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HomeMy WebLinkAbout0081 WARWICK WAY - Health ��1 11�p�r�vv�L� .��� � �.�-� —��� oA No!9 j... : FEs.............................. THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH ------... .............0F..... .P �1. ,�. - .............---- Appliratiou for Disposal Works Cfoustr uffou Frrmit Application is hereby made for a Permit to Construct (Y-4 or Repair ( ) an Individual Sewage Disposal System at: t ocatio •Address or W ...0 POL . --.d� ....----•--.-•----•........................... ..3.�Y_ .�.f..1.�� .. ... Installer Address Type of Building Size Lot... feet Dwelling—No. of Bedrooms.............,..........................Expansion Attic ( ) Garbage Grinder ( ) �`4 Other—Type T e of Building No. of ersons____________________________ Showers YP g ---•--•-------------•-••---• P ( ) — Cafeteria ( ) Otherfixtures ----------------•-------------------•--•--------•-----••---•--....•-••-••••-••-•••------••-•---••--••-•-------------.......----..._..---------------- w Design Flow............. _____________________gallons per person per day. Total daily flow.._.._.3_3_.._0______.__._.___:___.gallons. WSeptic Tank—Liquid capacity/tIPP_.gallons Length....e_'____ Width...._C•(.__ Diameter________________ Depth___.._ ... x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......../-_........ Diameter____. Depth below inlet.......6__ ..... Total leaching areas Z (PQ Dosing tank ( ) Other Distribution box Percolation Test Results Performed by-._ _ _._ __�'?, L_ ZAK Date_�_..'l_7—e� aTest Pit No. 1___ __ _minutes per inch Depth of Test Pit_._.�4lf._."_rDepth to ground water_!L?�T__ _ GL, Test Pit No. 2________________minutesper inch Depth of Test Pit_..___.._._________. Depth to ground water_�CV10V?��� a -------•--•--•------••-•--•--•-••••••-••--•---•----•------ ................................................................................................ O Description of Soil_______________________�.f'-- .......... x w U Nature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ ..---.....-•-•-------••--•------------------•-••-•-•-•••-•-•--••-----•--•-••••••-•---••----•-•-•••••--------•----.-•-- Agree t: undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the roi io of Ti 5 the State San' ry Code— TIN and signed further agrees not to place the syst o er on I a of Compliance has ed VIthe bard of health. - ................................................ ..Zt . ........... Api n Approved BY--- --- _--- -- --- ................ • ..................................... ...-..-....•--•--• ............ Date A ication Disapproved for e o owing reasons:----•-----------------•------=-------------------------•----------------------------------••---••----.......---- -----------------••------•--------------------•--•.--•---------------•--------------------------------•._- Date PermitNo......................................................... Issued_.......................................................Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t. /..0 W A4..--........_OF.... .f.--l.p.�lU [............. k Apli iration for Dwpos a1 Works Towitrurtion Prrutit Application is hereby made for a Permit to Construct (<) or Repair ( ) an Individual Sewage Disposal System at: ...W awl 5-1.4..........��-Y----------------------------- Gal. ZZ................................... Location-Address or Lot No. •--••................._^------...----.....---..........--••------•-.............-•^............ ............................................. ----- .------------------------ ._._.._...c------- Add W Owner ress •--•-----------------------------------•----................................. Installer Address p� U Type of Building Size Lot--- 7-.-3 l`''-S feet ------ --- q I^� Dwelling—No. of Bedrooms.............�3..._......_...._..._......Expansion Attic ( ) Garbage Grinder ( ) ` a Other—Type T 4 e of Building g ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures .........................----•----- ... w Design Flow...........2 5.......................gallons per person per day. Total daily flow. _.............._..._ ons. WSeptic Tank—Liquid capacit/.0.0Q.gallons Length...G�....... Width__....`:--.--_ Diameter________________ Depth....__._....___- x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area ..... Sri f-t.6.09•D. Z Other Distribution box (� Dosing tank ( y '-' Percolation Test Results Performed b __ .d ��. �. 1A)C• 8 _/7�. Z Y Date ------------------------------------ Test Pit No. 1----!�• .- -_.minutes per inch Depth of Test Pit...1' -u... Depth to ground water"&'7---��- CarN7��ED Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---•---•--------------------------••-•---------•--------••} .......................................................... O Description of Soil.....................` -'....----- `�c/1�; x ---------------------------------------------------------------------------------------------------------------- U .........---•-----------------•-------•-••------••-------------•----------•--------•-----••-•-••-----------------------.....--------•----------••------•--------••-•-•--------------•-•---------------- w U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ---------------------------------------•-----------------------------------•----.....------.....---...------------•----------------------•---------------------------------------.....--•-------.... Agree t: h undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with th r "sio of T S the State Sanitary Code— The undersigned further agrees not to place the sys n er ion ti ifi of Compliance has been issued by the board of health. ed Appli n Approved BY _' ` , .� I/ e TT . ---•--•--------------------•--•------- A ieation Disapproved f o the lowing reasons--------------------------------------------------------•-----•-----------------•---------------- Date PermitNo....-------•••-_..... Issued-.-----•--•-----•----------•-------------------------•-- ................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH s 4� ..........................................OF Trr#ifiratr of ToutpliFanrr I O CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by.. .. .................. .............. . ......----•---- --•---- "._`. tI sal at te has been installed in accordance with the provisions of IT F . j of The 5,�+�te Sanitary Cod asibed in the application for Disposal Works Construction Permit No.__..._ _ dated_ , d:.. ---------•--------••- THE ISSUANC�E OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® A GUARANTEE THAT THE SYSTEM WI FrI ION SATISFACTORY. ----• Inspector..... ..... ................... I' DATE.... ...... p .......................... ----...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH .......OF.. �� - t.�............................ N '`�O..r�.1.lp FEE..eQ Diopo orkn, Tonstrurtiatt Frntit Permissionis eby granted ----- ------- --- --------•-----------------------------------------------------•-------••------------•-•-----------------•- to Construct (, air ( ) a�vidual S .; ge p al S ,tem at No0. ��.. .......... .... .... ....... -------•---•--------...-------•----------------•. ........ ............ reet f as shown on the application for Disposal Works Construction Permit ��{0- e ' -'fv--- .... d DATE. .r _ of ealth -----•-•-------•-----•--------•---------------••-- FORM 1255 A. M. SULKIN, INC., BOSTON L_�'J � ':� T ION SEWAGE PERMIT NO. VILLAGE Uc7fUT FKVJ LL F, INSTALLER'S NAME i ADDRESS OC�(� [� • of)YZ. C-o s U I L D E R OR OWNER DA T E PERMIT ISSUED DATE COMPLIANCE ISSUED T-� • ��G K off- rt�us� -- ;v ;�= �� 3� gyp' L'0CAT10 r ' EWAGE PERMIT Q. VILLAGE r j I N S T A LLER'S NAME _Ji. 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