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Home My WebLink About0037 LIETRIM CIRCLE - Health ✓5V 4- LOC,.TION : 5EW&.C,E PERMIT UO. VILLAGE 3_7 - r e t✓in - cIe _ — — W ST ALLER 5 ► WE ADDRESS BUILDERS 1J WI F— P, Q,DDRE.55 DL1TE PERMIT 155UED �/� �� —L D s.TE COKAPLI W lCE ISSUER; 5��?,�/ 9�7 .JJ Y �,f 4 N0 .LY_...C-) ............................ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH _...... ..... ... ...............OF.............................I..........._..-._ -__...-.... .......... AVV iralion -for Diiipoiiat Workii Towitrur ion rrmit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: Location-A . or 1, o. ti. -� �... caner Address y, J�7'�) ...................... -�-Z.�--�O?^rJ... 2r ?Z'1 ✓t----- ...... ------_---- Installer V Address d Type of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms.--_-_Dwelling— Attic ( ) Garbage Grinder ( ) a4 Other—Type of Building _ a ------ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures W Design Flow............................................gallons per person per day. Total daily flow-------------------------_--------....._.---gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width---------------- Diameter__---...-_ il-_-_ Dept .___ _-. -_--- 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 ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date--------------------------------------- ,� Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water_..---__--._---.--.-.__. rX4 " Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.--._--__----.----_.-. O Description of Soil------ ------------------------------------------------------------------------------------------------------------------------------------------------ x W ------------------------------------------ ------------------------------------------------------------------ ---------- ` U Nature,of epairs or Alterations— wer when applicable.-.-__ _S'" __........'......_ -----------------_------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article YI 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. , Signe -------- F �-� ate _ ApplicationApproved By.................................................................................................. Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------- .......................................................... ----- ------------------------ - `� ' to Permit No..... Z7y......&�)..-•------------------ Issued-----.................................................. yDat=.-------------------------------- -emu J C No. � FEs............................ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH _.. _. . ... .. .... . .. .OF...................................._-:.-...... Appliratinit -fear Bi-Apufittl Workii Towitrurtion Untuft Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: 121 ---------- ------- •-•-•---•-- -- Location-A _ or o. ------------�--..........G~ Y' .Vr°� of ....................... ................................................Co ...... dress ,a ------ � � Install.ler 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 ( ) dOther 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 ( ) aPercolation Test Results Performed by--------- -------------------------•-•-----...--•-•-•--••-------•-•----•-- Date............. -_---------------------- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..-.-_--___---_.-_..___- (xq Test Pit No. 2................minutes per inch Depth of Test Pit--------------------- Depth to ground water........................ a' --------- --- DDescription of Soil - ----------------•----------•----------------------------- ---------------- ---- ----------- - ------ ---------------- x W ------------------------ ------------ ------------------------........................................ � -•-- V Nature o Z,epairs or Alterations— —wer whe applicable .-------- .,sr""� !� ��'� ._''6"__.�_ . ........ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I 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. Signer • ( ------ew'--.---------------------------- -� Date ApplicationApproved By.................................................................................................. ...................7. .-----•------•----- Date Application Disapproved for the following reasons:---•---•--••.............................................•-----------------......----------••--••-•-••••-•-----. Date Permit No.__.1 Z y---_._ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ ................OF........0 .......................................................... 0W.rrtifiratr of fanu phatta THIS IS TO CERTIFY T is the ndividual Se e Di osaI System constructed ( ); or Repaired ( ) by--••-.......-••---•---•-•••------...---'.�-•----•-- 1�0.. I4t QI ilL0 ------------------------•---------------------------------------•--•-•---•-•---------- G r Insta r at................... I t ..... {ECG ty ►+°'"'"''C Vl r� .� has been installed in accordance with the rovisions of Article NI of The State Sanitary Code as described �� application for Disposal Works Construction Permit No. Y THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....................=.................................................-......... Inspector......................................------•---------.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH '7 .............'.�d�^..... ..OF...........�044WS� .�: ................................ ®� No........... •-•--•--- FEE------ � DiriVviial lVarkfi Tonfitrurtion 11atuff Permission is hereby granted ----••• ••----••---------•-•----•-••-- G -•---------------------•.....---------•---••-----•••-••-•--•--....._--_... to Construct ( or Repair (600ran Individual Sewage Dispo al System Lr TttC ---- rl L.G(T C2C�` ------ --- _ "... ------. ---••-•--•_...•- at No.•---•••• Street as shown on the application for Disposal Works Construction Permit No _ ____._. �__._..��..__.._.._ /� Board of Health DATE......... I --------------7---------------------------•----• FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS i