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Home My WebLink About0363 BUCKSKIN PATH - Health (2) _� t 3��so r i,)- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -----.......... ........................O F...........................--............................-----.._............-._.......•.. Appliratiun for Uiupuual Workii Tonstrnr#iun Errant Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal ys a 3` = � rr%!�-.--..�°!}l-y... C ........ .11:�.�............��..�:..I................................... •-- Lo ation•Address or Lot No. -'(Z�14.!q.....��'...f��c�/ pi_q..---•.......................... .............ZC 7`�%LviLvE........................................... O n r Address a ............... ....... Installer Address d Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) A4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 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........................................ Test 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........................ W ------------------------------------ -------...... -------------- •............................................................................................ Descriptionof Soil........................................................................................................................................................................ U --••---------•-•--•---••---------------•....---•--.....-------------------••-----•-------......-----------------------------------------•------•--------••---........-----.......-•-•-•----------------- ------------------- ---------------------------•------------.••-•-•-•--•--•--------•--•-----•-------•----•-•--------•--•-•------•••------•--------•Z ........................... Nature of Repairs or Alteratio s—Answer when applicable...__..A.40----___-I.............. �Q C�?............................ -------------- ---��i�� a�f�iE�2.---•------- --------••------------------•-----------•---------------------------------:..... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL ITLL 5 of the State Sanitary Code Th undersignel further agrees not to place the system in operation until a,Certificate of Compliance has been iss d the b d o health. D ApplicationApproved By........ . ...... • •.------• --....................................................... -•• ' Date Application Disapproved for a following reasons:................................................................................................................. -------------- -------.............------.............------ ...._....--------•------------------------- Date PermitNo......................................................... Issued....................................................... Date No.�!-... - ��'� FEs. .a .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................... ....................OF....................................... Allp iration for Dhip ual Workii Tonotrurtion thruat Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address t or Lot No.r... ►.4/zfef./�._s.................••--•---------- ------.......C-OX.T�::�v � ........................................... Owner Address ' fL.:,1! v.3....,. .r?. __....._... t0..-e.............:......................... Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther 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........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil.......................................................•----......------------••--------------------------....-----•••--------•---........•-----.............-•----•-_.. x - , U ..........................................................:.............................................................................................................................................. w U Nature of Repairs or Alteratio s—Answer when applicable _.. ��.rrrrrr�� ,��i��i!C,3........................... 04....-----/--- ••••- -------•----------------- r� .4LJI,u ...----------------------------• -----------------•-- ---..... ---•-•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL L 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu d b the b d of iealth. S ........ ig ec " r.:- ,r. ----- Application A 4 Da Approved B Y - ---.....--•----•-•-••-•.............................•. ..-- -14V� ' --------- te Application Disapproved f ors: e f of in reasons:-•-------------••-....--•-----------•----•----•-------------••---------------•--------•-•. --•-------•....................••-•---•-•-•--•••-••----------•••--•-•--•-._.......__....................--------........................ Date PermitNo....................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTHt4: ..........................................OF..................................................................................... Trrtif irate of Tontpliatta THIS7I�S CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by .._'.. .Z?. � f. '{ /---- --�. !ns taller. . -------------•--- ----•--•--••-•-------•.....-•-•------------••....-•••...--•....••---at fr L..... has been installed in accordance with the provisions of TITL�F 5 of T. e State Sanitary C�-o�ef Aes4e in the application for Disposal Works Construction Permit No.._ -5 ...... ........ dated.__.. >_.;!.....�f� ............ THE ISSU NC OF THIS CERTIFICATE SHALL NOT BE CONSTRU AS A GUARANTEE THAT THE SYSTEM 1dV F CTION SATISFACTORY. DATE...., . =l .. .................................... Inspector.. L/ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,,. ...........................................OF............................................................................... ...... No._ .... .... FEE...r................... �io�oo�C o > �at�tritr#ion �rrntit Permission is hereby granted. ----•-•................................................................ rs to Construct .(,,,-'or Repair (/ an I l`vidu Sewage I �os _.. at No. tA - Street ' as shown on thXapp ation for Disposal Works Construction Permit No.__..-•-__--- � ed =- _-�-.-- DATE---. ............................................... ,and of�Health FORM 1255 A. M. SULKIN, INC., BOSTON ,