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Home My WebLink About0072 GLENEAGLE DRIVE - Health (2) ��ll�- �� p / -, _ No........................... Fsa...... ...................... d THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �°_.. ... OF.............. - ✓- S..,MLE...... ................. M�2 Apphratiun -fur R.ipuiitti Workii Totuitrurtiuu Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal \ System at: .................................... . .........?,_�. ....12-L........L........................ ocation•Address or of Igo. ....... • ...... --•-- ---. . ---------------------•---•---....................... ...................... -�' ...... ` ............. Owner_ Address Installer Address Type of Building Size Lot_.` 2. .� ....... feet Dwelling�No. of Bedrooms-----------Z---_________________________Expansion Attic ( ) Garbage Grinder ( ) C14 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) i Q' Other fixtures _ ________________________ -------------- d Design Flow..............��.-�.....j... _._.gailo s per person per day. Total daily flow...........��_ _ ______.. .__...._-_.gallons. WSeptic Tank Liquid capacity{ __ _ a ins Length................ Width------------.--- Dia eter---------....... Depth-.-.-____.__.... x Disposal Trench—N - -------------------- Wi d Le ----------- .. T leaching area-._.__. --__.___...sq. ft. Seepage Pit No..-- Diamete =- Mlle i� ... '-•--•--• ota 1 cling " e1 sq. it. z Other Distributio box ( ) Dosing tank /� � Percolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ --� a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water.-.-_.-.-.----.--.-_-_- rX, Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water_..._._____.___.-_-_---. •------------------•----------•----------------------------._....-•----......................................................... 0 x Description of Soil------------- ----� ----•--------------------------------------------------------------------------------------------------------------------------------- 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 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 thud of health. fined---- o .� . ................... Dat _ Application Approved By............ ... . . . .••-- .... ---- Application --- --- --- e ate Application Disapproved for the following reasons------------------------------------------- ----------------------------------------------•........_............ ----•----------------------------------------------•------------•----------------------•---•--•------•--------------------------•------------------•---------------------------------------------------- Date PermitNo......................................................... Issued........................................................ • Date f � A THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ------OF.............. - ................................... A I w -a B sl " L�..... .................. Appliration -fur Ubipoii tl Workg Tomitrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at f•r t ��1 Y- %su _� ---------"----•......... .........................................•---------•---- .........................'................................................... 1 Location-Address 1 or Lot No. ti pp _ ------------------------------"---•---------------.....-----"--------------------•---•----••-- f Owner, ' L Address ♦ a C Installer Address d Type of Building Size Lot_______...______>........Sq. feet U Dwelling-kNo. of Bedrooms----------,,S................................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fi!r ___________ ___ _"~ ----=/------------------- ------------------------------ ---------............ - Design Flow_______________ _______ ons per person per day. Total daily flow___„___. gallons. ' Septic Tank—Liquid capaci y_-___ g-t ons Length-__-__ _____- Width.. ._.. Di, eter---------------- Depth............... Disposal Trench_No_____________________ Wid'1i ��'_:Y _+�"T.&'irLength n—_ dTotal leaching area.--._.-__-__.-___--sq. ft. !` \ .'C�+ Seepage Pit No:f__________________ Diameter...................- Depth belfw inlet-_._ ______________ Total leaching area-.-_-..._--._-__--sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date---------------------------------------- Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water..-.__-_---.--.--._.._.- ri Test Pit No. 2_______________minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ ---•-:....•-----------e?- -----------------------------------------•-•-•--•-------------------------•------------•---------------------------------•--__-- D Description of Soil------------r 'z--`-... ",��-----•---""-"-•-------------"----.--.•---------- U --------------------------------------------------------------------------------------------------"-""-"-----"•----------------------------"-._...---"""------------...---•••.._.._..-•----------. W -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n issued b th rd of health. Signed...... _ g y-�------- Date ApplicationApproved By----------------------•-•--•••---••••-••-----•----------•-••-----------------•.---------------- Date Application Disapproved for the following reasons---------------"-....---_.......-"-----"-------...._..._..----"--•-"-•----------------------....------------•••-- ------------------------------------------------------ ---------"---•---...-•-----------•------•--------•..----.._...---•••-_--- ••-•---•-•-•--------------••--------------------------------•----------- Date PermitNo......................................................... Issued-------------------------------------................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ % ......oF.................RUNSTABLB.............................. .- Trrtifiratr of f ompliaurr 41,,E IS CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) j ....... .. .. Ins 1 er a`f..... f---._...•-- --- ` . • .., ------- ---- -------------------' has been installed in accordance with the provisions,pj YtI of The State Sanitary Ede a described in the application for Disposal Works Construction Permit No-----.........P_s-----____-_--_-____--_--- dated.. __...t,.._... . "t--_,,.__,________- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST, UED AS A GUARANTEE THAT THE SYSTE IL,L G-TION SATISFACTORY.' ✓ �,� /"r�; DATE-�� Inspector................................................... ._ �= l '�' C.�'.�!,.� , THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.............Bl.i._.....-....---- --.............................. No......................... Fi ---•-•-•--••-••-_-_._.. A A Ri� >�ot � L6, 111 rr�ti# Perifiissi s� � "'� i hereby granted -_ T---------------------------"----- ------- to Co st ct�" ).- 'r epair ( ) a' Individual ,agert�Disp sal'Sys- - �-�` - atNo....................................... --- - --------------------' -_cet_.-......................--------------- -----/........................ ' Street � •,� as shown on the applica "ion for Disposal Works Construction/(eP 'iit /No 1_ `E___ _ ited_,___.__ .r ______________ ----------------------------------------------------------------- Board of Health DATE....................................................._------------------------- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS