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Home My WebLink About0057 BENT TREE DRIVE - Health (2) Gen-�vi c l..Qi No......77•1 e Fizz.... .............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® 9F HEALTH ... rooL 0F......... .. .. ----------------- �I 4vvftralivu for Riivviia1 Ifork (Ionstrurtiou Vaind Application is hereby made for a Permit to Construct or Repair an Individual pp y ( ) p ( ) Sewage Disposal e� ..S...y.st at �t_... .....�. ��, -Q... .6"✓k.-..... a\.7t jeN 5..... Y .... Lt - ress ............. uner Address •. ....... K�. ......... (o.... .. .. ................. ..... .. .. ... ..+ ............................ ...... Installer Address UType of Buildin Size Lot.._11.. �---......Sq. feet Dwellingl�No: of Bedrooms_.-.......................................Expansion Attic ( ) Garbage4Grinder ( ) ` 4 Other—Type of Building No. of persons............................ Showers a&t ria04 Other fixtures _ Design Flow.. .................. e gallons per person per day. Total daily flow.._ W g ......... ..g P Pe Y y —7...d`��.�' ................gallons. 04 Septic Tank Liquid capacity j .gallons Length................ Width................ Diameter...............`Depth............:.-. Disposal Trench—No..................... Width...........r!? �Total Length........._._._._... Total leaching area._____...........•.sq. ft. Seepage Pit No.t-_j............... Diameter../ ........ Depth below inlet...... ...... Total leaching area..J..d. . ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch, Depth of Test Pit.................... Depth to ground water------------------------- PrA Test Pit No. 2................minutes per inch epth of Test Pit.................... Depth to ground water-__--__.-______--__..__- --------••---- . ---- -•••-•• ......... ......................................................................................................... O Description of Soil................... � �'°'- x U ....................;..................................................................................................................................................................................... W U Nature of Repairs or Alterations—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 bee5.iVued by the board of 1 SignedL _. r • •••••................. ••• ................ D. Application Approved By..- 4 (�sjt(. -J.X � _ -1 Application Disapproved for the following �wing reasons:.................................. ----.-J..... -----•----- dte ..............•---•----------•-------------•-------------------..._...----•------........--•---------...---------------•--•--------------------------------------------------------------•......---••-•- ...... Issued ^s Date PermitNo.•-•-••-•-•-••-•--••••-•-•-••....•................. ...... P---- �` . ---------------- Date No -' Fnic ................. i; THE COMMONWEALTH OF MASSACHUSETTS BOARD QF HEALTH I l ° ..... o F......... 'w a $aR .................... Apphra.tiVtt for Bigposal Mark (91infit°nr'tion Vrrmit Application is hereby made for a Permit to Construct. ( or Repair ( , ) an Individual Sewage Disposal System at 4 Loeati n•t tress F rof i.. ° 7,�"'e r tl,f...r;`^ ............. ei:i`!�.:�a, .•f°�$*I<p�v=Cs{�e s �a.Zy'�.,,. Rw,Cw �x",�`�... ��,..�'»�' " Installer Address Type of Bu>ldmg Size Lot_-_ : _ ! : ..Sq. feet Dwelling 'No. of Bedrooms__.:::_ ....................Expansion Attic ( ) Garbage Grinder, ( ) aOther—Type of Building ___________________________ No. of persons............................ Showers ( ) — Cafeteria. ( ) Other fixtures ----- __ _________________ _____ _-___...._._..__..._..__. W Design Flow___________________ ..gallons per person per day. Total daily floes -____________.gallons. W Septic Tank Liquid capacity/1"lr'_gallons Length ______________ Width................ Diameter................ Depth ... x Disposal Trench—No o ___________________ Width.... ,,?Total Length Total leaching area_______ sq. ft. Seepage Pit No:. _ __. Diameter. _f .-_ epth below inlet_______ _________ Total leaching area._.,- ft. . Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed hy.___.;'--------------:--:._:'__,___.`___.. :.-__-____..____...-__._....__. Date................_..........---:__:____.. Test Pit No. L...............minutes per inch Depth of Test Pit..___.__._:__.__.__. Depth to ground water__-_____,..._____-..__-. w Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Raf ._..•-•.............•••-•--...-•-------•---••----•--•---•••------•--- --••---••-•-.._.........._._.............. O Description of Soil______________•---..` A 4-14.: .� ._ •------------------------------------------------------------ U .•-•-------------------•-----•------•---•-•-----______•-------------•----•-•--•-------._-----------------.._.._____----.____.....--•--...----••-__.._._.___............................................. UNature of Repairs or Alterations=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 been^sued by the board of heart, � a Signed r at - ; .sw D _ .._. .... _ Application Approved By-- & -`, �/. '•• ate Application Disapproved for the following reasons:---•---•--------------------- --._._...---------------._...----------------------------------------..... ......_....••--------••••--•-------•---•-•...............•--•___..-------•-- ........................------------•-•-•--•...-•------=------------------••••------•--•-.____.--••••--------•-------•- JP Date Permit No......................................................... issued f' s ---••------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD Q HEALTH I OF........ ..�. ,:; � J � t :...... .. . . ................... ............... _eT IS I .'TO CERTIF hat th Indlvidual Sew ge Disposal.System constructed( or Repaired ( ) by. ._. . ° , r --..................................... at.. -= ------ a ., .,y �--- ------- ----- ._ has been installed in accordance with the provisions of Article XI of The State Sanitary Code as cescrib d in the..' application for Disposal Works Construction Permit No,_-____ - �+---.__.'.-_..___ dated :.. __ _ _ PP P '- . THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUAR �; THAT THE SYSTEM WILL FUNCTION SATISFACTORY. I DATE...... ..... ... " .� -•-----------------_...._._.. Inspector . �..... .. ., . THE COMMONWEALTH OF MASSACHUSETTS 3yy € BOARD OF HEALTH - OFG ... '. No..... .. f . .: FEE._ ,,:.............. 'Permission pis jteby granted___ ; _. ..... '" - a to Construct ( or Repair$y All, Ilxdiv tt ; ew age ]11Sposal System _ .Iat No.. ' 'off Street as shown on the application for Disposal Works Construction P7.illit N0::5,q.15 � .Y D ted..- ;.L Y9 B 1[�a°(t DATE................................................................................ FORM 1255 HOBBS �,'& WARREN,.INC.. PUBLISHERS