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Home My WebLink About0072 ASHLEY DRIVE - Health a �qs h le Prf �� ct os+ No...-- ._ 1--......... F$s... ... _ 40'+ THE COMMONWEALTH OF MASSACHUSETTS�BOARD,ePF HEALTH OF... ..... .................. .............................. ......... . ppfiratiun for Bigiosal Works Ton strurtion Puntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syster ... ................. .... ..................................... �J.� ocat on�Addr.. or o. dress a ----........ - = ..... .... .. ----------•.. ......................�' ...... .......------....--------....----......---....---- Installer Address ,ram UType uilding �j Size Lot.../„]__,' .....Sq. feet Dwelling—No. of Bedrooms.............. ..............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures ------------- ........................................ W Design Flow.......................5_0_... ._.. 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.1c epth below inlet.................... Total leaching area_3.A.:;�-sq. ft. Z Other Distribution box ( ) D sing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water--______________--_____. 40 Test Pit No. 2................minutes per inch Depth of Test Pit.:................... Depth to ground water........................ a' --_--------- ODescription of Soil.......... •••-- -• -------•------------------------------------------------------------------------------•-----•--•-•--•-••-•-•-•- x U ..................................... -----••••••--•••••-------------•-----•----------------------•-----------------------••--------------............................................................. UNature of Repairs or Alterations—Answer when applicable................................................................................................ -----------------------•-----------.................---•------------------------...------------------------•------------------••--••.._..........-•-••• Agreement: The undersigned agrees to install the aforedescribed Individual ge Disposal System in accordance with the provisions of.Article XI of the State Sanitary Co The unders' ned rther agrees not to place the system in operation until a Certificate of Compliance has been ' ued by bo d of h th. L----------- —-----------------------------—---------------------------- - .Z y ? Signe ..... ._ ..... .... .................... I .. Dat ApplicationApproved By--------------------------------------------•------------------•---------------•......----•----- Date Application Disapproved for the following reasons:---------•---------------------••---------------------...........----•---...------...........-•••••............ ................................................... ............................•.........................................................-............................................................. ��o �- Date. Permit No......................................................... Issued �o....IZ"F Date .. No...... ............. FEE ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Ap, phraiion for Disposal Works Tonutrurtimn Veruttt Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at�.. r ........ d :. ... ...... �: ..,...:.. ....................... r .... ..... Iocahon•Address —^� �3 r ,No ............:.:.. f"r "2. r f:. 1 �.1v�J,,m,......................... .. c:. 1 J S ........................... 'g j Ow jadress a4v`�??aasly::._..;f:✓ .1 .tA`"'_,.&. "..ifi::'"r.iF .. .J f_xr ....___-----•---•-' ••-- •-__----••---•---- �r Installer Address r">E- x UType Buildmg Size Lot---/S..1__' ....Sq. feet a Dwelling—No. of Bedrooms.............:�=m::'.`.._--................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) —.Cafeteria ( ) d Other fixtures ._.. g g P P P Y Y �'r�2 gallons. W Design Flow____________________ __._.....,. gallons per person per day. Total daily flow....._...r.,<......__.........__..._...._. WSeptic Tank—Liquid capacity/ gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width _._ 3 ....... Total Length.................... Total leaching area__.__ .sq. ft. Seepage Pit No..................... Diameter...... epth below inlet.................... Total leaching area.' 4_.. -sq. ft. Z Other Distribution box ( ) Ding tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit._.,.................... Depth to ground water............___________- f4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Description of Soil------... _:.. ?' .� -----•------ U .......................-................................................................................................................................................................................ W x ••---•-••••----------------------------••--•.._......---•------•----••-•••----------•-••••........._.....-•--•----•-- ------•-•----••--•----•-•---•---••---••-•-----••--••-•--•--•-•-••-••----•........ V Nature of Repairs or Alterations—Answer when applicable................................................................................................ ---•-•---------------•------------•------•••-----•------•----•-••-•-••••-• •-•-----•......----_...._•••-----•----•--------...-----------------------•---•--••---------------••-••--•-•----•--•---•••---- Agreement: The undersigned agrees to install the aforedescribed Individual wage Disposal System in accordance witli the provisions of Article XI of the State Sanitary Cod The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been tied by ttg bo d of hth. Signe ..e/f' ................... Date Application Approved By...... ------•-••••---------------•-- t Date Application Disapproved for the following reasons:"-------------"...-----•---•---•---•------------... --•---..._.....----••--•-•--•-•-•-----•----------•--------- ................................................................•-.-•-•-•------....---......••----•-•----•--•-•---•----••••---.•-•-•-•-- .............................................................. Date v. PermitNo......................................................... Issued._._ - --�'-,-----,---. -------------- • Date HE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH y.��,✓�e , ............OF.... '. °...�°�+~"� � `. (Irdifiratr ,af (famplianrr T 5 S TO CE F That the Individual Sewage Disposal System constructed (Vor Repaired ( ) by ....... .. �, ' !. '" . ........... . ---------------------------- -•------•-....... ---------------------- ................. ......._...------ *dr -fig Installer ---------••-•--••.................... has been installed in accordance with the prov;`lsions of Article NI of The State Sanitary Cod 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 W.Aliz IINC�TIObI SATISFACTORY. .......DATE••-- „.a.................. ............. Inspector.................................................................................... HE COMMONWEALTH OF MASSACHUSETTS BOARD .OF HEALTH r .; _ j ............................ � NO .... :...4. FEE_ ,Btsvil a, Work n ttrttun. rrutit .. - � _.� , Permission is hereby granted_..--- --•• ------- ------- ---�....�.._...�_y.-- --:.- -•-•- -....-- -........••-............................ to Construct ( r Rep ndiv>chtal See Disposal System U. sc f r atNo... ry .... .: � .........._.._._.._... f _..................1" °':........ ; Street as shown on the application for Disposal Works Construction Permit No...e ........ Dated...��a.y...-..7.3 ... vy Board of Health `0 DATE_.:. ..................................... FORM 1255 HOBBS IN WARREN,'I.N:C., PUBLISHERS • /' ;,�