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0005 HENRY F LORING ROAD - Health (2)
f C THE COMMONWEALTH OF MASSACHUSETTS BOARD F H H Appliratiun for Disposal Workii Tonstrnrtiun rumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Z' Loeati n-Address or Lot No. ............ ......... ............................................................. ............................................. .. ...................._..... Owner Address a (...........•-•----------------••-••••......•--•-----...-•-•---•-------•----.... .---•••---•••••••••........-•-•-••••-•-----•.........---•-...---•-.............-••--•---------.... Installer Address Type of Building Size Lot...r�S_T_.. .. ..Sq. feet U Dwelling—No. of Bedrooms...........................................Expansion Attic (�Ao) Garbage Grinder ( ) a Other—Type of Building .....0i'-. .__ No. of persons.. ......................... ShowersCafeteria ( ) Other fit ......... ..... WDesign Flow............... ................gallons per person per day. Total daily flow---_._....._. -. .............gallons. WSeptic Tank—Liquid capacity...�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 Percolation 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........................ ODescription of Soil............................................................................................................................................--------7-----------.------ x ---••-••••-------------------•--••-••--•••-••••-•••••-•-•------•---••-•---•-•-•---•--••...•.r•-••--•-•-------•-••••••--••-•••-----••••--•-•••••-•••---••--••••-•-•-•-•---•••............---•--........ U Nature of Repairs or Alterations—Answer when applicable-------------------------------------_______•••-•-••--_------•---------........................ ----------------------------------------------------•------•------------•----------..•...----•-------------------------------------------------•----••-----------------------------------------•--••••-- Agreement: 4 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of HT?.; p 5 of the State Sanitary Code— The undersigns .further agrees not to place the system in operation until a Certificate of Compliance_bas been issued by the board health.. gnedpr��� Application Approved By•••--.....••. .......... •••............. = l.. : Jet � /......... Date Application Disapproved f r the following reasons: '--------------------------•--•--------------...---•-------------------•-----•............••.....------ •-••••••-•••-•••-•••---••--•.........-••••••••••••--••--••-••-••-•••-•-••---•-•-•-----•-•......••••••-••------•••---•-•--•-•-•••••-•-•-•••••••--•-••••-••-------•-•...•••-•--•••--••••••--•••••------- Date PermitNo......................................................... Issued............................. Date allo........... ... `l THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................................--....0 F.......................................................................................... Appliration for'Biopoottl Works Tontrur#ion "amit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at:, ..............••.................. .._......................................................... •••••-••••-•••••---•................-•••••••••••••••••••••••••••••••-•••......•_.........•--...... Location-Address or Lot No. .... -------- — ....._................................................................. ..........--..........................................................................1........... AFC Owner Address W "W� Installer Address UType of Building Size Lot__________________________S q. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ------------------------------------•.......•- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................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........................ R'+ ------•--•-•-----•....................••-••.................-••-•••-••••......-•••--......---•---•-•......................................................... ODescription of Soil..................................................................................................................................................................... V ............................ ••-•••......---•.....---•-•••-•••-••••----•-•••....••-•-••-•••••-••--••-••-•••-••••••-•••---••-••---•••-•-•-•••••••-••.............••----•-•-------•............-••••••. 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 TITTLE 5 of the State Sanitary Code—'The undersigned further agrees not to place the system in operation until a Certificate of Compliance as been issued by the board of health. iigne ------••-------•----•--••......................................•---•----••-•--•- i ..... Lf r��/` to. ApplicationApproved By....------•-- -----�--"-`---�-"-'------•------------------------•-••---------..._.........-•-......-- ---�--"�----••- �....._.... Date Application Disapproved or the following reasons:-----•-----------------------------------------------------------------------------------------------•-•------. ...............................-......................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH j�L ..........................................OF...............................................................I.................. (9rrfifirFa#r of ToutpliFatta IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by........ .. `•.• ................... ... .....I ----•------------------------------.--•--------------- nstaller 4,1 �Slr� at. eC.... ••... --•• 41b�,� .has been installed in accordance ith the provisions of '" F j,,pf The State Sanitary e s� in the application for Disposal Works Construction Permit No 2..70 ............... dated.-. .°.f / t"' ._... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BEZCONSTRUED5 A GUARANTEE THAT THE SYSTEM WIL U TION SATISFACTORY. DATE.... 7..d�7.......-••-••---•.....................••----........ Inspector --•--........_.....---•---•------•••-----•-----•-•---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................................... N .•....................... FEE........................ �io�ol ork� �on,��rttr�ion >erattit ,.,: , Permission i ereby granted..._..,.. .... .................;;;5; .........--------------------...------------........................................ � -- ,,ter,,;•--•----.. to Construct - R Individual--S .C�ag sposal System atNo. r ( ,+.. --•--- ------- ----------------------------- r Street f as shown on the application for Dis os corks Constru n Permit No..................... D ..............._. .............. ....................:................... . ---•••---...._.......................................... oard o ealth DATE•••-•• OK It -----•--•---•••-••-••-•......-••.....•••............. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS s1►�GLL- FAMIt-`� - �{- BEOtZr�oM � \ %_ ,r 06 GAIl BAG& (�Wt.JDEt2 pA►LY FLOW - IIO Y. v-= 44.�' G.RD ✓ _ j �15po5At. P1T USA lvoo GAL. Sol ©T ?-: �bo s.F x 'M� G,Po U 50T+0M AQE.A: c 5,F• { 10© S.F x I• o � low. G. . � >:x , -TOTAL. DA►1-Y �LOy,( s t{=�4DG.PO, ,V/ .rye.\ 'S. j s, k PER.COLAT1oN RATE] I''IN 2MIN oa.t>✓5S ;., .-r� . uEt,� U I, t`P�SH OF filgSs�ci,t� � �P��N OF 1-4� - .4> �a per' WILLIAM ALAN ¢ NYE v} o �A.1 No. 334 " JJF9 p O moo, 1510 19 F 4 �Na SUq,4 `d i -Air Imo-to'1� G• • S To P FWD {8I JWV- Se Lw INST.fA�n�,�IK y' ,j GC.L. 5G o • Gt,P LEACH INV. INV. G� PIT WlITu � �lo�L SG'� II Sd. GER.TIFIGD PI.oT VL PL.A►J 1Novdp•T No SGALE SGALM 1't= S� DATE �✓' �915�. 1',. p>.,P.N REF EtZ6►� t:E '� 1 ' GER•i'1FY TNAT 'rNE �'o�uoQ�'tolJ S1doVYN INI;.R�o►.i GoMPL�(5 r11TN'THE SIoELINE � �.� Z� � Auto SETee.GK R.6Q�IR.EM>=N't� oF 'fNE 11 'TOWN or- C3a 9-N i5r--rAl-N-cam,A N-D 145 N o'er LOCj Z112 D -WITN *! T Ft.o o PLA.1N I-11 G1-I (�bN DS SECT.DATEBAXTE1Ze WYE- INC.$3• ' REG I S't 1✓Q6ti'IAN�S u w EYoes i. T►115 PL&I\1 1�i KlorT Bt% W:U Id AN 03TE2VILLS- • MASS. (I • Iu5-1-R.�MBt�•t' Sv2vG-�( �-tH OFK'SE"r5 6uout,� MOT DG- DE-7f:.t',f�i►�C t. r>'t t.IIaG�J APPL IrA►J"r p,l�4nl 5���,�-. r�G .