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Home My WebLink About0004 DUNASKIN ROAD - Health (2) $w'��. ��/ �V� vxe��✓ka, ��9�n\JEJ!,i`Fi�. r .r. r'+ art „ a FA No......J-1/. a 2-�- O f s THE COMMONWEALTH OF MASSACHUSETTS 4( .� BOARD OF HEALTH .. . . ..............OF.......... ...: AppliraatinnJor Big uiitti Works Cnnntrnrtion Vrrmft Application is hereby made for a Permit to Construct ( ) or Repair (f/f an Individual Sewage Disposal Syst a r�'n ---•---------------•--------------------- -: /p Lo n�Address or Lot No. Owner Address a . � Installer Address ' Q ype of BuiIdin Size Lot............................Sq. feet U Dwelling-9 No. of Bedrooms_-.---_--.-j----------------------- --Expansion Attic ( ) Garbage Grinder ( ) aq Other—Type of Building ---------------------------- No. of persons------------------......... Showers (f ) — Cafeteria ( ) P� 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------- e__.. Total leaching area....----------------sq. ft. Seepage Pit No.�Y�ltot_____ Diameter......... Depth below inlet--------- Total leaching are a...-..-_-----__--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-.-.---.-.----.--------- �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water............-----_-----. W -- - - 0 Description of Soil.------4IC -----------------•-------------------------------------------------...--'---.._..-------- ---- ..--------------------------------------- �4 _L---------------------------------------------^�-�----------------------------------------------------------------------------------------------------------------------------.----------------- ------------------------------------------------------------------------------------------------------ ------------------n ---------•---------------- U Nature of Repair or Altera ons Answer wh applicable..___ -------/�.=-_ d®®..____ .............. ------------- _.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I 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 by the board of heal h. ---�f f�--------------- Signed-_. T ------- - Date Application Approved By----------------------- =-------- --------------------------------'-----•-•------...--------• ----------------------- ---------------- Date Application Disapproved for the following reasons:-------•---•-•..................••-------------•-------•---•-•--•-------•--------............----------'---- ...........................I........................................................................................... -•------•------------------------••----------------------................ Date Permit No. i I? = Issued 1/��r� Y-----------------_----- Date NO-Al............. Finc 5�� .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH . .... ... .... .... ........ OF.... . .............................. ................................................. y. Apphration -for Bhipoiial Workii Ton5trurtion Vrrmit 'Application .is hereby y a e for..aPermit to Constr.j!�t or, Repair ,( /,I •an"*lndiVidual Sewage Disposal System aA: ...&"Jz� .......... ..... . ................................................................................................. .. ................. _- cation Add on'Lot No. --- ------- --------------------------------------------------------------------------------------------------- i) Owner Address AA ............................................................. 4.. .... ...................... ----- ....... ------------------------I.iistaller &V W4 1 Address U ype of Buildings Size Lot----------------------------Sq. feet Dwelling o. of Bedrooms_____ _________ __________•-_-.--------Expansion Attic Garbage Grinder a Other—Type of Building ----_--------------------- No. of persons_.._..._.._._._...._.__._.__ Showers Cafeteria Otherfixtures ---- ------------------------------------------------------------------------------------------------------------------------------------------------ Design Flow............................................gallons per person per day. Total daily flow-------------------.......................gallons. Septic Tank—Liquid capacity............gallons Length................ Width....__......._.. Diameter__--._..-..-___ Depth___-..-._..--.- �9 Disposal Trench—No. .................... Width-_---_-_-____-_-_-_- Total Length__---__---_-____-.- Total leaching arca--------------------sq. f t. 6- Seepage Pit No---------Z......... 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----------------minutesperinch Depth of Test Pit____________________ Depth to ground water..-._---..___-_--.-.._.. GPI Test Pit No. 2................minutes per inch Depth of Test Pit.._...............__ Depth to ground water__._--_._-_.__-.--_-.__. -------------------------------------------------------------------------------------------------------------------------------------------- 0 Description of Soil........ - ----- -----------I................................-------------------------------------------------------------------------------------------------- U ......................................................................................................................................................................................................... -------------- ----------------------------------------------------------------- ------------------------------- ---�W------------------------------------- ---------------- Nature of Repair or Alteratio s nswer when applij ble....../-!n------ ------- ----- -------- ica --- ------------------- U L -Z / ... ------kAIAI�__ -- ----P------101.&4_tio--- --------_-AYZ A-_------------_---------------_------------- ------------------------------------------ Agreemerft: 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 operation until a Certificate of Compliance has een 4iss d?y board of ..eal.th. .. ... .. Signed .................. Application Ap rMedl,By................ ....................................-----------------------................. .......... ---------- ----------- -- /I Date Application Disapproved for the following reasons:................. .................................. ................................................. ...................................................................................................................................................................................................... Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS -A!Mrl BOARD HEALTH .......................0 F.... .. ....................................................................... Tntifiratr of T mplianre wo eTCERTIF That he Ii Disposal System constructed or Repaired L)I- Ila Oividual Se.... .......... T1 S-1 y ... . ........... b .. . .............. . .. .. ..... --------- ................................................................................ r . ........ t1Z at.......... ......................... -- ----- ....................(f....I.. . .......... ............................................................................ has been installed in accordance with the provisions of Article '9f The State Sanitary Code as described in the application for Disposal Works Construction Permit No--_--_---/. ....................... dated._...___.+......------.........�r............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED S A GUARANTEE THAT THE SYSTEM WILL FU CT15N SATISFACTORY. DATE...........X.—...71,--------T....................................... Inspector........./? ................../........................................ ... .... ---- ---- --- THE COMMONWEALTH OF KAS.SACHUSETTS '4 BOARD`,OF" 1,H E- Y .. ... ..OF.... ............. ........................... No..... ...... FEE........................ a Qlamitrur Permission is herIiby,grante�d.. ........ ....4.,_ ------- ........... -------------------------------- to Constru an ;-pdividual Se age ,ft ( 4 or Repat �postLystem L atNo._---1-------- ................................. . .... .............. ......... ...... -------------------- Street I 1 2, as shown on the application for Disposal Works Construction, Permit;N, . ....... ................... ---------- ................................................. Board Health 7----------- DATE........ ............................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS