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Home My WebLink About0367 GREEN DUNES DRIVE - Health (2) OWL-- f 6e� 4 . , _ 61) No.---F ------. Fs> ... .................. THE COMMONWEALTH OF MASSACHUSETTS ,,. ;`;--._'BOARD;`; " _'BOARD OF HEALTH L4 ;0 ....... . . °Z.. ..........OF......................................................................................... Appliration for Ii,4 aiittl Worbi Ton6triartion Vrrufil Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System a ��(11 l Lo o -Address o No. v, , , � - AT ----------•---- ---------------------------- --- y fOwner dress Installer Address d Type of Building ' Size Lot______________________•--___Sq. feet U Dwelling No. of Bedrooms____________________________________________Expansion Attic ( ) Garbage Grinder ( ) p., Other—Type of Building ----------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ------------------------------- - - WDesign Flow............_________________________--__.gallons per person per day. Total daily flow--------------------------------------------gallons. WSe)tic Tank—Liquid capacity------------gallons Length---------------- Width.-___---....._-. Diameter._-------------- Depth................ x Disposal Trench—No- ____________________ Width-------------------- Total Length.................... Total leaching area...-_-_.____...___-_sq. fI. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area------------------sq. It. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------------------- ------------------•-----------------•-----•---------- Date--••-----•--•----••--------------------- Wa Test Pit No. I----------------minutes per inch Depth of "Pest Pit_-_____.•.__--_--___ Depth to ground water...-_____.__-__.---_---. Test Pit No. 2________________minutes per inch Depth of Test Pit-------------------- Depth to ground water_.........__-_----.. -•-•-------------------------------------------•-----•-•-----.....................---•••---••--•----........................................•-•---•........ 0 Description of Soil...............................................................................................------------------------------------------------------ .-------_------ x W ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------ .-------- V Nature of Repairs or Alterations—Answer when applicable............ . �_ _®..4—-_ - £______--- ------------ - --------------,01s_r----�0A------------------------------------------------------------------------------- ... 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 fur er agrees not to place the system in operation until a Certificate of Compliance has been issued by boar. Sig ------ --- -- --•-------------•--•-•-----•- Date Application Approved BY......�� ----- <. ... . ...•------........ D ----- - Application Disapproved for the following reasons------------------------ ----•------•--•---------------•----------•-----....................................... -------------•--................-•-•------•-•--------------------------------------------•-•--••----------•---•••-•---•-••-•-----••--•-------------•-----------------------....--------•...------••---•. Date PermitNo........................................ ............... Issued........................................................ Date rj No. Fica..1-21................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _. .. ..... _ ...........OF..........................:........... __....:. Appliratinn -for UhipwiFal Workii Tonmrnrtinn Vamu Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Cr� ti o VA,ig ...................................... • ---------------------------------..... ...........................- (�d ----------- ` L, i n-Address t No. --------------�............------- . . v-------------------------------- --- --1 --=------ .... -------------------------------- Owner ress d Installer Address UType of Building Size Lot............................Sq. feet .-� Dwelling�4 No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) per, Other—Type of Building ............................ No. of persons..-_____-_-_-__-_--_-..--__- Showers ( ) — Cafeteria ( ) P4 Other fixtures w Design Flow............................................gallons per person per day. Total daily flow...........................................-gallons. 9 Septic Tank—Liquid capacity----_-_-_-_gallons Length---------------- Width---------------- Diameter................ Depth.--.-_.__--_---- w Disposal Trench—No. .................... Width-------------------- Total Length-------------------- Total leaching area--------------------sq. ft. x Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area........_.._.--_-_sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------------------------------------------------------------------------- Date---------------------------------------- a Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ fs, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water__.--.___-_--...__------ -----•--•-•----------------•--------------------------------------------------------------- -----•--------------•-----------•----------•------------------ 0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------ x U w V Nature of Repairs or Alterations—Answer when applicable.-.-__-----14 14-___-_._.-a---------------za- v-- -- 11 0 -- ----------- =•- ---------------'1.--------- ---•-----U',----•-••-----•- --------------------------------------------------------------- ---•--------------- Agreement: _ The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code—The undersigned fur ier agrees not to place the system in operation until a Certificate of Compliance has been issued by boar�ef ... .... St - �f - ----- Application Approved B Date PP PP Y mo t/ =� 7'7. �-............... Date Application Disapproved for the following reasons:....................... --------------------------------- ...................... ....------.-- .-•-•-•--•.............................•-••----....------......--......-------------•----------------.-•--••---•----------------•---------------•-------------------------..........-----.......----- Date Permit No......................................................... Issued..... r-?— Z(S ..................... Date THE COMMONWEALTH OF MASSACHUSETTS _ BOARD O HEALTH r�. 6, ...........OF.......... .... ...... ... ...--•------••-•---............. 021,rrtifiratr of QVIomplianrr � T I, LS T,O CER FY Tat the Individual Sewage Disposal System constructed ( ) or Repaired ( ) I tal'er - has been installed in accordance with the provisions of _ tic e of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...y___-J-�:,,2_________________ dated--_.7'.7_".7a THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS RUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE. -------- -------------- ------ Inspector r.�f-f -t .ZZ A"r THE COMMONWEALTH OF MASSACHUSETTS BOARD 9V HEALTH No. / ----- FEE .................. �i� n �ar*k T trnrtinnrrmtt Permission is hereby grant .................................... ._. .•;._�.✓.._-._ ________________ to Construct ( ) or pair ) an Indivifl 1 Sewage D posaI System at No.... ...... 1``�--`--".6� �-z ------ -------- (l—r,� Street n _ S as shown on the application for Disposal Works Construc mit N . __ t' 1_- Dated...7---.7 __.7----------------- -- _... ,- ---------------•-----.._ 7 S P Board of Health DATE ------------------- ------ •. .......... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS No.--- ------------------ ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD /IPF H EA ...............OF'...... jL-4. - ......... -...... Appliratiun for Bi-sposal Warkii Toutitrnrtinn Vrrmft Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal Sy ..ka-ft,...JD ... ..... ........ ...... . ................... 'Jy Location-Address 4, .................................................. Owner Address W Installer Address Type of Building Size Sq. feet Dwelling-INo. of Bedrooms............. ........................ Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ....._...................... No. of persons......................... Showers ( ) — Cafeteria ( ) Pa d Other fixtures -•---•-•---• ---••-••--•••-••-•-•••-••-•••-•-•-----•-----------•....---•--•------------•-------••-••---- Desi n Flow_______________________ gallons per person per day.- Total daily flow...._. �� allons. w g g P P P Y Y -----------------------------g WSeptic Tank/—Liquid capacity gallons Length................ Width................ Diameter................ Depth__.____.__-___- x Disposal Trench—No. .................... Width�_____,._y_._____�. Total Length............... .._ Total leaching area_______ _...........sq. ft. Seepage Pit No..... Diameter_ !/. .t�__�Depth below inlet....._.. .__._ Total leaching area__®_`�...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bv.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to'ground water___-___:_________-__-_- �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------- ......................................... _.. ..-•----••••-•........ D •- ..... Description oo ________________________ b U 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 furtlier agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sig ... -• •-•----•--••-••----•--•••••---.....•••--•-••-••--•--••---•------•----••. ................................ ate � Application Approved B -_- -•--•:7 PP PP Y s � ar� Application Disapproved for the following reasons:---•..................••--•---•--------•-------•----•-•----------..._--•--..................................... ......-•-------••----.._..---•--•---.._..---•--•-•-----•---•--•--•-...-----•-----------------------------------••--------••--••-•-•-•--._._...---•••----•-----••----••-••••••••-••••--••••••---...---•-- Date PermitNo.--..................................................... Issued........................................................ Date �.��. ._-------- -- ---------- � N�. --------------- THE COMMONWEALTH OF.MASSACHUSETTS BOARD F HEAL-lb V Al7 g may.. ......_.... 6iS. �.. & „n q�,,"_i u--':z`'a': 4 � A ph-rativtt for Disposal rks Tonstrartiott -ermit Application is hereby made for a Permit to Construct ( or Repair ( . ) an Individual Sewage Disposal �) Sys pin a . 2 , a i ..:.......... 4sCat .. oatio Are a;�JA . 1� ............................ ...... o , Q 2, ............................ o Owner Address 7- Y. � ............................................... ........................... ......... ..Add ............_ ............._......... Installer Address Type of Building " Size Lot_ _k: "" ....Sq. feet Dwelling- No. of Bedrooms........ .... .............:......Expansion Attic ( ) Ga bage Grinder ( ) `4 Other—Type of Building ----------------- ___ _-_------•- No. of ersons_______________________ __ Showers Cafeteria--- -----•------------ — a ------------•-------------P--- - ( ) ( ) Other fixtures f . W Design Flow:................... . :_gallons per person per day. Total daily flow___._ � ..____._._gallons. P4Septic Tank "Liquid capacity. gallons Length................ Width................ Diameter................ Depth._.............. xDisposal Trench—No .................... Width Total Length---- .... Total leaching area....... .sq. ft. Seepage Pit No... ., e th below inlet.._...... .. Total leaching area__ F .:'P ft. ---------- Diameter-�•�` 1�---- P -• -- g -- -sq• Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by .......................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-.__.___.___--__---_-._. rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.. ................. Depth to ground water..............._........ --- d •••. Description of Soil......:.... ......... .. ,�: .. _ f_ ,. ---------�:s � "r 4c d V --------------------•----- ----- ---------••-....-•-•--••---••----• .••-_.. _._....••.....--•--------•--•- ••• -•-- ff 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 the board of health. Signfd. s " --•- ----••-•••----••----••----••-•••-- - 71, de Application Approved BY b �lg -------- ----- .,_t ✓✓ Application Disapproved for the following reasons: --------•---------------,,,.-•-----------------........-----•----••-••-•-•-••--••-•-••.--•Da•-•••••_........ -------••-----•--•-••-••--•......................•-------.----•-•.---_.._....._...---•-••••-•----................. .............................. Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD) F HEALTH (111'ertif$rate of Tompliattrr leen CERTIFY, at the Individual Sewage Disposal System constructed ( f or Repaired ( ) k by ' ✓ ...................- In.,tauer at... ______ _____________________ _._...........___..____... hasstalled in accordance with the provisions of Article Y1 of The State Sanitary d as c cri I in the application for Disposal Works Construction Permit No_______ _________ ________/�-____ dated ____ __. _. ._ ' '.._...._..... THE ISSUANCE OF THIS CERTIFICATE SMALL N®TAE CONSTRU O AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------......:..: .a' ~i•-----------••--•--•-•------------------ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD Of HEALTH 2 t...........OF . ................ Ge No I................. FEE. ............ Permission.' eby granted '�� fo,Constr. ' or Repair. ?' j ear an lndivtdusl e isposal Syst Z $, at No _.a :3{'� .. .•alb E f - � � � / a........ ,g .. Street' as shown on the application for Disposal Worts Construction Peprrt No. . !Dated..... ........... Board of 11C 31C�1 DATE...... ........................................................... t, ' . �. FORM 1255 HOSES & WARREN, INC.. PUBLISHERS