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Home My WebLink About0060 HARRISON ROAD - Health (3) Coo f4akn's00 Rai., (a& � n aaa 10"We y No.: � F�a... ......... TH COMMONWEALTH FMAS^CHU u TS j,/�BOARD H ............... ,Z ppliration for Diapas l Worko Tomitrurtion Famit fuApplication is hereby made for a Permit to Construct ( ) or Repair )6_ 11 an Individual Sewage Disposal se.s �- ........: .................................... .......... -.c c`56h INC)I,a d � Q„/U�.�le,. Location-Add{ess or Lot No. ....... r... ,....�.:...®. " •� ----------------•---•--------.----- --...---------------------------.---.----------------------------------------------------------- �. Owner � Address .....................................••----------------. ---- Installer Address UType of Building. Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No, of persons............................ Showers ( ) — Cafeteria ( ) P4Other fixtures ................•--.........-----•-------•.....------.._.,. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacityl.,M..gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter............,------- Depth below 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........................ f14 Test Pit No. 2................minutes per inch, Depth of Test Pit.................... Depth to ground water........................ P4 .........................................................-------------------------------------------I------------------------------------------------------- 0 Description of Soil.......................................................................................................................................... .................._.......... x U ....--••--••---••---------------•-........------....-------•--------------•---...-•--•-.............----•------------------•-----------•---- .......................................................... W ••-----••------•-----------•------•-------•----------------------•-•-••-•--•--------•-----•----------•---•. . ------- ----- - --- ----- ----- - U Nature of Repairs or Al erations—Answer when applicable..__ . _. ....--/__� �------tt. a_.-...�a........ -------------------------------A- _.._... :... �, ----.-•---.--------.-.------•--.--------------•--•----------•---------•-----•--------•-•---•--- ..---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITIf- 5 of the State Sanitary Code—The undersig d further agrees not to place the system in operation until a Certificate of Compliance has been§ssued by t e o d of hea h Signed........ . ---•-••------ --=-. ........ u.t ...--••----•-------------------- ' 'a Date ApplicationApproved By---- ----•--------------- -----------•. --•-•----- .... ......... -- -•--•--•--- --------- --------- ---------- Date Application Disapproved for the following reasons----------------------l. ---------------------------------------------------------------------------------•--.----- ----.----------------• -•--------•----------- -----...-•-•-----•-••-------------------...-------•--------------•••----------------•------------••-•-----•---- .. :... Date Permit No................G..f1 e .....------.. Issued....................................................... Date !� a f` 1 11 NLy No.._4�........ g Fss..'l✓............. THE COMMONWEALTH OF MASSACHUSETTS BOARD FF �I�A �"I-� _. I �I Appliration for Disposal Works Tonstrurtion Urrutit Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Sewage Disposal System at: ...................................... .} ..._._................................ _.........__......................._._...... ....._......._........ ._..........--•. Location.Address or Lot No. v' , t Owner Address Installer Address Type of Building Size Lot____________________________Sq. feet Dwelling No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 04 Other fixtures .......................................... W Design Flow............................................ per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacityt;jf_:____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........................................ aTest 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........................................................................................................................................................................ -- W -•--•-----------------------------•-•------••••-••----•----•--------•-----------------•-•-••---•••--'-•---------f' ;-. -. x ` f ._ U Nature of Repairs r Alterations—Answer when applicable.-;�;.:,�f-�.' ------ .__..r....l..-__��_�•'_____.___s_�___... __.__... �.. L Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee%4issued by t e bo�j"d of heath. Signed t Date ........................................... •--•-•----•---'--••-••--------•- Application Approved By F ` I •-•--=-•--•-•-:=-.; =..= `!=�= Date Application Disapproved for the following reasons--------------------------------------------------------•----------------------------------...-'-•'---•-••-_----- .....................••-••--•-•-•-----• ! (`l ) �° Date Permit No._____/\_,-l.__f-.r11'__ .��. Issued. Date THE COMMONWEALTH OF MASSACHUSETTS faOAR /�///�l� D OF HE LT J, �� Qrrtifiratr of Toutpliattrr THIS T° E ,IFY,,Thgt the Lndividual Sewage Disposal System constructed ( ) or Repaired (Y ) e !�.�::�t--_�.- ----------------------------------------------JJ----------- ��. nyy Install / : / has been installed in accordance with the provisions of TIT' ' '+`j of . Mate Sanitary Code desc bedGin the application for Disposal Works Construction Permit No.__._._C?___ _'y_I._.i____._. dated-.-.--- .��e__.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE TI T THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................•-----..__..........----......_-••••---••-••-•_..... Inspector................................................................................... THE COMMONWEALTH OF MASSACHUSETTS ARD OO .................................. ........ _NZ ....V.�( FEE..L/.:_ ispos",,arks T.ottaq t� rr ti# Permission is hereby gran e _ �/ --- t/t-�'::-a.1�`.. . s to Construct or a it ) an�j i ldul}le, ge Dip �>1� 3stem 1 / Street---`-.-�•�,--- Q as shown on the application for Disposal Works Construction r it No _ __ !__O, Hated_._ __ . .� ________ - i'll 1 •-� DATE..................!f1-. ..�!_U. ............................ Board of alth FORM 1255 HOBBS & WARREN. INC., PUBLISHERS