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Home My WebLink About0082 ASHLEY DRIVE - Health (2) S� Ash(s No FIzz THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appluatintf for Ilip'nsal 18erks Toustrurt' U rrrutt# Application is hereby'made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at - . .......................................... ............. ................- ..................... Location-Address or LotNo. ` ............. •---- .......................... .............. ............. ................................... • _ ^ -Owner Address Installer ;' Address . Type of Building Size Lot............................Sq. feet U Dwelling—No, of Bedrooms.......................................::Expansion Attic ( ) Garbage Grinder '( ) Other`-Type of Building No. of persons.......................... Showers P4 g -------------:..:_...---•• P -- ( ) — Cafeteria ( ) aOther fixtures - ---••-•------------------------------•--•--•--...........--------------------•-----------••-•..... ----------.............:.••-------- , W Design Flow..__.-:5_55 ...............:......gallons per person per day. Total daily flow.. 3 .................... .....gallons. WSeptic Tank—Liquid capacity.............gallons Length....:........... Width................ Depth................ Disposal Trench—No..................... Width...................... Total Length.................... Total leaching area.................:_.sq. ft. r ..._ De th below .... g q. Z . ' ' Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed`by•---•-•----•--------•--------•---•=----------------------•-••-----•••---- Date........................................ a ; ; Test'Pit No. .1................minutes per inch Depth of Test.Pit...................... Depth to ground water.......................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 4 Qy Description of Soil.....................................--------------------------------------....-••---•------------••-------••---......_--•--------_...._.._....--------....::......--.. U ---------------------------------------------- -------------------------• -------•----------------.........••---•------------------_---_.. ........_........ _-•-•-- i W ------=------:-.--------------------- ..............----•-------•--------------------------------------------••-----------.-/---------•-------......................-•--=------. U Nature of Repairs or Alterations—Answer.when applicable....1.1,14 __�v' `--_..._:6i s .�.... . ._I........................ �Agreement:' The'-undersigned agrees to install the aforedescribed' Individual Sewage Disposal System in accordance`with the provisions of'1= • 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until.a Certificate of ComplianceTha een issued by th bo of:heal h. V ned---•---- ---- -CP �- - = - :. Application Approved By------------=---------••-•-••-. .. ._y . -------•a..--- ..... at -. Application Disapproved for the following reasons:.......:.............: .. --••-•-----------------------•------------------.....----•----=----------•-------•------......---•------•.......--------•------------------------------------------- .................................. Date Permit No........ l_.L% J_ .. Issued_..... ' Dat s�...:�'-`^�fF'4�+n�i:�.-`y,.,•�+-,.r._.s•V}�,"'�. .,;-�....�+b-... •v.��'' '.".rwL:tYX`^i•ary.,.t.yam_„�3!'v�.�ri�>..kr��.......�+^.,.W..:�...:.i +,.:s .•y. r .!' _ - w .:o-�!y,i«ay;/.S."1.e1.�,._r�vX`.-'�'•+"'�*i,J No.. o Fss. r % THE COMMONWEALTH OF MASSACHUSETTS ' i BOARD �OF HEALTH �1 .71...... U. '.........OF.-.......-e,-1r_.VZ.i!..1. ........................... Appliration for Disposal Weds Toustrurtion thrutit j Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: ............ s`.-.-___. ..:.._.... . ... .................... •!VT> �2�,\� a ............ - .._._ .... .. . ... .._.. .... ..........� Location•Address or Lot No.� ...... ...... c 4+ ........................... .............. l4�!tt-:!� .... .............................................. .... Owner Address "Cr -�f^--_............................... .....•.... —N- ...�� {M fJt i� �' C 1A;10�.t 1,4� �• y Installer Address t Type of Building Size Lot-- q feet 0_4 �� Dwelling—No. of Bedrooms__. 'S ...................Expansion Attic ( ) _ ( )Garbage ( ) N Other—Type of Building ............................ No. of persons...._....._...__....... . Showers Cafeteria Otherfixtures --......•-___.._...••--••--•.......................................•.........-•-•----•-............._....._..__.__._........_.._.._................. W Design Flow.......5........................gallons per person per day. Total daily flow-_ 3 .............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... . ..f........ Depth below inlet................ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ 14 Test Pit No. I................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........................ La . ------ 0 Description of Soil....................................................................................---- W V ------------------------------- ----------------------------------------- ---------------- •--------------- --------------- •----------------------------------------------- •---------- ._........ .......... ._ W UNature of Repairs or Alterations Answer when applicable._..... '_._dlru ...... -� _..� --------------- rn ...11 LptcY•s'c�' ir' � ' a,:)_�. -••-•-•---••--•-•-......-•---••---- -••---••-••••••••-•••....--•••-••--------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 71TIZ 5 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 theb.oard of health.. f Signed `. ....• ••... •--..I ...................... �L-3 - -_ Date � Application Approved By----- •..............•-................ :�= •.._.......... �. Date Application Disapproved for the following reasons:•••-••••------•••-••••••••-••••-••---•-•----•-•-•------•---••••••-••--•-••••-•••..................•-•--....... ................•-_....--••-• .._.....--1••......--•------------__...-•--•-•..............--••---•---...-------•----........_..•.=............................................... Date )_��Permlt No.--•---------------------------------1--------•---..... Issued_--•----------- ----- -------._.......... ; (Date? THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � .............77 UJ VU.......OF... ................................... Trrtifiratr of Toutplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired f<5 L:� _ t by---•............. . 0 57�A;A` -_= ' . .,r....:... Installer at....................................�-cN�-`.... ...... ................ '�,'` �-••--------•-••-•••-.......-•-....--•-••......---•••-•--------•- has been installed in accordance with the provisions of TITLE'— 5 ot�-The State Sanitary Code •ate, described in the application for Disposal Works Construction Permit No_. �." ......._.. dated_____________?o/<`�f�.�3�........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......................... ..- � � .....•---•--• Inspector..•-•-••-----•••��-- r , - - ........._.. _.... THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH _ / _�`Z�C:SI�b`. OF ±a�!ZVVSIU4_ 4" ............................. 2n�. No.. 1441 �.. FEE........................ Disposal Works 01.11.11natruction Firrutit Permission is hereby granted•--•-- b1t!C _. . __ -( -----•----•-•-_••--•••--•-------••••-•••---•-•-•..................•.. % to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo.......... ., C,a _ .u_...-•-�•M•--. . --...•...---•-.-" ``�,...----•----------•----•••-................................................ Street r / L ,r as shown on the application for Disposal Works Construction Permit No.................. Dated..fit-___- ......_........ Board of Health may' DATE................. ............................ ................................ -