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Home My WebLink About0012 DEEPWOOD CIRCLE - Health CUI�fl� aEs - s� S M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR A� ca�rrrwx �o MAMMUSA GET ORGANIZED AT SMEMIM No.<sQ � d� t - if.& Fmc.....�......_.� .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH AVVIiratinn for Uiipnaal Workii Tomitrurtinn ramit Application is hereby made for a Permit to Construct (L-r or Repair ( ) an Individual Sewage Disposal System at: - 12, ,CGT y Jew"Ou,Got7 C' .c4, �L-A,,'�� ...../yi!ft.._... -..: -.......... — .......................................................................... --....--••--..................---•---- .----- --- Location-Address or Lot No. ......9......a.............................%N ....... Owner Address W i_C GC'. 0 . �f Installer Address d Type of Building Size Lot__ ...�_.............Sq. feet aDwelling—No. of Bedrooms...7-h.,Z.e.e______________________Expansion Attic (W) Garbage Grinder (,Vo) p, Other—Type of Building _e'9 .............. No. of persons.......:................. Showers ( ) = Cafeteria Other fixtures ..........-•-••------•......... .. W Design Flow.................................116..._..gallons per person per day. Total daily flow-_______-__--_____. -_---�.3 .....gallons. WSeptic Tank—Liquid capacity...........gallons Length................ Width................ Diameter---------------- Depth...,............ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No----------_--------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) - "" Percolation Test Results Performed by.......�..iCie__._B'9 u''e -_.........•................... Date.... ?'_/.`�!._ s .......... Test Pit No. 1.....a-------minutes per inch Depth of Test Pit---!y........... Depth to ground water.ti<!............... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.-_____-__-___--_..___- a •••-•••••-------------------••-•-•••••-•-•••--•--•••--••-•--••-•-----•----.......---•........................................................................ 0 Description of Soil-----O. A _;e.... ------------------------------------------------------------------------------------------- •U -••-••••••••-••••-•._._...••.............•-•......- -. � -••--•------------------------------------•---••-•-•--•••-•--------•---•-------....•---------••--•------•-•------------------------•-•--•----------••--•••--••••....--••••..................---•--..... 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 rov 'ons of iiT ,i'. p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation 1 a Certificate of Compliance has been issued by the board of health. r A 1,1 igned---� T-.• Y- �..'.�r. _�__ PPlicationApproved By..-••-----------------------------------a-� . ...---•-----•---•-----------•--------- ........................................ Date 'Application Disapproved for the following reasons------------------------•----•-------------------------.....---•-----------------------------•--••-•------•••••-- --•-•-•--•-•••••••-•.._....-••--•••----•-•--••--•-...----•-••-------•--•.....•••--••---------------•---•---••••--------•----•---------•-----••-•---------------•--------•••---••-•----•----•-••••------- Date PermitNo......................................................... Issued_....................................................... Date t` NoE_`-� 3 K(ry Fmc.... ............._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . .-- .....OF... 7W,6 `n •---•---------------------------------••-•-----------............--------- Applirtttiou for Uiipaaal Works Tomilrartiou ramit Application is hereby made for a Permit to Construct (L-�'or Repair ( ) an Individual Sewage Disposal System at: •.. .................... ....... Location-Address or Lot No. 7JFly ' GCY..�.. �..'�.Tc �✓� / //��. Owner Address .............................................. ------------•-••-------••-•---••----•----•------............................._.. Installer Address _ dType of Building Size Lot...1.............. 3 Sq. feet U Dwelling—No. of Bedrooms-__- '______________________Expansion Attic (1,16) Garbage Grinder (N,,) p�.l Other—Type of Building ............... No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures --------------------•--••-----•• . W Design Flow................................1CG_._..gallons per person per day. Total daily flow......................._.3.3_�?__...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. ~' Percola ionrlTest Results Performed byy b.t�«_____e'g_�'> �______________________________ Date....a-lcl- 0_s __..____-. z O () Test Pit No. I......�'�.......minutes per inch Depth of Test Pit...Y........... Depth to ground water._/.................... rX4 Test Pit No. 2................minutes per inch Depth of Test Pit............._...... Depth to ground water........................ 94 --•-•----••-••-•--------••--•-•---•---•---•-••••--•-•••----:..-•-••---•..........:..•••-------------......................................................... 0 Description of Soil.......�2.-`-'1 .t o "./.....�' 'a-,<........................ x v--........-------•-•-nCo�n- UW ..................=---------•-----•-••-------------------------•-------.......................................---------------------••-•-••--------••-•-•------------•-•---•-•-•----•----••••-•-•-_.... Nature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------- ---------Agree nt: h undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with e provisions of ii 11-^. 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 bboard of health. I igned--- a � / i . i;af t Application Approved B G.. ' �' Date Application Disapproved for the following reasons________________________________________________________________________________________________________________ --------------------------•-----------------•-----------•--...---------------------......._..•--•----=_•-. =-----------•--•--•-•---•-••----••-----•-••----------------•-•-••---•-------•-••--_------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �r�gf irtt#r ,af �u�t��itt�rr THI$IIS TO {CERTIFY, That the Individual Sewage Disposal System constructed �' ) or Repaired ( ) bY-•••........- ..........-•-------------------------------•-•-----------------------..._.....-•-•---•-----._.......------------•-------------...---........•---...........__ Installer at.. L?�.._.. st y �`*, C-----------•- - ---`-=-•.......((i................................................................. been installed in accordance with the provisions of f _ 5 of The State Sanitary Code as described in the application for Disposai Works Construction Permit No----- ____ dated_-.-__' 1/ {_______________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS UE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE._..... - Inspector t --- ••••-• ....-••--•--- ..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r _ r L�/_ ?G...v"..................OF.-.... � ST - -� - 1, No. �1:........................ Permission is hereby granted--•--•-•-•---.�- r. ;.....-...-•---••---•••••••-•-------•-•-------•-•----••-•••-•••--•-••--•-••-••-••---••....................... to Construct �( -,<) or Repair,.(�1) an Individual ewage Disposal §ystem, 1 t `1- r at No.- - - -'' �r �- f Street as shown on the application for Disposal Works Construction Permit No. f -�_` '. Sated... r _............................ .. _. -.j-� �S ._ Board of Health DATE_ FORM 1255 Hoess WARREN, INC.. PUBLISHERS -4 ) •1 �,1►.tG°�C FAMkLY - BC'D000M Dts,%Ly FLOW a 110 A 3 = 73oG.PR SEPTIC .P. 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