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Home My WebLink About0061 POWERS DRIVE - Health -o k eys b r t,6-e- to l - 021 I No.... Fmc..... .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH ............... _�7t:55:rlw",-------- OF............. .e&�. Appliration -for Bwpoiial Works Tow5trurtion Prrutit Application is eby made for a Pe_7rmi,...LConstruct 1( ) or Repair an Individual Sewage Disposal System at: ....... . .... .......... ...... ....................... ....... .............................................. - --------- -------------------- ------------0 at' _... 'Z_r,ess Lot NQ, ...... . ........ . ..................... .... ...... ......... . ..... . .... . .................. ...... 0 r Address j........ ..... ........... ... .... ................ ........ ....... _0 .................. Installer AL e of Buildi Size Lot............................S ect Dwelling No. of Bedrooms----------------------_-------------------Expansion Attic Garbage Grinder Other—Type of Building ---------------------------- No. of persons........ -------------------- Showers Cafeteria 04 Other fixtures ---------------------------------------------------------------------------------------------------------------------------------------------------- Design Flow............................................gallons per person per day. Total daily flow............................................gallons. IY4 Septic Tank—Liquid capacity------------gallons - Length________________ Width-.___.._..._.. Diameter........--....._ Depth.-..--.----.---- Disposal Trench—No----------------_---- Width-------------------- Total Length_................... Total leaching area----- --_----------sq. ft. Seepage Pit No--------------------- Diameter-----__---______--_- Depth below inlet_--_---________----- Total leaching area-----------------_sq. f t. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed'by----------- .............................................................. Date.....................---------------... Test Pit No. I................minutes per inch Depth of Test-Pit-.-.-_-____-_____-. Depth to ground water------------------------ Test Pit No. 2................minutes per inch Depth of -Pest Pit----/................ Depth to ground water........................ ----------------------------!-----------------------/-------------------------------------------------------------------------------------------------------- 0 Description of Soil--------------------------------------d................................ ------------------------------------------------------------------------------------------ x U ..................... -------------------------------------------------------------------------------------------------------------------------------------------------------- ..... . . ------------------------------------ .................... -----------------------------------------------------------I-- ---- ------------2t-------------- --- hen applicable - --------- --------- Nature of Repairs or Iterations Answer ------------- .... es -------- ---- .............................. ------- --------- .... ---- 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 b1n issued,bj the. bo7d oWfhn alth. -----igne ... . ... - -- -- ---------- -- ........... .............. Date Application Approved By------- -- --- ....... ... te Application Disapproved for the following reasons:-------------------------------------------- ------------------------------------------...................... ................................................................................................................................................... .......,-----------*4 ...21 ------------------- ----/Da/te P , i;a`; PermitNo......................................................... Issued----.... .. .... ............. ----------------------------------------------------------------- No.... � -- Fins..... ...................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH y- .........OF............. .. . � Apphration -for Dhipoiitt1 Workii Towitrnrtion Vrrniit Application is hereby made for a Permi , Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ; Y -------------------- l;af.•-Ad ress --•---o--Lot Nq. . -----==� - ---- -----"�": ..............•-••• --- = ----- /�j,�J O r Address Wj` �t ��-.•-•----- "�" r ---------- � � Installer � •� �•�d�rts_s �j+�/'` d e of Building j Size Lot____________________________S eet U Dwelling No. of Bedrooms________________________________ .Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures _______________________________ _ _ W Design Flow....................................._......gallons per person per day. Total daily flow_____________________.__________-_-.-._ -_-gallons. P4 Septic Tank—Liquid.capacity------------gallons Length................ Width------._....... Diameter--------------- Depth.--------------- W Disposal Trench—No_ ____________________ Width--------------------- Total Length-------------------- Total leaching area-._.-__-..-_._.-----sq. ft. x 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 "Pest Pit-------------------- Depth to ground water..-:-----_--.___--.-..-. f� Test Pit No. 2-----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ ODescription of Soil------------------------------------------------•----------------------------------------------------------------------------------------------------------------------- U U Nature of Repairs or ]terations—Answer w en applicab ...____...._ _._._. ._. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with j 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 b n issued b the box}d of alth. igne �!� .......... / Date Application Approved B . G. y _ ate Application Disapproved for the following reasons____________________________ ____________ _________................................................_........ -----•-----•-----------•-------------•••-----•--••-•••----•-----------•------------------------•----•---••--------------------------•--••------•---.-----•••-•-•--•---------••------------------------•- Date Permit.No......................................................... Issued......................................----------•--: Date' THE COMMONWEALTH OF MASSACHUSETTS BOARD Of HEALTH ............I .t ! .................O F......... , ✓i�.- . . v. ....................:....... Af4;' , Trxttftrtttr of f�untrltttatrr THIS IS TO,C_ER'TsIFY-,,,.T at the Individual Sewage Disposal System constructed ( ) or Repaired ( ) �.. .rah �.s., ....�.....'------ bY•---•-•-•- F -----------------------•-------•----------•----._...-.------------------------------••- < s' tnst111er has been installed in accordance-with the provisions of Article f The State Sanitary Code as described in the application for Disposal Works Construction Permit No-------- , t " ate 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 r f . 4 }NO.__ � ._ FEE_...`...... _. Pemission is hereby grante -- -- ----- toF Construct�'( or Rep r ( an Individ,al Sewage Disposal Sys em --- at No. (1�/ ,�f = . ----- �' -------- 1 .- eet � as;shown on the application for Disposal.Works Construction r it No. tted __________________________ 4441< . _____ ________ _____ _ __ --_ __--.--_ .. ...-__. __..__. ____...________----.- i Board of Health DATE........ ............................... FORM 1255 OBBS & WARREN. INC.. PUBLISHERS FA No...... -?.k--- Fus..,`�r: .... THE COMMONWEALTH OF MASSACHUSETTS BOARDO F-oEA.f"Lc -:-------OF. .... . .. .. .... ....: ................... .... ............ Appfiration -fur Uiupuutti Workfi Towitrurtion, Application is hereby made for a Permit to Construct (po<or Repair ( ) an Individual Sewage Disposal System at: _ ---------------•--•--•-••....---•- --•---...• . ----•------•-----•--•-•----•-•....-•--•------•--------...... Locat' n-Add ` or Lot •o. Own Address a :1. C_Q vs, \,'Fy c C14 s tom`\ Installer Address ,p UType of Building Size Lot.... "........6..Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) a.,., Other—Type of Building ----------------------_-__ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures --------------------------- d ?� C� 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--------------- �an e*C1" _ -. epth below inl t___ �.............. Total leaching area, d_ ...sq. ft. z Other Distribution box ( ) Dosing tank Percolation Test Results Performed by---------------- --•-•-----•---••••---- Date........................................ aTest Pit No. 1................minutes per inch Depth of 'Pest Pit-------------------- Depth to ground water_..__.._--__--_------ (i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.-.-.----_--__-._--_- _. ----------------- --- ------- ------------------- ------------------------------------------------0 Description of Soil-------- " - v' `!-�--`----•------•------'•---•------------------- ---------- .......---------------- U ........ ......... - W ----------------------------•----• ---------- -- -----------------•---•----------------------------------•---•-------------------------------.-----•----•-----•------------ -----------•---------•----- UNature of Repairs or Alterati ns--Answer when applicable..._............................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article 11 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued by the board of health. Signed.. 3 /� 3 /at, Application Approved By- -- ..... •.- - -•-- ......... ....... .� 7X.... _ Application Disapproved for the following re, s s:--•----••--•-•••-•----•-•----•••----•--•--------•-----•----•--••--•------------------•••--•----•------------ -•----•-•-----•---•-•-••••--------•----------------------------•--------••---------------••-••------•----•---------••---------------•- --•--..--- --------------- Date Permit No......................................................... Issued. ��1 Date ?A No.---- Fizx. ..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD 0 HEr--% TH A-144"? ----.OF....". .. ... ... a -----.............................. Appliralion'-for Biiipaoat Workg Tom urfilan Application is hereby made for a Permit to Construct ( t,) or Repair an Individual Sewage Disposal System at: -----------------------"--------------------------------*------ ---------------------------------------------------- ....JA ........__ Loc Address or.Lot No. ....... ....... .......... N ................... ..................... . \Owner Address ........... ...................... .......... ......... Installer Address Type of Building Size Lot------ feet Dwelling—NO., of Bedrooms__________-3 ________________________________Expansion Attic Garbage Grinder PL, Other—Type of Building ---------------------------- No. of persons..______-:--_______--__--.-- Showers Cafeteria 04 Other fixtures ----------------------------------------------------------------------------------------------------------------------------------------------------- - Design Flow.... 5.Cc W D Fl -------------------------_---gallons per person per day. Total daily flow..... ..........................gallons. 9 Septic Tink—Liquid capacity4 P----gallons Length................ Width.._............. Diameter-----------.-_-_ Depth---------------- Disposal Trench—No. . ........... Width--------------------Total Length.................... Total leaching area.-_-----------------sq. f t. Z ;.;a '3 'r�--t 'th below inlet Total leaching area '?-6-)Seepage Pit No..-/---------5... .........il.011521 -_a;)-------------- -A" (rP ,.,..-.sq. ft., Z Other Distribution box Dosing tank ( ) 'V Percolation Test Results Performed by.-------------........................................................... Date---------------------------------------- Test Pit No. I----------------minutes per inch Depth of Test Pit.................._. Depth to ground water..---.--.-_.--.--.--.-_ (I, Test Pit No. 2................minutes per inch Depth of Test Pit...._............... Depth to ground water-_.--.----_.-_-.--__.-.. ---------------------------------(....................................................................................................................... 0 !$ % -_ I k�* 1- L Description of Soil------------ SN.......7t7 -7 k� �__�-t�------------- .................I------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------- ------------- ------- -------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alter'Ltions—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 .... ... ....s be---- issued by the board of health. Signed-------' --------- ... . .. ---- ---- ------ xM...... ... Dat -Approved By. '0. Applicafion -- -- - -- ----- ---- ..... ---------- - ...... ... - --------- LAA64e- ------------------- Date 71 Application Disapproved for the following runs:---------- ....... 7 -- -- --------------------------------------------------------------------------------------- .................................---------------------------------------------------------------------------------------------------------------------------------------------------------------------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -A . ....--OF................ .... ............. rrfffiratr of 0,11MIlhaurr TINS IS CERTIFY, liq the Indiviy�plal Sewage Disposal System constructed or Repaired by--------V _ef.......... ......... ................................................................................. k Installer. . ...... ... ........... ........_................................................at...... ------- o(e sqr*b d the has be n installed in accordance'with the provisions of Article 0 J�(e State Sanitary Code ede application for Disposal Works Construction Permit No____ 0--------------- datedl__�--- ------ .......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM W F N TIO SATISFACTORY.2 �� ..... ... ...... DATE_. .... ... ................................. Inspector-------- ............... .................................... v. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH '7F..... . ........................OF. ...............y.................... N 0...... J, FEES............. .................. Permission is hereby g e.. ..... . ranted--- ---- . ... . . . .. ..........................•.............................. or e R pair Indi D* oral System to Construc, atNo.'--� .. .................. ----------- ..... -------------------- -- -- ---------- �n i .......... Street as shown on the application for Disposal Works Construction Pelmit,Now Dated.............. ............... ............. DATE Board 6f Health .......................... 25.5.....�I FORM I B13S & WARREN. INC.. PUBLISHERS