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Home My WebLink About0030 LIMERICK COURT - Health (2) l r�9 � � ga -77 N ......... F , . ........: ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH144 (Oct ?A4- ��/,el ....._.....-•-•-•-•------- Appliration for Disposal. Work.6 C oustrnrtiun Famit, Application is hereby made fora Permit to Construct (\.�or Repair ( ) an Individual Sewage Disposal" System at ...... = = ---------------------------------------------------------------------------------•--•------- ..� �ocat�•L ddress or Lot No.A.....---•-- .............:...........:.:..:..... .................. ......... ------................. ._-_----- ---------------------------- Ow ,/ Address W _---� / I/2f ......................... ..........---•---------••-----•-•-----•-----------........ ----•....................•-- A Installer Address Q Type of Building Size Lot__ 705'�;,....._Sq. feet Dwelling—No. of Bedrooms__ ________________.__--------------Expansion Attic -( vr Garbage Grinder ( ) Other—Type of Building �+ � yp g __.lam __ _ No. of persons____________________________ Showers ( ) — Cafeteria ( ) Other fixtures . w Design Flow________________rzf........................gallons per person per day. Total daily flow........ _v.........._............gallons. 9 Septic Tank—Liquid capacity/b0�Lgallons L�gth________________'Width.:.._.___ �____ Diameter................ Depth................ Total leaching area_______ __ _�_s ft. � Disposal Trench—No_____________________ Width......��_...... Total Length..... _.___ g �__ q. Seepage Pit No..................... Diameter.................... Depth_below inlet..........a........ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) C� !'�` �'G��11 i"�s - 77 Percolation Test Results Performed by_______________ � �_�� .._.. �"f:_______._._____ Date......... _7.7a_A_... ►� / 17. Test Pit No. 1____ _________minutes per mch Depth of Test Prt._.____.__.__.______ Depth to ground wa er........___�.:__.__ It, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Description of Soil------ a ,� �� % t`- 1 �G�Z.L�-t�� r�/� � �" � A..-../s�< ....................................... --•-•• •- c, ----------------------------- 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 iITi 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 i ued by the board of health. -•-------•-•---•--••----- rr 1 //�/ . �+ -� / Date.! Application Approved BY 1�•/...////"/ I2 !1 ,•_�� OdJ/ ------••-••••. y-----•••--•7-••--- • Date Application Disapproved for the following reasons:........................../___--_________________-___-_•___.. _______•________ . . ___-........-- .................. ... .•----....------------------•--•-----•--••••-•-----_•••-• - a Date Permit No.......................................................... ssued... `.'0 7 s THE COMMONWEALTH OF MASSACHUSETTS IL- L-0•. BOARD 'O HE T ------ r---iv l ....OF...-....... --- ........ ......................... A1141firatilan far Dis'pas ai Works Tonstrnrtiun ramit Application is hereby made fora Permit to Construct:(fir or..;Repair ( ) an Individual Sewage"Disposal"141 System at .............. �` - ocation d cess or Lot No. ....................................l= ................. ....................... ....................-...._...___........_ _... O Address .17 9V............ ............. ..........:.,......................................................................................... Installer ' Address d Type of Building Size ..Sq. feet ,,. Dwelling-No. of Bedrooms. ............................Expansion Attic ( Garbage Grinder ( ) U Other—Type of Building .__: '___ No. of personsr............................ ShowersCafeteria a• d r Other fixtt}j res =^ " Design Flow................4 ' .. gallons<per person per day. Total daily flow_______- " ._._____.__.._.....__.gallons. W .........................` WSeptic Tank—Liquid'capacity/09gallons egth .............. Width...______ �___. Diameter________._______ Depth._s:_______. Disposal Trench—No_ ____________________ Wldth.... �_._ _ Total Length ---�� Total leaching area_____ _sq. ft. x .: Seepage Pit No-----------_------- Diameter.................... Deptli.below i let_ ____ ....... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ::' '�� n x Percolation Test Result Performed b :_............ js!G ry �,` -- a Y � Date._. Test Pit NO. 1_'. ----------minutes per inch Depth of Test it.................... Depth to ground wa fi Test Pit No. 2______ ri,� utes per inch Depth of Test Pit.................... Depth''to ground a r_________. ._-•., 4 ` �� t Description of Soil ........ . .. -- - - - W ••--•------•---- ----- ----_. ....-••••--•-------------- •-••- ...................................................... U Nature of Repairs or Alterations Answer when applicable_________________________________ ___________ J! ••--• . Agreement. �. l' ;. '�:: :. •° •-. ..--- _z ...... The undersigned agrees tots install the aforedescribed Individual Sewage Dlsposal System in accordance with the provisions of TITU 5 of the state Sanitary Code—The undersigned'furEheragrees not to place the system in operation until a Certificate of Compliance has been is ue by the board of health sign 1�!. `..__... g ` - ' ' ` .._... - -- Date': I�� /4 Application Approved BY_ � G !- ' _ ... -`:?e,�! 7_; Date Application Disapproved for the following reasons.1 --------------- ------------------- ............ --------------_------•-------- -•-------•---------------------•----•-----------------............---------------........:-------...----------.._...._...............-----------•-•----------------......------------......-------=----. e,,; Date PermitNo........................ : Issued-.................................................... Date THE COMMONWEALTH OF MASSACHUSETTS " BOARD OF EALTH .......... ........ OF............. .. " '........_...C�Mifirab of Tomplittnrr THI IS, ERTIFY •That the Individual Sewage Disposal System constructed l ) or Repaired ( ) by .. .. .. M /�, dri�_aalll - •: has been installed in accordance with the provisions of T 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No. ....... �.�"'............. dated:-..-7'"';?_:/' ............. THE ISSUANCE OF THIS' CERTIFICATE; SMALL NOT EE`CO RUED AS-A GVA ANTEE'"}H AT THE SYSTEM WILL FU CTI N AT ACTORY �_.DATE.....__ -----.-- Inspector ........ ............................................. THE COMMONWEALTH O•F MASSACHUSETTS BOARD OV HEALTH ............. ........... .. OF...... .. ............................................................... fnv No....... w s FEE- = •----••-•....... �spwia To 6u amit Perm> sio�by granted= �` . . . to Con ct: r hair (`' ) an Indio e�a e Dl al System a - -- -- - -- ----- e Street" ,y as shown on the application for Disposal Works Construction Perm• o._ ___.___ .__ Dated.__._ '"�.'�_�._'" 6 ................ ................. -•--• --- •---•--- Board of Health DATE: �`4 :. m .. R FORM 1255 HOBBS & WARREN, -INC., PUBLISHERS - � t k u . 4.. _. •,,,.. .'_ `s."-'. .:.. �+.J-? �y .n. - �_ " �iy- _. - N Bpi- yy _ ! .•"F � . a _ - - ;s= _,MCA. - ..q / p• '.` s 4! OGV®L4i _ _ x • II 7-7 •a s L eQ ill D LEYEI C4,6AN `TAW 0� 7-" _ 4. A ST . •4• !/4rR �T -• AI/c 174 /"��K - K b- a�I. _ _ ' k o P C4 a . _ 5 see► �- •r._ - ` - t rrT - 6. / e®� Al0VA(Dl WA I.�Ii �A SLf. _ -� � 4` � �ET4//�q�'E `D%S�aSA�L SY�""P'EAg'l ' •= � ,_ i.., V' a _ LEA CH 610G F'/;EL D SCALH / _ . 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