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Home My WebLink About0160 GUILDFORD ROAD - Health (2) l fo0 GU (idfDrcj {2o rp THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ... .... Applira#ion for Bhiposal Works Tonstrudion rlermit ,S91 Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systemat.. .. ... .................. ....... ..... .--........... ......... `1.. ?........ ... . .. .. ........ .... ............ Location-Add s or Lot No. .... ........................... ...... ...a�g !:�. wner Addres a .......... ................................ .. t -•-•--• . Installer Address UT e of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms ____ ________________________Expansion A tic ( ) Garbage Grinder ( ) aOther.—Type of Building _ _______ ____ .._ .... No. of persons........... ............. Showers ( ) — Cafeteria ( ) dOther fixtures ---------------------------------------.............................---•-•-•-••-.......---...••-----•----......................-----•-•--•.....---- W Design Flow............................................gallons per person per day. Total daily flow.._.._....�d._0...................gallons. P4 Septic Tank—Liquid capacity-//PA_gallons Length................ Width................ Diameter................ Depth................ xDisposal Trench—No. .................... Wi }�_._ Total Length.................... Total leaching area____._._......... .sq. ft. Seepage Pit No--------------------- Diameter_-____ Depth below inlet.................... Total leaching area. 0.......sq. ft. Z Other Distribution box ( ) osing tank ( ) Percolation Test Results Performed bv.......................................................................... Date........................................ a ,4 Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water___________-_-_-__-__.._ (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------ ---- - - --------------------------------------------------------------------------------------------------------------------------- O Description of Soi` mr U ----------•---------------------------------------------------•----------------------•-----------------•----------------._.....----------------•--•-•-•--•----•------------• x -----------------------------------------------------................................................................................................................................................... V 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 Co —The undersigned further agrees not to place the system in operation until a Certificate of.Compliance has bee ed by the d ealt Sigd_. .... a .-•-• • ••-- ............... ................................ Date Application Approved B /'r L � Z ..................... Date Zs Application Disapproved for the following reasons--------------_---------------------...--------------------....---------------•--.................--------.... ---•.................•------......------------------------------••--------------...-------------•--.........---------•-•-----------------------------------------------......----------•----._.......... Date Permit No. Issued. ...................... Da e No... 4?.,..:...... Fn$...��......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �.,. 6 ti ................OF.....91lke.t^r ant• Bisposal Works Tunstrurtinn Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at 4. ....... Location 1 .. .. �•}� �,� , j �, ,.,[/ Lot .,......i Y..l..*'F'f'Y'�::'�:sY'6 I.l..f:."Y`' "`•Y.: t:.},`...s:.......................... [. ...a..-.r Y.i..::�1,................. ,...... .f., cif as! � ... ..�?�; ):t�: :�:�...�^k J!��':e'Lt�.."'.."'.::`� .............................. �:!19�.. 4-,y):.�J.�xt�,,,,�,�....�`�• 'Addres........� ��t`�.-- Installer ;J Address T e OI Building n g Size Lot............:...............Sq. feet hI Dwelling—No. of Bedrooms............ . . ....................Expansion A tic ( ) Garbage Grinder ( ) No. of ersons. a YP g p ............. Showers ( ) — Cafeteria ( ) Other—T e of Building _..._...._ d Other fixtures --------------•--- ---------.............. W Design Flow.................................... ......gallons per person per day. Total daily flow.......... ` ^'...................gallons. WSeptic Tank—Liquid capacity./ gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No...................... Wa4th r:. Total Length....__...._ ._.. Total leaching area....... . .,.sq. ft. ZV Seepage Pit No..................... Diameter.o & Depth below inlet_._..__.:. Total leaching area— ."''sq. ft. - Z Other Distribution box l6osing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit" No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-:---_-_.__-____-_-__--- (� Test Pit No. 2................minutes per inch Depth of Test Pit.....................Depth to ground water........................ -------•----•.......................•-----------.....-•---............------••--••--------..........._----•--•-........... O 0 Description of Soil =pre'' ° : ................. V ........................-.............................................................................................................. ------------------------------ --------------------------------------------------------------••----•--------------------------:-......'' == 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 Co —The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee ed by the,lyd Health Sig ed °.._:� '------ .. ----------- Application Approved B - . ...:_.:s .._. ..... PPPP Y ... ::. .................. ........................................ Date Application Disapproved for the following reasons:----•-------•---------••----------------------------•----....••-•-•------------•.......--•------------•--------. ......................................................=.................................................................................................. ----• ............ PermitNo......................................................... Issued.------ ....................................a Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O.F HEALTH ..C..................OF........ Trr Wirer of Toutplianr THIS-IS TO CERTIFY, That the Individual .Sewage-Disposal System constructed ( ) or Repaired ( ) Y ,..:. --•------•----------•-----•.-.---- ,. ✓ eil�ta ler . at-•-------I.... �� ---->= ..... � � ¢r'`}�"r��; ✓��- ----------------------- has been installed in accordance with th provisions of Article XI ofj�T ,4tate Sanitary C, i ps•��s°ct b i in the application for Disposal Works Construction Permit No......................................... dated...._........................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................. Inspector.------......----.........................-----..................................... .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . s.!''................. OF....... / �'.f, -r.. No:........... FEE........................ ✓' Permission is hereby granted........ " ^'""'"" ...-. . to Construct )=Qr Re�ai ( ) t div' ual Sewage Disposal Sy., , at No.. '"`��-1,'` ...._.� �t, �t!° t..:........... T Street 2y" as shown on the application 4for•Dis osal Works Construction Pern ' No._,Xe9 ..... - ated._._•_ . ' Board of Health DATE.................... -•------------------..................... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS No.. . .......... F$s.....Z................._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH row.M....... ®F.......�3A�ws �.b 1 . ...................................... Appliration f nr Uwvaaal Works Tnnitrurtiun Van it Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal �Se System at .....:1.2. ........... ............atio ................................. ..... ....,,, \�D �✓._ UQ,/�_Add ss ..... .......... ....... ..... .... � .j. ...�. .R..... :. .:..�............. � !�eStssL.......... a1�.5C�'......JdY-:`-'�aC.6+.......................... .. .. .... ..... _ Owner r ---Add s a ..... --. --• --- --•- . .. -•----- ---- -------------------•--•-........... . .•-. .. Installer Address UT e of Building Size Lot----/. �" _._Sq. feet <w:,. Dwelling—No. of Bedrooms...... A- ---------.-Expansion ttic ( ) Garbage Grinder ( ) p` 1 -:- Other—Type of Building .",,A�orc. _ No. of persons......... . ..:............ Showers ( ) — Cafeteria ( ) a' Other fixtures .14 - - -•-----...........----------- W Resign Flow............................................gallons per person per day. Total daily flow............. ........._..._..gallons. W Septic Tank—Liquid capacity/gallons Length................ Width.... __:....... Diameter................ Depth................ x 'Disposal Trench—No..................... Widt Psingtarank T,. Total Length................_..... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter___.___ epth below inlet.................... Total leaching area.3.lf.�-..sq. ft. Z Other Distribution box ( ) D ( ) aPercolation Test Results Performed by--- --------------------------•---•--•--------•--•-••--•------------------ Date...................................... 04 -Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water....................... (1 Test Pit No. 2................minutes per inch Depth of Test Pit.-__--___-_-_..... Depth to ground water--_--______---_-_-_--__. O Description of Soil__ =^r 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 bee ued by the hQArd ealth. Sig "Z - E Dat Application Approved By----••• •.. ---.. . .......... ate Application Disapproved for the following reasons:--..................... ------•-------------------------------------------------------------- -•--------••..... .........................•--•--------•------•-----------•••-•-••-•••••--_.._..--•--•-••-•--•-•-•-•-------I.......................-....................................................................... yy Date PermitNo......................................................... Issued.... ....__..........-- ' Date -- ------------- ------ ------------------------------------ "------------------�- - -- - No. ._(4 4......... FEE.... ................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H�EALTH ........... {_ ... ........ OF........ ;6&�............................................ Appfirativit for Raposal Works Tonstruawn Prrutit Application is hereby made for,a Permit to Construct or Repair an Individual Sewage Disposal System at: , ...................... ..................................................................... ....zat.14 # Locatio -Addr ss ........ .12 .341.......................... Owner A� ....... ......... ................................... --------------- ----------------- Instal Ter Address T of Building Size Lot.....Z,!' �!=...Sq. feet U. 7, 14 Dwelling No. of Bedrooms........... .......................Ex Garbage Grinder 4 �7c ansionettic Cafeteria om! Other—Type of Building No. of persons___...... .. .......... Showers PL4Other fixtures ....................................................................................................I Design Flow..............................................gallons per person per day. Total daily flow............. .'-----------------gallons. 9 Septic Tank—Liquid capacityjallons' Length.....I........... Width................ Diameter.___.__.__.__.__ Depth..._._._...__._. :Disposal Trench—No..................... Width.. .............. Total,Length.................... Total-leaching area....................sq. ft. ZWO Seepage Pit No_______________ Diameter.. ,4' bepth below inlet..,..,............... Total.leaching area. ft. Other Distribution box Z i;lksmg tank Percolation Test Results Performed by________________ .:........................................... "Date.-_________..__.__._________________.._. Test Pit No. 1................minutes per inch Depth of -Test Pit...._____.__._....._ Depth to ground water_________.________ ._-. (s, Test Pit No. 2................minutes per inch Depth of Test Pit..___..__._.____.__. Depth to ground water_._._...________..___... 0 tx........;�p--------------------------------------------------------------------------------------------------------------------- Descriptionof Soil. ......:;A--,................................................................... .......................................................... U - -----------------------............................................................................................................................................................................... -----------------------------------------------------------------------------------------------*......................................................................................................... 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 Co ;u67-The undersigned further agrees not to place the system in 3.s b operation until a Certificate of Compliance' h bee d by the drdhealti. Sig .. ............................ ..... ------- .. ...... D'*t....... Application Approved By...... 7 'Vas-ZeZA....... ..... ............ ... ............. Application Disapproved for the following reasons:.............................................................................. ........................... ...................................................................................................................................... ................................................................... Date PermitNo......................................................... Issued......................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .OTP. .........../41)/Vri..........OF....... (Intifirate THfS-IS TO CERT-IF4YLhat the Individual Sewage Disposal System constructed6�_) or Repaired by.......... ),4 -t........ ....... --------------------------------*--------------*--------- -------*------------ at......... ---------------- ---------------------------- has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for DisposalWorks Construction Permit No-------------------------Y.tJ dated_)_ _ _Y�>:�47_�......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector..................................................................................... • THE COMMONWEALTH, OF MASSACHUSETTS BOARD OF HEALTH F &�L.................."...I",..................................... No..... Uwpoli4l�ivvrkli Tonstrurtion 1krutit Permission is hereby granted.... ......L...:.11.,H ............................................................................................. �(--T-------------------- to Construct Pr Repair a div&ual &E�yage Disposa�Sysieffl 2�2 at N R . ................................. ...... ......7. .. ............. .. .......................... �Street Z os 7 as shown on the application for Dis osal Works Construction' Per swt;No.:. .../Dated...•6 'S X2................................ - --------------------------- 2,;L Board of Health DATE :. ........................ •.............................. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS.