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Home My WebLink About0047 GLENEAGLE DRIVE - Health (2) y� Glen �l� 7 No...._ Fmic ....... ........... THE COMMONWEALTH OF MASSACHUSETTS BOARD9F HEA TH ----------r... ............ Applirativit for 43hipasat Marks ClIonstrurtion Pumit Application'is -hereby made for a Permit to Construct , or Repair an Individual Sewage Disposal Sjst at: ......... ........ .411 ----- -- ----- ation-Addrei Lot N --------------- ...................... ......................................... -- ------------ ....... 40wner ....... Address ............ ........ ... .............. .................................................................................................. . ......... ...Installer Address U Type of Building/ Size Lot----------.................Sq. feet No. of Bedrooms .--s------.. ..... ..............Expansion Attic Garbage Grinder a Other—Type of Building -----------------_---_-- No. of persons............................ Showers Cafeteria Other fixtures ------------------------------------------------------------------------------------------------------------------------- .< 7-------------------------- Design Flow', ::._X_ a'llons per person per day. Total daily flow._._......_...477_�- -- --------gallons. capacity-___P4 Septic TankL Liquid ____..�7gallons Length................ Width------,.--..---. Diameter--------- ------ Depth..------------ Disposal Tank —No.................... Width------------ otal I ..... ---------- Total leaching area. - ---W ---------sq. f t. Seepage Pit No- - -------------- Diameter. ------ 'te.... .............. Total;j1ching areQ5k___d,6q. ft. Other Distribution box Dosing tank Percolation Test Results ...... Performed by--_---------------------- .......... Kate __J/ Test Pit No. 1................minutes per inch Depth of Test Pit._.._.__............ Depth to ground water----_-----_--------- Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_-____-_--_-____._------.................................................................. ........................;..... .......... -------- ------------�_ ------- 0 Description of Soil.................... .... .... ............... ------------- U .................................................... . ................................................................................................................ - --------------------------------------------------- --------------------------------------------------------------------------------------------- ------------------------------ U Nature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------m----------------------------------------------------------------------------------------------------------- Agreement: 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 been issued by the board of health. Sign ....... ............................... i ��Dae Date Ve --- -- ----- Application Approved ........ ---- -------Ali( Application Disapproved for the following reasons:...................................... ................................ _r_ ----------------------------- ........................................................................................................I--------------------------------------------------------------------------------- -------- Date------ PermitNo......................................................... Issued........................................................ Date ------------------------- -- --- - - --- --- -- ----- ---- ---------------------- ----- --------- ------ -- -- ----------- �� .... --•---- FizR.... :. No..... ` ................... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEP.LTH 1_1i:11114 OAK......... 0F. -------------------- Appliration for 3 ipusal Workii Tonotrurtion jkrutft Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal Syst at ; • ation-Addres t No v .............--------- .: r am ------- ..................... Owner Address .-:.------- = --- Installer Address Q Type of Buildin • Size Lot............................ Sq. feet U DwellingNo.•of Bedrooms__.• _____Expansion Attic ( ) Garbage Grinder ( ) p,, Other-Type of Building ____________________________ No. of persons---------------------------- Showers ( ) Cafeteria ( ) P-I Other fixtures ........................................................ W Design Flow�nch _______-_ _______.___ gallons per person per day. Total daily flow........- ____� -------------gallons. WSeptic Tan Liquid capacit _ gallons Length________________ Width_._._-._.__-___ Diameter_______-_-______ Depth--.............. x Disposal Tr —No_____________________ Width___ _Total engthl Total leaching area-____.. ._._-._.___sq. ft. Seepage Pit No.-/--------------- Diameter./ `_ _----- n4e ----------- Total leaching area u <.ft. z Other Distribution box ( ) Dosing tank ( Percolation Test Results Performed by------------------------- ------- = :.- -=- -------- 1 ate.............................. Test Pit No. 1................minutes per inch' Depth of Test Pit____:_______________ Depth to ground water-_-_________________._.. r=, Test Pit No. 2................minutes per inch Depth of Test Pit____________________ Depth to ground water------------------------ -•-----•-----------------=--•----------•------•-------- -------------- •---- ----- O Description of Soil - ------------------------------ = - ' ` { / r"1 -••--- ••--------••---------------••-------•--------------------------•----•-- V Nature of Repairs or Alterations—Answer when applicable-----------------------------------------------------------------------------_________________. -----------------•-•-•--•--•-------••-----------•------•-------------------------•-------------------•---•-•--•---=-------W____-------•------•---•-•-•-••---_____-•--•----------•---------------------- Agreement: 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 been issued by the board of health. Si ne �, t% .. Dale �. '� Date Application Approved By--- = ' Date Application Disapproved for the following reasons-------------------- - --------•-------------••---------------------------------••--•-----•- •-------•--••-•-••---------•---------•---•----•------•-•••---------------------------•---•--------=•--•---•---------------------•-----------•--------------•--•-----•-------•----•----------------- Date PermitNo.......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH M 4.111 . Tntifirate of Toutphanre THIS IS TO CERTIFY, That the.Individual Sewa e Disposal System constructed ( or Repaired ( ) bs r" c ?��e / _-•----•---- ---- --•--------•-----------•-------------- Installer at ............................ a = r ?_ r ?f ........ ` A'' �r '-•-•---•-•- has been installed in accordance with the provision4sof Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.___ ...___................. dated---------:/ ' .___ ' ______-__-___ THE ISSUANCE OF THIS CERTIFICATE SHALL,NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL. FUNCTION SATISFACTORY. DATE-----------------------------------------....................................... Inspector-----------------------------------------------------------••---- .............. THE COMMONWEALTH . MASSACHUSETTS BOARD OF HEALTH s AI ..:.................. Fr��-�` -: `....-� O C t...a.,� �. j� -, ----------- FEE---==�=�- --•-------- orkii Tomitrurtion Vermin Permission is hereby granted---- -----4°M �� _ -� :rw_ d �' ' - ................................. to Construct.~(' nor Repair ( ) an Individual Sewage -Dispos 1 System ,-� at No--- ,' s ` ,• ! Street as shown on the application for Disposal Works Construction Pe t No � n ated*,//1___ z �______________ -, - DATE-----------------------------................................................... Board of Iealth FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS -