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Home My WebLink About0046 JOYCE ANNE ROAD - Health //0-7 THE COMMONWEALTH OF MASSACHUSETTS BOARD QF HEALTH jonyoF...-.. .................................................. Appliration for Disposal WorkP Tonstrnrtion ranfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systgm at: .. ...... .� :.Qaw. - ' r1 ---------- - ------ -• -=-------------...........:----- at' or No, Y P� S� ...................... f Owner Address a -- ............ ---- ---------------------- ----------------------------------- ......... ---- -- Installer� Address Type of Building Size Lot.L-_ ® ........Sq. feet .., Dwellingg-No. of Bedrooms...... ...............................Expansion Attic ( ) Garbage Grinder `4 Other—T e of Building No. of persons____________________________ Showers — Cafeteria a' Other fixtures ---------------------------••••- W Design Flow. _.___.___�__S...._....................gallons per person per day. Total daily flow__3�"____ ........................gallons. WSeptic Tank�Liquid capacity��_U�_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 area3m� _...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........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 19 O Description of Soil-------(�` .:. =' C....---" Gi'`` - � ,.. � '-�,` V _. - x 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 TI I'�U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance hasAbee * b he oar of health. Signe . - - - -- - -----...•••-••----••-•••••-••--•---- Application Approved By--••-•-••- - -• --••• f�111 ... ..._..--•------ Application Disapproved for the following reasons:......................................... easons__________________________________________ •••------------••••••-•••••••-..Date-----•--...._ ------------------ Date PermitNo......................................................... Issued-....................................................... Date No... . ................ Fps... �............... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH . .......5 ..................................... t Applira#ion for Bhipoii al No o Tomitrudinn Prrutit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal Sys em at: w //TIo ig'-Address z Cf. /�rylp�� // W Owner f Address Installer Address // vType of Buildi g Size Lot....�_��_.___.._._Sq. f Dwellin�No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder Other—T e of Building ............... No. ,of persons......................_.__.. Showers — Cafeteria Q' Oth "Iiires ......... --•-- Design Flo •--•-••------------------•-___6W....gallons per person per day. Total daily flow....................... gallons. 9 Septic Tank—Liquid capacity............gallons Length________________ Width................ Diameter________-___.._- Depth................ W x Disposal Trench—I .................... Width_/-2............ Total Length._............. Total leaching area. _yt.....sq. ft. 3 Seepage Pit No................___.. Diameter.................... Depth below inlet.................... Total leaching area..................sgj ft. Z Other Distribution bob"(; ) Dosing tank ( ) Percolations Test Results Performed by_ i............................................................... Date---_.................................... Test Pit;No. I ...............minutes per inch Depth of Test Pit._____._............ Depth to ground water........................ (s, Test Pit Nb 2...................$ minute e ' ch Depth of TTest Pit.... ....... Depp to ground water Descriptionof Soil..............•---............-•-----•---------------------------•----••--•----•--••.--.......................------•--•--•--------•-•-••-------•--------•-•......s---.. x 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 TIT1:; 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Com fiance has be sued t�board f Health. t Si 'ed . f ..................... ....�� D to ApplicationApproved By.........................................------------------- ---•--------............. Date Application Disapproved for the following reasons:--•----•-------------------------•------------------•-------------....--------------------------.......--------- -------••-------------------••-•--•---...............--------•-- .......................-............................................................................................................... h Date Permit No........................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH .............oF.......:...... 7 .............-� �?G... --•................ (Infifiratr of Toutpliatta TH S TO C ;�IFY, That the Individu l Sewage Disposal System constructed (�r Repaired ( ) .. ------ ----- at..`��.Y .S. �`'��-'L.Y�.��/'�6 --• I ltallel�--K-�/ has been installed in accordance with the provisions of TI 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.._ -_ -_-.-!;_7:j`"._..___.._.. dated----- .... ,,_ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........ .' .................................................... Inspector_.. 1� THE COMMONWEALTH OF MASSACHUSETTS BOAR— OF HEALTH No. ........... FEE... ........... Ehapooal Workii �aana�#r r#Uan ernti Permission is hereby granted............................................................................................................................................. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo.................................-------------------------------------------------------......••--------------------------------------------.......................•-•--------- Street as shown on the application for Disposal Works Construction P t No,t ADated.i-n/2.:!�_A!............ n �/ Board of al DATE--------------•••--•-•- �1• T FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS st164Q.LC- CAMIL..NI( - . 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