...... :r ...� .1 Appliratiaatt for 43hip sal Works Toustrurtiou Prrulit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: y' Yati; L -Address or Lot No. •--...="-- ,,,,aaa�^��—___ ,.`;.:a. = -4-----•--------------------------•- --�--•--------------------- Owner Address WW s 4[staller Address Q Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms........... -____Expansion Attic ( ) Garbage Grinder ( ) P4 . Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a Other fixtures ..................•••-•••------- Design blow_____________________ __ _ allons per person per day. Total daily flow._.___= .__ � _._.___.___._.__gallons. -•-- .,,. W xSeptic Tank� Liquid ca acit�- V.'*allons, Length-------------- Width -_-_____._-___ Diameter---------------- Depth----__._-___---- p - N� .................... Width___________ 60tae�/-,-,v lLngth--sz_ Total leaching area-------.1__•--___--sq. ft. Seepage-Pit No./_ ------- Diameter/, • _ , t € Total leaching area-6L-2-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.-____.___-_________-.-. 0�4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_-___-______________---. P4on -- ----- ------------/ Description of Soil------------------- .. --�'a::: - -- U ------------ ---------•-----••-••-•••••••-••-•••-•••-•-••••••••-•••••••-•••- W UNature 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 undersigned further agrees not to place the system in operation until a Certificate of Compliance has he fen issued by the board}of health. Signedh� Ci r �1 t• • Date Application Approved By - _ - Application Disapproved for the following reasons----------------------------- 7•-•----•--'•---••••---•--•- ------------------------•----•-•••••-•- ----------- ...............................................................................................................................------------------------------------------------------------ Date PermitNo.---.,i'2..Z......................................... 'Issued....................--................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................. ..........OF...:...... ..................................... (Se'thifirate Lit Tatuphattre I divid al S THIS IS TO CERTIFY, That th�e dividgal. Sewage Dis 1 System constructed or Repaired';(,. ........................ . by---------------ife' ---------- ----------------------------- --------------- Installer ........................................... .,,- ------ ...... ....... at....../ I.- ....... .... has been installed in accordance with the provisions of Article X1 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 FUNCTION SATISFACTORY. DATE............................................................................... Inspector-7.................................................................................. THE COMMONWEALTH OF MASSACHUSETTS, BOARD OF HEALTH ............. :..t ...................................... /1-............OF.f No...... ........ FEE........................ PerMisgion is hereby. granted....... ................................... -------- t 'Constrtict o'r` Re airan Individudl Sewage DisposaAystem o r at N:o..-:.,e---�--- -------- .......... ....... ---------- ------------------------------------ ------------------------ stce, 5 _;�. z . 7, a u as shown on the application for Disposal Works Construction P No I Dated____-: ------- Aer ------ . ............ .......... .... ..-........ ........................................... B&Td of Health' DATE................................................................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS