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Home My WebLink About0079 HAWSER BEND - Health (2) 1-kGu&er6w,,, Cry, 19g 6ffq 0 Uwv{{A i 7 I E i I s N S M EAD KEEPING YOU ORGANIZED No. 12134 2-153LGN SUSTAINABLE FORESTRY MIN.RECYCLED INITIATIVE CONTENT 10% Certified sourcing POST-CONSUMER www.sfiprogrem.arg SFl-01290 MADE IN USA GET ORGANIZED AT SMEAD.COM -0 0771 No. .. 57- ....../...................... THE COMMONWEALTH OF MASSACHUSETTS BOARD �LTH E H OF ,4 —5 an— — all .............nr.... ......:...OF........... ............................ Appliration for Uhivasal Workii notrurtlint frrutil Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System aty 7 ...A ......... .. .. .............. .. . ....................1:�� i ----------------•...... .. L cation ress or of No. .......... ... .. ...................................... ----------7-------- ----------------------**'"*-------- 0- _190_-Otl'l�---- -- ........ ------------------- .................. ....... .. ..................................... Installer Address Type Building Size Lot...../,$,_.2!ff...Sq. feet U Dwelling—No. of Bedrooms.......a....._._........................Expansion Attic Garbage Grinder aOther—Type of Building ............................ No. of persons_......._.__._...._.._...... Showers Cafeteria Otherfixtures ....A-,P,-�_ ---- ---------------------------------------------------------------------------------------------------------------------------- W Design Flow..........5_6..........................gallons per person per day. Total daily flow..........A.Q!2.....................gallons. 04 Septic Tank—Liquid capacity/"__-Z rallons Length................ Width...____._....... Diameter__.____..__..... Depth................ Disposal Trench—No. ................. Width............/,.. Total Length.__.._./..;;,,�. Total leaching area....................sq. f t. Seepage Pit No._'/4Lv�._ __ ......... .......... Total leaching area..- ------ sq ft. Z Other Distribution box Dosingto elk- 4-- 77, 1------ Percolation Test Results Performed by... :i. 7. . ........................ Date....I. ... ..................... Test Pit No. I.."0- minutes per inch Depth of �est Pit.................... Depth to ground water...________.._.......... ---------- fTq Test Pit No. 2................minutes per inch Depth of Test Pit__.................. Depth to ground water_.__._..........._..___. Ra .......... A x'4------ ...... ----------------------------I--------------------------------------------- _/-------------------------------- F, , ./-- 42 '.6&_.-7 r, 0 Description of Soil.......16_'La�.... .......... ................ x --------------------------------------'"------------------------------------------*----------------------*----------------------- -----------------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 TL IT U 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 I Ith .. ............ Signedl/.�1.._!1...._ Date 2A, ......./Y------ Application Approved By............. ........... Date Application Disapproved for the following reasons:......................................................................................... ...................... ......................................................................................................................................................................................................... Date PermitNo......................................................... IssuedL....................................................... Date � . No......................... Fss........��...................... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HE L ..---_.....+_"V .....OF......` Applirtt#ivit for Dispvii al Workg ni#rur#ion 1hrutit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal Syst .................................................... ..................................... .- ocation dress or.Lot No. ...�f . .....` ............................. ..•-•----................. ............. ................................................... W Owne Address a ............ . ........._ Installer Address dType oif Building Size Lot---- _ ' r....Sq. feet U Dwelling—No. of Bedrooms...... Expansion Attic ( ) Garbage Grinder ( ) a Other—Type T e of Building No. of persons............................ Showers Ga YP g ---------------------------• P ( ) — Cafeteria ( ) Q' Other fixtures ---A;P " ` -------------•---•----• . Design Flow.........6- w_41...........................gallons per person per day. Total daily flo ___--_-- : P.....................gallons. W W Septic Tank—Liquid capacit;?f� gallons Length---------------- Width................ Diameter_______......... Depth................ x Disposal Trench—No. idth___. Total Length Total leaching area____________________sq. ft. Seepage Pit No....�. ".. er....... �pth - Total leaching area.................sq. ft. Z Other Distribution box ( Dosinggtank 7 aPercolation Test Result Performed by.. /-)4 ''`� n�y� ""�"`' �_______________ Date.._.��._.� ..�_�_.________..-. ,.� Test Pit No. 1_-/_--__---_-_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........................ ........... '---------- --- :-=o u .------•-••-•---------------••---- D Description of Soil....... . y - ............................ `...z.._..... ----------------•---•--------- U ••-•------------------------••---•------------------•-•------------------------------....._......--•---.....---•----- 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 TIT1E 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 bopird of kalth. J� Si gn d4 � ✓� • f ' �1Date Application Approved BY , ! ! _... .---•-------•................ ..._ --- -- ✓ Date Application Disapproved for the following reasons---------------------------------------------------------------••----------••-----------•--. --•••-------.-_.... -----------------------------•-•---•.........._.....---••-•--------------......-•••-•---........•-••----•---•-•-----••-••--------•••------••----...--•------------------•-----•----------...-------•--•- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � ....... ~y""".....OF.. .......................... +a (9rr#if irtt#e of ToutpliFatta THIS IS TO CERTIFY, T Pt the ividual Se. age Disposal System constructed or Repaired ( ) by ' - , ............................................... Install has been installed in accordance with the provisions of�ThI 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit N .__-J.. _ l...................... dated_.,/-__ ..................... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM W44L FUNCPON / SATISFACTORY. DATE..... . . ` 1.$LZ_1.•-.. Inspector.. THE COMMONWEALTH OF MASSACHUSETTS L BOARD OF HE 1 77 ...... ....OFH ................................. No 21........ FE16.5.................. Disposal lVorkii % VIm rani# Permission is ruby granted ........,.�=r._...".... to Constru t . or Repair �n Individual Sew ge Disposal System f Street as shown on the application for Disposal Works Construction Permit No---------_____________ Dated.,ll.-_=_7.:.......................... ................... J �� __..._ __ .. -' ....... ... .....„ '7 'OrBoard of Health f DATE........-/.R== 2- ( ..... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS Sk Q6.L-:- �7&ICIL. 4 w T`5 DzooA& 43-1 t_tU C�AfZ AC i✓ c-rzi ��-1-tc TA+�t►C _ �30,� lSo % = 4�5 6.Pv. ,ry �'.}} U Ste: t C>OCR 6A L. hT ,�15P�_.A,L PIT - USE ((>OQ C-&J �o. \ rn`� FiYQ� S[ WALL AeE.A = (SD s.F'. i Imo sF ,� -z.s TOTAL -DESIGN = 425 G.pn. ExP F.M. d `( m PE2GDLQT1ptJ Cs'ATE ttt.f Ztitlu 02 LESS. . i ,x� �� ' L1 .. `L,371` . f TAT FG.99+D Top Fwo = I\�. :•Y tuy t 9 7, 'Z- . L.o A M "P,ve I vaa ilrv, ?� £ Su.4 Sc��... 4'ppe 2�lSl' Iuv. Goy. 9 3 ,r -Box' ye.G6 ScPric I o INV. ! TQ�tK . ' Ioop 9G.o liuv. t►N•9G.a5 •.,r UAL. LAN A. G tjai>iVfA War,-1 ri f �1x ►�p • WASM�b " C!✓tZ�'tFICL? pl.b'7' �L.!-L�1 Frzo t L_ Lor-ATI ot-J 8 ,O Uo 5Cnt_Cinn.=5o FY bAT� 11 J l b f� 7 NO TE;-, l 7 1 CMlZ-rl--4 T14AT' T(-AC FO.VN'DA,T 0►\I5t-kNc/�.3 PR_4hl . 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