HomeMy WebLinkAbout0228 FIVE CORNERS ROAD - Health (2) // 07
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-17 No..7� L. �.» f //�g✓ FEB..........vr..rl....
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
L. --T aw. N ...............OF......
l
J .� lirtt i�an for Disposal Works
Tonstxnrtinn rrmit
Application is hereby made for a Permit to Construct (1/) or Repair ( ) an Individual Sewage Disposal
System at:
�3. _.....11 d�.�tlp. . �1!/7 R1�'�.4 --------------_ 0.7.... j...........................................................
I Lion-Address r }' or Lot No.
............
..... �I AJ-----.�.'�� k ...
t .� �✓!r1d!!..._s
Owner Address
....UETo2t.!.?a.---. .....�05.._.......................................... ............ _a................................................
Installer Address
UType of Building Size Lot..r .�.F._0....Sq. feet
Dwelling—No. of Bedrooms_._..._.....�..........................Expansion Attic (N�59) Garbage Grinder Wo)
Other—Type T e of Building No. of persons......................... Showers
� yP g -�- -�--•---------•-• P --- ( ) — Cafeteria ( )
Otherfixtures ..---•------------------------------------------ -----•--------------------:------•-----.............................................................
W Design Flow.......1Z.0..........................gallons per e to p`�r day. Total daily flow.........22 2.........._..._.._....gallons.
WSeptic Tank—Liquid capacity/M..O.gallons Length.$...a..... Width`,(O.... Diameter................ Depth.a.`?4.".
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No......../--------- Diameter....6............ Depth below inlet-----6...`_..... Total leaching area.'Q-0.D_._sq. ft.
Z Other Distribution box (1j- Dosing tank ( )
aPercolation Test Results Performed by.__PZ4nN A_4_b...A.!:.j r7-1,0 rADA4 Lt.1_l.-S_......
Test Pit No. 1.4.-;. _minutes per inch Depth of Test Pit---- _�..__. Depth to ground water------------------- ---
LL, Test Pit No. 2_.-4,...Q....minutes per inch Depth of Test Pit...l.�......... Depth to ground water........................
C4 --------------------------....................................
----------=--••..• .................
.........................................................
O Description of Soil....0. 2 ..r�._Z_,0A"? �$.l�!D..... c�. �,G?ic- `rP t�
V ......... AA leA... .. /ll_....... .r➢/1!!_b.._..^.----- /l � t4� s ._..... r►tit. �7i.�c S:....._lnt
UW ............ -------!£S-z.......00�®c.E3.................................................................................................------•--....----•-......--------------
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 TI'i U 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.
Signe s ...............
Date
Application Approved By...... L__ '�
Date
Application Disapproved for the following reasons-.......................................-........-........................................-...................._
----------------------------------------------------------•----•--------------.........----------
Date
Permit No......................................................... Issued...wl 74a�•---------------
Date -
.. o
V ;Z$�A�
No................ ....... Fx$..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
t ,ram
1.v...44J.1K.-..... - ....-OF..... .1Lt!. .T4
.................
Appliration for Dispaii al Workti, Toustrnrtivit Permit
Application is hereby made for a Permit to Construct 4. ) Or Repair ( ) an Individual Sewage Disposal
System at
.............. ---------------------------
t n-Address, or Lot No.
, �l' G -- �' '. t ,► ---=------------------------------ ------------------------- •--
uE I OtZ.i Owner Gress..........................................'- ._...-
a ►.x� .iaiZCOS _...._ A�Ias-rra
� Installer •• Address !� � �� S feet
Type of Building Size Lot__ ___,,_________ _.... q.
Dwellings—,N_9.,,of Bedrooms.____ __________________________Expansion Attic (t�i/9) Garbage Grinder tQ0)
pa, Other ,,Type of�-Building n�,��j________________ No. of persons_________._________.________ Showers ( ) — Cafeteria ( )
aI O.ther fixtures ._
Q ¢ Ad�v !
W Design Flow..... ram . ...... ._gallons pe l pier day. Total daily flow____________ __ !.........._............gallogr
WSeptic Tank—Liquid capacit,� _gallons Length.49!4.____ Widtl*?'rtf _ Diameter................ Depth$. _0_._...
x Disposal Trench—No_ ................... Width................... Total Length ________f____. Total leaching area....................sq. ft.
Seepage Pit No.......I/---------- Diameter_:_____________ Depth below inlet___.4............ Total leaching area_ 00..sq. ft.
Z Other Distribution box (901 Dosing-tank ( )
'" Percolation Test Results Performed b OVA_ �A�___ '_ dt ' R __ � .�____ Date.).,*
a Y is
Test Pit No. l4 .An..minutes per inch, Depth of Test Pit.../_.-4......... Depth to ground water........................
fs, Test Pit No. 2_4__a_..minutes per inch Depth of Test Pit_:�4P_ ....... Depth to ground water________________________
O Description of Soil 0.. A 9 � 4 At....h1vio 9V��d/� 1 f�
x ¢
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 provisions of TITIE 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.
Si ne ' �► .
1,�, _ yy ---------------------•• -------------------------•---•--
`,. YS�w� �- S y - yy-- Date
Application Approved. By ,u�l�'� `.`.'`� '---------------
Date
Application Disapproved for the•f ollowing reasons----------------•--------------------------------------------------------------•----------•--•-------------••-
...........................................................•.............................................................................................................................................
Permit No......................................................... Date
Issued_- ----- '�/--=-- --------•
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
1 ...........................:OF..... 2.1�5...Ni�IG....................................
�rr�ifirtt�e laf f�unt�rli�anrr
THIS IS TO CERTIFY— That the Individual Sewage Disposal System constructed ) or Repaired ( )
by -U�To® 1 ���TNE25
_---------•--- _-•--
nstaller
i r u c ot2 IJE RS �IoR D at ..._OT -1
Y. has been installed in accordance with the provisions of kT F 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit N s___.l__ ,r_____________________ dated_-!/j-_-_f.)e .................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCT19W SATISFACTO .
dr
DATE.. --5 7............. Inspector C/ ........................................
t'
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH ,
i � t o t� 2ry�-r .. c
4
Dispnsttl Work.5 Tons#rnrtion Permit
Permission is hereby granted E T�2 I itiJa
........ ..........................................................
-to Construct 6 l or Repair ( ) an Individual SewageAisposal System 1
at No.._-�OT----• 1 F lUlr C 021JE(c5 1S' ?-----------------•--------•---------------------------------------•
Street
as shown on the application for Disposal Works Construction Vr
it N _____________________ Dated4/-/ `-74!Ft.................
rd of Health
DATE-- ............................J .....................................
r� -
FORM 1Z55 HOBBS &WARREN. INC.. PUBLISHERS:. -
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