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Home My WebLink About0005 GINA COURT - Health (2) 191 ........... THE COMMONWEALTH.OF MASSACHUSETTS BOAR® OF HEALTH _VOA ,Q.'N...............OF.......>... Appliration for Disposal Works Tonstrnrtinn Permit Application is hereby made for a Permit to Construct ( vJ"or Repair ( ) an Individual Sewage Disposal System at: ...... i .... vw. --------------••••..............--•••- •••.... . ...... ...- •• . -Locati n Address • o Lot No. r. .-. •. � ,— --. ................................... Oywn - Add ss . ...... Installer Address Type of Building Size Lot...%5.00_V.._..Sq. feet Dwelling—No. of Bedrooms............. ..........................Expansion Attic (NO Garbage Grinder N() aOther—Type of Building ............................ No. of persons............................ .Showers ( ) — Cafeteria ( ) Other fixtures - .--•----- -•--------- W Design Flow............... .\.O...............__..gallons per person per day. Total daily flow._._......3..�_'D....._........•.._...gallons. WSeptic Tank—Liquid capacity.0 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 ( ) p , aPercolation Test Results Performed by........... ......... ..... 1....... Date.....4:7:. ...................... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water--_-__"______-"_---_,__. LL, Test Pit No. 2.........._-----minutes per inch Depth of Test Pit.................... Depth to ground water................... a ......•••.................. ......................................................... 0 Description of Soil.....-_ -_: O _ f ub xL - ur-ck � ,c......><.s�---------------------------------------------------------------------- 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 iITL% 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 �.. .......... Date Application Approved B ............. e__ .. "�` '� -------G (9� e f Date Application Disapproved for the following reasons:...............:. ..-..------•------------•--•-------•---------.................................................. •-------------------•---._... ----^-------- `. " r r =. . fd, i --•-----------------•----•----------------... Date PermitNo......................................................... Issued.------......= . .................................... Date Nd. .....'.... THE COMMONWEALTH OF MASSACHUSETTS . BOARD OF HEALTH ... `Nn...............OF..... ..1 .h.. .. .. Appliration for Disposal Works Tonstrurtiun lirrutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at •Locati n-Address �+, �y or Lot No: Own Add r ss ------------------------------------ Installer Address Type of Building Size Lot... .....Sq. feet U Dwelling—No. of Bedrooms.............. .............. .....Expansion Attic (N Garbage Grinder '4 Other—T e of Building No. of persons............................ Showers — Cafeteria QI Other fixtures --------•-•---- -••••-......••• . W Design Flow..............\.\-U...................gallons per person per day. Total daily flow.........3_-3.5............--.......gallons. WSeptic Tank—Liquid capacity.k0q!".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 ( ) aPercolation Test Results Performed by...........K. -_ ....... __.__ ° ........ Date...._. .....�................... ` Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ G% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... �+ -----•------------------- --•---------------•-----............... ••----------__-_-___ -------- •--------------------------------------------- O Description of Soil__.___�''_ ^'_____________________�.� ..______ .......... 1Ci__ 3 ----------••................•----...........---------------- 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 iITIE 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 ..................... Date Application Approved By...............v.,_�. : . .:....:....... f - .'1_/--•-•--•-- f ' ate Application Disapproved for the following reasons________________________________________________________________________________________________________________ --.......-•-•-•-----••---....-•---•----••-•-•-••---•••_._._...---•---•-••-----•••-•-•-•--------•---•-•-••-•••-•••----••---••••••-••-•••••-•-•••-•-•--------------•--•-•--•...••••...------...•-------=-- Date PermitNo...........................-............................. Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O, F HEALTH .......�.. ,-.:f`.............OF.......... ?.. .? :.. "?' ✓'".`................... (Irrtif irate of Tontpfiattrr THIS-IS TO CERTIFY, That the Individual Sewage Disposal System constructed (V) or Repaired ( ) by••................=-•--...-' ........•---------.- :::' ...:b--...--------------•-----...--------------•-------•-------------------------..----....................._.........----...-- Install has been installed in accordance with the provisions of TI�LLE _55 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No. -c�.'__-5.t�'�................ dated............................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.. .......... , _Z ................................................. Inspector---------. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH y,. .?tea OF........... O_s...C.........- . -" N . .......... .... FEE.34)-••............. 11iapooFal Works Tuonotr iun Vrrmit Permission is hereby granted............... >= •••••-••....•-••-•••-----•-••-•-••-•••-•......................... to Construct (,--*I or Repair ( ) an Individual Sewage Dispos System , at No..__ __'S. . fi. ti �k. A.\—.fZ, � `` •. ---•-------------------------•----....... Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... /Board of Health DATE';....` 7/6/�_- r FORM 1255 HOBBS & WARREN. INC., PUBLISHERS I� ❑ Ste_.1Gtr� t~•a�nt��!-- =�'"�s✓u�o•K •��'S � f v -,ArZ-0-Ar_C O uO � 6-r�t s.tt> .t?. �- &t L.�( 1r tCtti = t Ib x 3 % � o ,.p.V.�^y �"'• 43 Gp USA- t r_>c� GAL-. - - • } . ,� ► I71SP45as_ �iT - t-. Sc �o�� Can(_.. \ -SCPc:VAU. 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