The URL can be used to link to this page

Home My WebLink About0066 BUCKSKIN PATH - Health (2) pc,+A N 9 1 jI 1 1 I 1 Finc ........................ THE COMMONWEALTH OF MASSACHUSETTS OAR® OF HEALTH ...OF......�,, ---------- 0Aq Apphratian for MoVoonfOurko Tonstrudion Vamit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: j.d.f.,...A........... ... ....... ... ............................................................. .. .... . . Location-Address or Lot No. ................ wner...... ............................... ............................................iZres.s........................................... .............. .. ........ ........ Installer Address Z. ------ Type of Building, Size Lot �C,07!vb Sq. feet U Dwelling—!'—"-No. of Bedrooms..,.-40t�............................Expansion .....S7...............Expansion Attic Ga71,a,g"e,*"G"'rinder ( ) Other—Type of Building ........................... No. of persons............................ Showers Cafeteria ( ) P4 Other fixtures ........................................................................ ...................................... .................*.................... Design Flow............V.. 7..........................gallons per person per day. Total daily flow.............. ._._._.__.___._gallons. . ..... 1:4 Septic Tank—Liquid capacity/Ob...gallons Length................ Width_________-_-_-__ Diameter_______-_.--____ Depth_._.____._._._.. Disposal Trench 4�N Width____________________ Total Lengtl�_ Total leaching area....................sq. f t. 0----------- ---- ---------- _0 Ziq� Seepage Pit No. Diameter.................... Depth below inlet_._.a_.........a ......... Total leaching area.!��4�...... ft. 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_--.-_--_--_______--_--. G Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water._____......______.._... ... .................................................................................................... 0 Description of . ......................................................................................... U ---------------I------I---------------------------7- ----------- .......................................... ....................................................... -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 un signed further agrees not to plag the system in operation until a Certificate of Compliance has bee sued by the board of health. Y 4 Sig ... ........ ....... . .....................S, ... . ........V / , .......... ............Application Approved By........ . ..... ....................... ....U,4,f. ,- ...... to 7.................... Application Disapproved for the following reasons:----------------------- ...................................................................................... ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................... ............................... Date ---------- .................. THE COMMONWEALTH OF MASSACHUSETTS OARD OF HEALTH rr :. OfF...... Apphratiou for 13iiiVosal lVarks Toustrurtiou Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at Je A—! r...je A s ...4,a,4. ........ Location•Address of Lot No. .' • .....-.................... ........................ �............. ........._...._.............................. O.O w�ner Address ..... .: :: ... ....::... ...................,........ .......... Installer U Type of Building, Size Lot.t ....Sq. feet Dwelling=No. of Bedrooms___._.: !______________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ---------------------------------------------------------------•------------------------•-••---------------------------- Designw Flow_.._._..__ C°.. __..gallons per person per day. Total daily flow.............. �`:n. .______.._____. -•... ...........:..• a P P P Y• • Y _ _ gallons. W Septic Tank—Liquid capacity°;; ____gallons Length................ Width..........:... Diameter................ Depth......._-------- Disposal Trench—IV . . ______ Width____________________ Total Length Total leaching area....................._.sq. ft.. Seepage Pit No. i :.__. Diameter____________________ Depth below inlet----� ..._.._ Total leachingaread__26mr'ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by............................................ ............................. Date........................................ Test Pit No. 1._________ _____minutes per inch Depth of "rest Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------------------------••--•-----------•-----------------•-•-•---------------•----•-•••----- O Description of Soil—,-.. x11........-.......................................................................................... U .---•••......-•-•-•-----•---- --•-••--- ....... -•-•-•-• •--••-. w ---------------------------------------------------------------- .............................. -:----------•••••--......................................... 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 ce has bee operation until a Certificate of Complianr} ssu.d by the'bo rd of health. r e a �Sig ........................... •-+ __. � � Date � Application Approved. BY r------------------- ... --- Application Disapproved for the following. reasons:---•-------------------=------------------------------------------------•-------------•------------------...... ---...-•-•-----------•---•---------------------------------------------------•-•-••••...-•--•••--•••----•---------------------------------------------------•.----------••------•-•••--•------------•-•- Date PermitNo......................................................... Issued........................................_............... Date 'THE COMMONWEALTH�OF MASSACHUSETTS BOARD OF HEALTH (9rd fitatP Lit 01urApha xrr Tlhi� I T CER Y, That the Individual Sewage Disposal System constructed or Repaired ( ) by - 1 i--- ------- -•-•• -------- -------------------------------------------------- at.. •- • " has peen installed in accordance with the provisions of Article XI of The state Sanitary Code 1 descril� d in the application for Disposal Works Construction Permit No................... . dated.------- ___ f _. __. n__ THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE CONiNIONWEALTH OF. MASSACHUSETTS B00e4RD HEALTH '. O F....:..' 's"" � � NoFEE._ ................ r� Permission •s ereby granted._::._ `' tit__.._._. to Consituc ( epair ( n tndi idua l Sex%age o 1 yst ...... .. ...................... � atN � . treet s as shown"on the application for Disposal Works Consti uction Pe N ._ _ ._. Dated_-:. � - ...- .............. a e --------------- Board ... health Nl�' •--_- DATE----- ------------- --- :. , M. FORM 1255 H069S & WARREN, INC., PUSLISHERa - 6