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Home My WebLink About0035 CATS PAW WAY - Health (2) 35 cc&s ...•- f THE COMMONWEALTH OF MASSACHUSETTS �...�� BOARD F HEALTH CG�Yl�. .... Applira#ivaa for Uiupuual 10orkii Tomitrurtiun Vamit Application is hereby_made for a Permit to Construct. o Repair ( ) an Individual Sewage Disposal System at ............ ,.. ocat^ ddr o Lot ....CV..�,U �A.._. l�i c. ... ll --------------- -- o 5'. V_.. Pam✓ �..P.. ......... Owner Address J .. ......... ................ .................................................................................................. Installer Address PQ d Type of Buildin Size Lot............................Sq. fee U Dwelling—No. of Bedrooms_....................................Expansion Attic ( ) Garbage Grinder (A/ Other—Type of Building ............................ No. of persons............................ Showers(7) — Cafeteria ( ) a Other fixtures _________________________________ W Design Flow................ -----------------gallons per person per day. Total daily flow-----.. Q•._.................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 b ---------------------------------------------- Date.__l.44:'.. ......7.7......... Test Pit No. 1---/-.---�?.—�minutes per inch Depth of Test Pit.................... Depth to ground water...................... f3, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....._.................. >. ----• r........ �+ / 0 Description of Soil-----•-- Q...� -.-n �?-�__...Z -�------��------- s�- P _ j �- W -------------------------------------------••------------------------------.._...•---------------------------•---------.......:------•--------•--••-•-------...._..----------•---•-------•----...------ 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'T�'L p S 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. Si ed --- - ------ Dat Application Approved By....... .. ... ........ Date Application Disapproved for the following reasons--------------------------------------------------------------------------------•-.............................. -•-------------•----•----------•-....-----------•..---_._._....---------•-------------------------------------------•-•------------.....----------•-------•------------- ------- -- - �, Date PermitNo........................................................ Issued.....: ........................ Date I ....... .. FEsd................ THE COMMONWEALTH OF MASSACHUSETTS BOAR® F HE , ;tiT / '�..................OF..... r '� •1 ......................... Appliration for Bhip sai nrk,s-Tonatrnrtion ramit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at _ --.--- .... .....Wkz....- _... ----- ---------•- -----_-.... Ada �-: .T ---•----.._... !J_ ,!`•._... .0--•---W-.t l�'�S .......... ... Owner Address Installer Address UType of Buildi Size Lot............................Sq. fetot Dwelling—No. of Bedrooms___ ______________________________________Expansion Attic ( ) Garbage Grinder 4 Other—T e of Building No. of ersons____________________________ Showers t�•l YP g ---------------------------- P (7w) Cafeteria ( ) P-I Other fixtures ____.._..•---•--•••------------• . d ----------•---..... W Design Flow______________3 �__.____________._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 b f!_______________________________________________. Date._ `.6 7 Y •••-•---------------- a Test Pit No. 1__/-!2.t-_minutes per inch Depth of Test Pit____________________ Depth to ground water........................ G4 Test Pit No. 2................minutes per inch Depth of Test Tit.................... Depth to ground water........................ j a ! 3 Descr> tion of Soil-- ; �� aZ ----------= ----9------- v ' x .-----____ •- ..r. , • ------ > _.___._...-•---- -----------• -••-•- _=...•-.-•----.....- 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 , f"1T�'1� the provisions of ,.,�'•. 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. { S ed.. I .... - ------------------------------------------------------------------------ -••---------D._.....____------• . Application Approved By___.__ . <� _` /, 1 _ �' � _ fi .2 Date -••-----•----------------------••---•-•-------------------•--._.._ .........._. Application Disapproved for the following reasons________________________ _ , ---------------------------------------------------------------------------- t 's' Date PermitNo................................................' Issued.--................................................... s;. � Date THE COMMONWEALTH OF MASSACHUSETTS BOARD-'O HEALTH �rr#if irtt��;af ��ant��i�nrr THIS TO RTIFY, That the Individual Sewage Disposal System constructedor Repaired ( ) by...-� �......................•:--=-----......................... -------•-•-----------------• ------ Installer has been installed in accordance wit the rovisiol f T ` 5 of e Sta SanitaryCode as d cribed in the _application for Disposal Works Construction Permit No _�/ _.___ .......... dated....... . _.�_ , -__________ THE ISSUANCE OF THIS CERTIFICATE SHAL N®T BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE. `••_2.�.= -1--------•------•--••---•-•----------•-•---• Inspector.."----- ................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No t #+• ......... I4. ;, FEE.. ( Permission is hereby granted....•-:.___ . _ __..-•-------------------•---------------------•-------•-••------•---•---••••-••--••------....:_........-•---- to Construct�-or Re ,fir ( an Intliyidual ewage Disposal 'Syst at No. zy----—- /`v�J 6s ---'•a•--�.--�--�.'--�, w ---- �Gyo,�� -- as shown on the application for Isposal Works Construction Permit o_______ ____________ D to 7 � �_f c. _�__.... y }� - --• •-----••--•--------•- BoarH /Fleaitli`�' DATE...... -;------ --------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 1��1G►1 'DtS.TA. 1.10 C�A28A�� i".�JD'EQ 2>dl U,4 F L-ow Co.P.V. 1EF�T'ic T 11C = 33ov Ir-iO °ro • A-q1:j ..P.o. � �:z , USA- t 00C� GAL-. ,2ISPo!5, L. PIT - use logo GAL.. 40 AVIV . Sar,_, AL.L AV_EA. = Iso F s . xY._',_ 13 q D M^ ' _- tc�po c, D S►5'. A I .o = S>0 TA,c%C `7 `OQ 5 t" TbT,6 L DaI��f FL.DW = 330 6.PD. 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