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Home My WebLink About0057 BRIARCLIFF LANE - Health (2) 0'2�� / � r o _ - - _ - - - �_ �_ o � I'' e FNo....... .._ aog— 1 a 9 s:............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH ......... .......OF........... . ..... /j!L.' --•------•--........................:....... Appliration for Bhipoual Works Totuitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair (; '} an Individual Sewage Disposal System °� ----------- a -_.. __... .... .. ---- Locatign ess '-.-or-Lot-No• . ....At,( . 4... ..1. ........................ ...................................... •--•-------------•------........................... Owner Address W :.............................. .......•-----•-•---.......------••...._......•--•---------•----•----•.......................••.... IrvStatler Address Type of Buildir�g� Size Lot............................Sq. feet U Dwelling f=No. of Bedrooms....................................:.......Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ............... No. of persons.................._......... Showers Cafeteria Q' Other fixtures ------••--•-----------••......•. • . 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..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth .of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P ------------------------------------------------•--•-------•----------------•--...-••--------................................................................ ODescription of Soil.........................--•--•-----................................---•--•------------------------------------------------------------•-----------••-•--•-•----------- W •-•-•---------------•-----------------•--------•----------•-......--------•-••--------•--•-••••------------- U Nature of Repairs or Alterations—Answer when ap livable._.__ - 47.............. ..... .---•••-•---••-----• •...... .... �/ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI-E 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 the board of health. Signed...................................................................................... D e Application Approved By........................ _. '7--YMat7 Application Disapproved for the following reasons----------------•------.....-----------------------------------•--------------------------------------........... .................•--•---------•-••---•--•-•-----••---••••---•--•----••--•-------•......---••-•---------•---•------•---•••-••--•-••--------••------•-----••••••--••-'-••-•-----•--------•....•----•-•----. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH �.....OF...... ... .... .....`:........................._._.............. Trrtifirtttr of Tomplianrr �. TH�S TO ER Y, Th t the d:vidual Sewage Disposal System constructed ( ) or Repaired ( ) by..... ....... ............................ �Ys, ler has been installed in accordance with the provisions 5 of Th tate 'Sanitary Code as descri ed in the application for Disposal Works Construction Permit No�o----�j�6 �•------•---- dated-...-- - _� .._. .-------------•-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT•BE CONSTRUE® AS A C:IARANTEE THAT TIME SYSTEM WILL FUNCTION SATISFACTORY. DATE...--.. � 3.. .7�,--•....................•-•------..__...... Inspector..-- . --.... >-�"_ 5 No...... ... ...... ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH R, , , 4` Appliration for Bhgpoii al Vorkfi Tnnitrnrtion 1hrutit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual.Sewage Disposal I System a . ............ ......................................... Owner�{ss or Lot No. .... �° `_..... .=:'L....... ocat.. ... '..... ............................ �` Address Ingtaller Address Type of Buildinv, Size Lot............................Sq. feet Dwelling=No. of Bedrooms...........--------------------•-----___-___Expansion Attic ( ) Garbage Grinder ( ) aOther.—Type of Building --------------.............. No, of persons............................ Showers ( ) — Cafeteria ( ) al Other fixtures .----•--•---•-----------•---.... • W Design -Flow.............................................gallons per person per day. Total daily flow-------------------------- .................. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench— No.................•... Width.................... Total.Length.................... Total leaching area-___-__-..___.......sq. ft. Seepage Pit N:o.......... ---------- Diameter--------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ") .Dosing tank ( ) ~' Percolation Test Results Performed b ........•.................................. Date........................................ aTest Pit No.'1..::............minutes per i ch Depth of Test Pit.................... Depth to ground water-___-___-__-_-__---__--. (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----•-•--•-•-•-------------••-..._..•---•••-----••-•-•-•----•-•......•--••-----•••---...---.................---•--••.........-•------•----------•--:.......-- 0 Description of Soil......................................................................................................................................................................... W ---------------- --- a UNature of Repairs or Alterations—Answer when ap licable """. .__. :r._ a3�:...._.:.. -------------- • :=-� ........................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT:.t�.. 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 the board of health. Signed....... ................................. ............................................ ................................ Application Approved BY--•---•----------- -- ..............................`-•----•-• ' +* "4jDat ti Application Disapproved for the following reasons---------------------------------------------------------------------------------•-----------------._......--=--- ----------•---•-----••------------------•----•--.....------........--------••----------=----------•------------------------------------------------------------------------------.------------•-•---•--- Date y ' PermitNo......................................................... issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS s _ BOARD HEALTH . ..... ..OF..... -? ..... ....................... ................. T��ifirati of Tnnt,liFanrr THIS S TO ER Y Th t the d:vidual Sewage Disposal System constructed ( ) or Repaired ( ) by...., ....... - -- ------- ---4htate ol Ins ler has been installed in accordance with the provisions T-I j of T Sanitary Coe as described in the application for Disposal Works Construction Permit No -- ¢ lr............. da.ted-......----------- - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GU RANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE... ..F. ... • -----...................................................... Inspector--= ------ ------ ............... ----------- THE COMMONWEALTH OF MASSACHUSETTS � .... BOARD HEALTH No........ FEE 'Disposal n � ni ttrtinn 'rrntit Permission ereby granted._ _f... �" - ----- ----- ........................ to Coristru or K air ( in Idividuil Sewa Di p S s at No.{ - • - -------- - . _ ,._...... I '}".C n Street as shown on the application for Disposal Works Construction Permit Dated.. �........ . .................... -- --- ---- ---------•-••--......•-- �_ �^ ...................................s rd of Health,, DATE. FORM 1255 HOBBS. & WARREN. INC., PUBLISHER_ S t.