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Home My WebLink About0062 GLENEAGLE DRIVE - Health (2) C.o,me r v i t i 0 No... /_.... FZz1�..... � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..... ...d-w t✓ .OF.................BWMSTARLE...... ..........------------ Appliratiuu -fur Riiv r i at Workti Tomitrurtion Vrrnait Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal SyS. 7'is-o u--- -- ...-1.� - L --�� - M.l.......1�1- I�1 7�.._ Location•tl X4, .... ......... ..... ...........................................•--------•-----------------' ......- wner . A dress a _ ...... Installer Address Type of Building Size Lot__f _ .........Sq. feet Dwelling—1-77Vo..of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons.___---_--•---__--_-_--_-_ Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------------------------------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank-/-Liquid capacity 0 Q.gallons Length................ Width-------..--..--- Diameter................ Depth-.---_--_-._---. x Disposal Trench—No-____________________ otal Length--------- __._ Total leaching area--------------------sq. ft. Seepage Pit No __..___...._ Diameter_ _ _ th below inlet__________________ Total leaching t t... sq. ft. z Other Distribution box ( ) Dosing tank ( ) � ~" Percolation Test Results Performed by----------------------------------------------------------!____.FG..... Date........................................ aTest Pit No. 1----------------minutes per inch Depth of Test Pit_.-_____-___--_.____ Depth to ground water....-.------.--.-....... Gz Test Pit No. 2................minutes per inch Depth of Test Pit.-____-____-•-.._-_- Depth to ground water_._._--_-....._------- a ---•--------------------------------------------•----------------------------------------------------••-----•-----•--------------------------•-••------------ 0 Description of Soil-_--_f-r-_1 U --•------------------------•--------U -----•------------------------------- ---------•-------------------•-------•--•---------------------------------------•--------•--•-------•---------------------------------------•-•----- 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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be n issued by 1i e b d of health. Sign - •• -------------•------- •---- -- -•--••--•----- -----------••--•---- -------------------------------- Date '/C� Application Approved BY-------- - -. -- -- --- --- ---- -- ----- - --- ------- ..._. � --- Date Application Disapproved for the following reasons:.................................. . ........................................................................... ---.-----•--------------------------------•---•--•---------------•-------••---•---------.-_-•--------•--•----------•----------------.-----------------------•--•-----------------------------•-•--.----- Date PermitNo......................................................... Issued....................... ................................ -Date _ FRx............ THE COMMONWEALTH OF MASSACHUSETTS _BOARD OF HEALTH �✓....0F.............. ' �ANS_TABLE Aplifiration -fur Biiipoiial Worko Towitrurtiott Ppruttit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: < .7 C� `f :!'h.�e�... r� �,. �..... C .. .. ..�F _ i..... ._ "J Location-`Address or Lot No. Owner/ �_. , A dress .r7 .J ?__ ............. ............................................... 1-1 •{ .................................... ____.._..._._..._....__.._.........._ P_ <,.. Installer 1 Address Q Type of Building Size Lot.Ar. -�- .........Sq. feet U Dwelling— Expansion Attic ( ) Garbage Grinder ( )U 4--No. of Bedrooms------3------------------------ aOther—Type of Building __________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures W Design Flow._-_-_-•--.--•______________________________gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid capacity------------gallons Length---------------- Width------ - -------- -......_.. Diameter-_.--. Depth________________ - x Disposal Trench—No-___________________ Width....... ......C, `T otal Length-------------------- Total leaching area....................sq. ft. Seepage Pit No*---/--------------- Dtameter�_ ..:....__.'"'D pth below inlet.................... Total leaching area......______.____sq. it. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------------------------------------------------------------------------- Date-----_-------------................... Test Pit No. 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water__-_-__.._.__.__.___-- ;1, Test Pit No. 2................minutes per inch Depth of Test Pit-................... Depth to ground water...--. --__--_--_____--- P4 --------------------------------------------------•-----•---•-•----•--------•--••-••-•••......••...............•-•......................... ................. 0 Description of Soil------------ -------------"-............................................................. ------------------------------------------------------------------ x i V ............................................. �t,-----A� --------------------------- ------ VW ------------------------- ------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b en issued by t oard of health. Signed--- � c �' 9'—73 ---------•-•--•-•-.....---•--- ._.......••--------------------- Date Application Approved By----------------------------------------- •---•---••-------•-•-- -----••-••-•• ............. ----------------------------------------- Date Application Disapproved for the following reasons----------------------------•--•-•--•--•-------•--..._.......-•--•-•---------------•-.........----•._............ Date PermitNo......................................................... Issued------------------------................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD .OF HEALTH ............ ..r`:..�:h--f......OF.............16A�RiSTALE.................. ............. �OCE7erZ'117 fxfiratr of TompliaurrT. I"� ual Sewage Disposal Syst constructed ( ) or Repairedby.. '- Installe� at -•----....._.. ----------------- -----`•�'------------._+.--.-. --•-•-.................... •--------------•-----•----•--••-•------------- has been installed in accordance with the provisions of - tic of The State Sanitary Code as described in the application for Disposal Works Construction Permit M?---------------------------------------- daI- /;�._-..__._-________•-.--•-- TH ISSUAN E OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SY �E )#I"RNPT N SATISFACTORY. DATE................................................................................ Ins Gtea,-- .-•---•---- _ -------- THE COMMONWEALTH OF MASSACHUSETTS `BOARD OF HEALTH ............ ....... ..OF..........._..B — BE .................-----....... No......................... .1,FEis.. .............. er s5ror is.hereby g ...... .:---- ------- -- --- -•-•-•---•---------------- --- to'L cstt t or� ( ', In < Wa e f is S 1 System 1 ----------------641------ W atNo..•. • . •.•.. •••------•---•••-••--•••.......................rr —Street/* , - d eft f as how on the .pplication for Disposal Works Constar tiara Perml o .........Ca ..................... ...�. . y--------------------------------_ _ 4� Board of Health-" DATE............................................ ----------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS O II 1