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Home My WebLink About0080 GUILDFORD ROAD - Health (2) V:Va — os�— o 6 THE COMMONWEALTH OF MASSACHUSETTS EDAM® OF HEALTH _. ........_ OF........ M�4 qi, o% Appliration for 'ia agal Works (�onarur#ion Punfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................ .. . . ...... %,AAA...................................................... .. ......... J �,�Loo ationj ddress Lot No. ..... Installer ............. .. ..t��r.Y.....a...... --......... .. . Address � r Type of Buil ' g Size Lot.........? Sq. feet Expansion Attic a a Dwelling—No. of Bedrooms._........_.._.�y .................. p ( ) Garbage Grinder ( ) Other—Type of Buildin /�J� iX No. of persons............... .......... Showers ( ) — Cafeteria ( ) a YP g !�"" = = d Other fixtur s --•--------------------- -••--•-- --------------••--••---------------•-•---•----•------•-------------- .................... ..................... W Design Flow.......... gallons per person per day. Total daily flow.............`, . '.........._..........gallons. WSeptic Tank—Liquid capacity .gallons Length................ Width................ Diameter................ D-epth................ x Disposal Trench—No. .................... Wi Total Length.................... Total leaching area... .__.... sq. ft. Seepage Pit No..................... Diameter ..._Depth below inlet..__....__.......... Total leaching area_ ®_ ...sq. ft. z Other Distribution box Iksing tank ( ) aPercolation Test Results Performed by--------•--•-••-------•..............•------------------•-••-------------. Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil.. •-----•----------------------------------------------------------------------------------------------------•-- ----=----- ------- 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 ther agrees not to place the system in operation until a Certificate of Compliance has been i d by the b d o th. S. ed. ------ - ------ ----•--•------------- ---------- �a., Date Application Approved BY - -- !7 - - ate Application Disapproved for the following reasons------- -------------------------------- ..........-•----•-•---•-------------•--------------------------•-•••---------••--•---•--•••-•-•----------------••--------••••---•------. .......................... Date Permit No.----•---••----------------------------------------•••... Issued ----Z�1,3............ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a a: ........"ti '° v�..... ..........OF........ few i^. rri�y.rseL?, u Applira#ion for Ditipaiia1 Works Tonotrurtion Permit Application is hereby"made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: , , ...................... �. .:f.fi...�f4 `w` 1 "�` ................................ Lo arion lQddress r j If �h etf ('or Lot No, ................... 1 V'k w'„1' tbttyi�-,..+,.t7s1`-•'.'f. ...... .. . ...lr'`{•G�{ le✓'v'`y3x npeyr,'? 6 A dress t + , .y ..,....... W ........................* : f." # `� �G11 S 1�I ' ! t� t> 4r�S LTci 1-1 y1jf�,j { ,> .Jy M .SR:XS:.. ................... ...gyp:... .a...7:..d...«:...Y:Y.. .... f:�'3"�.d' 'Y-_•---........... Installer Address UType of Buil ing ,w: Size Lot....._.:' ...............Sq. feet Dwelling—No. of Bedrooms f............'`�°_9.b.......................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building It3'w' '. > .:.. No. of persons............... .......... Showers ( ) — Cafeteria ( ) d Other fixtures .........................------------------------------------•-------------------•-------•--------------------------- -•-•-------- •------------------- W Design Flow................... gallons.__gallons per person per day. Total daily flow.............:' .' }............._....:_.gallons. WSeptic Tank—Liquid capacity/�_ `.gallons . Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... W dth x. ........ Total Length.................... Total leaching area............. sq. ft. Seepage Pit No..................... Diameters ...`� , ;_ Depth below inlet......._............ Total leaching ft. Z Other Distribution box ( ) I)9sing tank ( ) Percolation Test Results Performed by........................................................................... Date........................................ W Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �X, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ cyi — � ------ ODescription of Soil---- -'�,`�'=��- --- ^��"--'a ..-•-•-------------------••-----------.........-•-----......................................................... 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 sfurther agrees not to place the system in operation until a Certificate of Compliance has been i ed by the board o alth. Sign d ; ��. c�- i _ ;,h ' ------. F d. Date Application Approved B A� `''",I-"" ` . ...... .. . ............ ,,.�v--•-- _ r-•-fie„--�:='t{!;�`- r . tt Application Disapproved for the following reasons:......................... __..................:.� ......_____..._......._..............._.na................. -----------------•-----------•-----------------------------•-----•----------••-••••-••-•••••--••-- Date Permit No......................................................... Issued . -- Date THE COMMONWEALTH OF MASSACHUSETTS tr BOARD OF HEALTH .......% `l" .V ...... ...OF....... '1 �� . rt< � '� Traif irate of Tomplianre THIS IS--TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by .a. ' t.< I' . q� - { / �. i,xnst F �+ U at....... ' =' `' =i ti .. _.: <` t�- 1` has been installed in accordance with the provi ons of Article XI of The State Sanitary.Code as described' in the application for Disposal Works Construction Permit No-------- ............. dated...........,,�: �''__z._ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GIJAIt�INTEE TART THE SYSTEM WILL FjUNCTION SATISFACTORY. DATE--------------- -- /�.-- -•-- ...-------- .�7e-- 7,T ---------------------- Inspector._....._..------.................- ............................................ ThiE COMMONWEALTH OF MASSACHUSETTS BOA-RD OF HEALSTH� x ..................OF.. ..-... .............................. No......�.;--. .. �../ FEE.......2........... Biiipoga.1,Norkfi T ��gAion rrmi# Permission is hereby granted >. f -.r. r-.a,�;' _ate`r s ..... .n.... �t: to Construct ( ) or Repair ( ) anndividul Sewa e D> sal System+ f e, treet as shown on the l.pplica n for Disposal Works Constr Lion Pertn� No.... j�, Dated .. �. / ..... !spYf. t Board ofealth s _ e DATE ,%`. ..... :;= -------------- �, FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS 1.