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HomeMy WebLinkAbout0128 GLENEAGLE DRIVE - Health (3) �g �(� 4erclkl pl , Cep INo Fim............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..--.% Gc-A ).. .O ......... ..o.9R t.V 5.T/r�..R4�...................... Appliration for Baipuual Worko Tomitrurttun Frrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: (5:4E1_I aA z ...... ...��l/.V !f./- ...... -- Location-Address _-••••••.- - -•.-..-..----••---.-•-•••or Lot No. J�/g!�/�� - -•- /, /------------------------------------------- --...............------.....•.................--•--•. Owner Address .......................................... ........:......................................................................................... Installer i Address dType of Building Size Lot.l5-.4a_3.1....Sq. feet Dwelling—No. of Bedrooms......: ...............................Expansion Attic (AA Garbage Grinder (/Vo) '4 Other—T e of Building _ No. of persons............................ Showers — Cafeteria l Other fixtures ......................... , ® -------------------------------------------------•----------------.-------------•--•--•------ W Design Flow........ZX..0_0....................... per<pers•an per ay. Total daily flow..__..__...��................._gallons. W Septic Tank—Liquid capacity/.QAA2..gallons Length, ',Or .". Width..Y_lt�_`' Diameter________________ Depth., .If..ro ' x Disposal Trench—No..................... Width.................... Total Length_.................. Total leaching area....................sq. ft. Seepage Pit No......�.___ _-- Diameter....<5_'. Depth below}}'nlet x< r Total leaching area � P� - --- ----- P p A �G��---- g ��----sq. ft. Z Other Distribution box ( � Dosing tank ( ) '-' Percolation Test Results Performed by.Kal?144--l.)-__Ar-...� L?..ReSr. Date.... 1911.2E.!`j�... .O9>f Test Pit No. 1 _ -__.minutes per inch Depth of Test Pit--- ....... Depth to ground water.,,V.O e........ fs, Test Pit No. 2.-4-.A­.minutesper inch Depth of Test Pit._rt.......... Depth to ground watev.V.,Os-.4;n....... a ................,.....-----•----.....---•-••-••-•-•-•-•._...........•. 0 Description of Soil..... ?__- _4!. ... C?.�9f _......_!4A/Z)-------- --•---•-- _r....... 0 51---------- cxj .4,),�/�5. /fF t� .t9%+! ' �--1 V C e ................................................... VNature 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 TITi.;.�. 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. ned.------ 3-----••..........................•-••-•------•-----•-•------------------- Date Application Approved By..... e4,/l = �d/ ._ ... ..................•.._ � . Dat Application Disapproved for the following reasons:------•-------------------------•--•--------•----------•-----------------------•----------...-•-----------_---•- ---------------------------- •----------------------- . ------------------------------------------------------------------------------------------------------------------------------- Date PermitNo......................................................... Issued--•------•-----•-- ................................ Date 01/1 THE COMMONWEALTH OF MASSACHUSETTS BOARD 'OF HEALTH .fr-.a .^.1...............OF........ L � Appliration for Disposal Works Tonstrnrtiun ramit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage�,Disposal System at ............firC/!/ f2 ff/ L�.._... .... _Z................. ........................................ er .... ....__ Location-Address or Lot No. %...... ... . .. � ,�. s .... ........ -------------------•-•----..........-----..........------............................... Owner - n, Address ......................................... ......._._.._ --•-•-...........---•-•-----.....------.. Installer Address U Type of Buildingrf Sq. feet ,• .; - Size Lot..l��_..----_--.. -� Dwelling-No. of Bedrooms.__...:�..............................Expansion Attic (Nd) Garbage Grinder (/►o aOther -Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ---•--•--••-••---•.................• •--....•-•-••.... A. d ------------•••-•. ...............•--•- W Design Flow.......... '' _'_......................gallons per person per day. Total daily flow......._.. .................gallons. e, WSeptic Tank Liquid capacity_,:N--..gallons Length.�'"a"...6.:'. WidthAl l:®.j'Diameter................ Depth.-.'"._.. x Disposal Trench—No. ...:................ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....'.=._1`.........,'Diameter...__.*...... Depth below nlet. ..6 Total leaching area.cr�_.GP? ----sq. ft. z Other Distribution box.( af)'. Dosing tank ( ) 4 a Percolation Test Results Performed by. e�? ! s?___. :.. �:.✓ra�' ?._.F?n_ <. Date....J;'1.'.A .&.•... ,�. � j Test P.it No. 1.5;L :...minutes per inch Depth of Test Pit..-/:.`.....__ Depth to ground water-_-- ! .......... 44 Test Pi4No. 2...-e---iL_..minutes per inch Depth of Test Pit._�'_Z:........_. Depth to ground water40A,­&:_....... :-•-•------------------------•---- -----------__..... - --------- ...............O Descri tidn of Soil...... _1 !Se e/2� ' .V4 tf : v ?-'�``t^ -------'exerz? fryw---- ? !. -----.V ...-.4.�-'l ! = W --•-•-.XMWit°-1@.1 ...------..:5 --- ?tit 1�tZ,°N? � 1------+s ? "A'? C� -e ............... VNature of Repairs or Alterations—Answer when applicable.................................................................... . --------------------------------•--••-----------.....---•------.....---------------....-----.........---••----------------------------••-------------------------._.._...--•••-•--•-•-•••••••---••••-••. AgreTment: Th'e`undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TIT E, 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. . Si ned --••-•---.....•--...,.•••-----•----••--••--- /� Date Application'Approved By... L y= .1,­14-4- '2._____________________ ` /� Da. Application Disapproved for the following reaso.ns:........................`'..__.......-....__..._.....__......_.........__. r, -•..............••••----•--•-•-••---------••-•-•...•-••-•-•-•...•-•-•-•---••--••••----.....•••------••---•••--••-•••-•-•••-•••-••-•-•••----•---••-•••-•-------••-••-•--•-----•••-••••-•-•--••--•------•-- Date PermitNo......................................................... w Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS 'BOARD OF HEALTH - »/�' a!'Pig........OF............... ��- r¢............................................. Tntifira r of Tumplianrr �,ks,t,IS TO C TI.Y, That the Individual Sewage Disposal System constructed ( �or Repaired ( ) by.. , �/ .. s... F ,. � ---- ----- ----- ----------------- --- at " . -l.t .� .t ' `w ? _._.• 1�.__-"��'� .---.......................... has been installed in accordance with the provisions of T T 5 of The State Sanitary Code as/describe d in the application for Disposal Works Construction _ __Permit N ___.._._ ........... da.ted_"'-__�1f''r'"..- ______________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �w DATE. .. ................................................. Inspector....... ........................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ��........0 F..... --- L•��' 'Z--r.....------................................. ,',�'f ..- No............1...._....._ FEE........................ Disposal, r1 �n � inn rruti� J� Permission t i eby granted--•�- •} ..... ---•----- a�-+®� .. ...--- to Construct (-; or��.,Re ( ) a � ndividual a age Disposal S tem at No...... k' -R'. i l_l` .------.... - '� `---0 reet as shown on the application for Disposal.,VVorks onstruction -Permit° To______________f._._ ed.._...... .........�.........__. ✓ r !� � . _� Board of Health DATE---..V - ---•-------------------•--•----....._.......... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS . , % , ,t; { t '/�j x ',,.. ..{Y - _. * `�' `"� _ 11 .•ads i.T- - sl . .r - • t l J 4 y i' M• ,k... ,, ,o r y.: r.,a , a ; Y: --a„ * _ . �t s_r,: F 1 l:: ' f' �� t ID % "j,'�­,I�.t­,,..-�..1,1�-'t:,I,".',�"­,I I..I-1:',.,,�1 .--.­—",I�It.,'�_"��.—�;--_-�,1�,_-�I�,N,�I�;,.�l��.I��,�I�"I.�j,�E­-I--,��.._�-1��..!�.,,,�­z,.,.-11"-��I 1-.�..­...�1l]"._--I�"�.I�-�-,�.�*,"'-_���.��,",�I-`.'3-/l I�,.I��'I�,�-,-,-,��&., IL 14: ° t b a i; Ju`3 t s , " 1. 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