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Home My WebLink About0068 FOX RUN - Health (2) (08 t-o� 4�u..r� No...T . y Fics....r ........... THE THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ��a Iv....................oF..... AkJi3......_.._....._.......-...... ApplirFa#ion for Diapos ai Works Tnnstrnrtion ramit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal Cj System at: ............ ...---_--.�- .......�_................................................... Locatilo -Address or Lot No 7e... ! 5.......... ....................................... W Oi r Add r ss �., ..._ ........ .r `.� -------------------------- Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms____.._. . ................Expansion Attic W, 0 Garbage Grinder (gyp) WOther—Type of Building __W _ .. .____. No. of persons____________________________ Showers U. — Cafeteria (4jo) Otherfixtures _. ------------------------------------------------------------------------------------•----------------•-------------------------- W Design Flow__________ : ________________________gallons per person per day. Total daily flow.._.__.3_11�.__.__________..__._____gallons. WSeptic Tank—Liquid capacity../ allons Length......l�_____ Width____,i_...._._ Diameter-----(-------- Depth._S___._.___. x Disposal Trench—No. Width.................... Total Length.................... Total leaching area___.14t(______sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ()() Dosing tank ( ) _ 1-4 Percolation Test Results Performed by.__C�b.__1 _ _L4-=_y_.____��t2. 5�Sa_ ___ Date___ _ Test Pit No. 1_._4_�__minutes per inch Depth of Test Pit-----L_'a—_______. Dept to ground water..... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ *--------- -------------•---•--------------------------------------- •• -•-----------------••----- ••••................................................ O Description of Soil...L?.&�.... --5t3UZ ........... "•-----------------------------------------------------------------------•---------------- x x5-c......5_` !Nb...................... ------------------------------------------------------------------------------------ V 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 TITLL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operati unt- Certificate Compliance has been issued�y e board of health r C/aj gned- ' ---•- •... ............. ... . `' -- ...... ---------- Da 4" Appcation Approved By........ -------------- -__G `------•--•------•----•------------•-•--•--- -.._._....-� - 2 - � ------ Application Disapproved for the following reasons_______________________________________________________________________ ----•-••-••--••-•.__Date-------------- -----•---------------•-------------------•-------------------......_.......--------------.....------------•-----------------------••------•-----•••-- ................................................. Date PermitNo...... ----------------------------------------- Issued_......... ` g .................. i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7(5rGa�`ti. .............•---.OF..... .1 : .......:. Appliration for Disposal Works Tonstrurtinn Prrmit Application is hereby made for a Permit to Construct {�O or Repair ( ) an Individual Sewage Disposal System at: .............. �t�tL.----•---...... ........................................ .... ._....•- Locatir-Address or Lot N - -{ ' -- & --- 3• - � -----•_... ............................... C �=• -•----.-------•---•------•---. ---- o _,. Address W ( ( ``'", # Installer Address UType of Building Size Lot............................Sq. feet �-, Dwelling—No. of Bedrooms..... ..'.j................................Expansion Attic Vd) Garbage Grinder (Z) Other—Type of Building _ x�erh------ No. of persons............................ ShowersCafeteria , ) w p' Other fixtures . .. . c� ----------------------- •--------•-•--------------------------------------------------•-------------------•------•-----... W Design Flow.......... _---••------------•-------gallons per person per day. Total daily flow......1_3._C)........................gallons. /. W Septic Tank—Liquid capacity../A00gallons Length-___- , .._._ Width....r,......... Diameter---- --------- Depth.,6-......... x Disposal Trench—No.}fl :___.. Width.................... Total Length.................... Total leaching area,11„-1......sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area............•.......sq. ft. Z Other Distribution box (X ) Dosing tank ( ) a Percolation Test.Results Performed by...':t>:..V .1 d E-__ r C� �{~ __. Date..dtw e-' 57 a Test Pit No. 1---Z_.:�_...minutes per inch Depth of Test Pit---- Dep to ground water_.__ .fr . ..._.. r: Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-----------------_--_-_. a •---••......----•-• --• -----•-•----••••...-•----------------•---•----.._..........-•--•------•----•--••----•---.....--.----- O .` YI.. r2. . =. . Description of Soil..:�..(7f�i.. �3?��U.(..� .--- - .-•--------------------------------------------------------------------------------•-•-•--- _ •... VW --- -------------- .......................5;r i 7------------------------•----------------•--------------•--------------------....---- 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 TIT' 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. Signed. �...... .. ....1 ---- Dat Application Approved By....... "�- �..�.. Dat Application Disapproved for the following reasons-==----= =-- -----------------------•--,-------------------------•----------------//-------------------......_ ---------------------•-----•--------------------•-••---------------.....................:............................................................................................................... Date t ram" . Permit No..... ........................ Issued....... �- ----�--y--................... D e THECOMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF..... ............................. Tntif iratr of ToutpliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (1O or Repaired ( ) by. y.......-=...................................................................................... _ nstaller at.......' =.....4....-----•--='..c a-----�. :(-1 .d.�� I _......._ o has application-for Disposal Works Construction Permit No.._.---:_-__p�:� f The State Sanitary Code described in the PP been installed accordance with-the provisions of TITLE ,•`> � dated...... :",�? � "_+"':_.____..__. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUA ANTEE THAT THE SYSTEM WILL F N TI N S TISFACTORY. DATE-------------••• . ..----•-•-----....... .._. Inspector...... ) .................................................... THE COMMONWEALTH OF MASSACHUSETTS '- _ BOARD OF HEALTH .: ::.� �. U QJ ...............OF... No. ..... .f r ��. ( 4 .11 t ` ... FEE... �.._ r-.......... Disposal Works dun traction rrutit Permission is hereby granted:: <. - 1.5.1"' to Construct . ) or Repair ( ) an Individual K=age, isposal System atNo.----1- ': .. ? ..._.h1�%t/ ............::•----------------------•-•-•------------------------------------- .. ........-•-•--. Street as shown on the application for Disposal Works Construction Permit�l`Io =. '`__ Dated......�� a.................... a' Board of Health DATE._....--•-----------------------•---------------...............:--------------•- FORM 1255 A. M. SULKIN, INC., BOSTON LEES/G/V 0,4 7`,Q � *tJdk FA Apt I L_1 3 13 ED/zoaAA- do 6•AQ73AG6 Z.IZADE(L � VAIL j Row 3�-1I d t 33o 4.F't> SSG TA14k 330Xl%to= 4qs 1,,� i / / �47-7 U56 1000 GAS 'DIAL [%i7' I�GAt�/I 'S>-vvrJ� 37•Z. SIvawAw - AaaA - l so sF I L5p X 2• S '37 s elpD POT!PkA AC A - L5a 5F PD TOT-A 4- DES tGlJ = AZs 6-PCI. I` TOTAL D41L. F-LOu-)= 'S304PD 0W— PeOc• 7A-M 1 (a A►N O(L LDS �� i 4(, G TSST +-3y 'MoMAI) 'E. 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