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Home My WebLink About0025 LONG POND CIRCLE - Health (2) I' , 0 �♦ S - No._!�M ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF....... .. ...................... Appliration -for Biiipoiitt1 Workii Tooitrurtioo PPrutit Application is hereb made for a Permit to Construct ( or Repair ( ) an Individual Swage Disposal System at., AVA _ 6 ................. Vl Location resS ✓✓✓✓ a .............. or Lot er Address Installer s Address Type of Building® Size Lot�Z __.e y Sq. feet U /ate arba e Grinder Dwelling—No. of Bedrooms________________ _____°..________._-____..._Expansion Attic ( ) g ( ) p, Other—Type of Building ----------_---------------- OtherNo. of persons___-_______-_--_-____-_.__ Showers ( ) — Cafeteria ( ) fixtures .._-_._ -__ W Design Flo .................... _�_ gallons per person per day. Total daily flow.................__.. ___ �_—..gallons. �°' P; Septic Tank Liquid capacity/gallons Length................ Width---------.-__.. Diameter................ Depth.__--_-__.-._. Disposal Trench—No___________________`Widt I._ ... ._. I - o al t ._ Total leaching area.............-------sq. ft. Seepage Pit No._...�-_______ Diameter '_. Depth elow in a Tot leaching trea_ ________________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........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---------------.-------- -------(yi i ._...--•--------------- - -- - --•- - ODescription'of Soil - -------------------------------- x U ............ .... Wµ""~-------. 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 Article XI of the State Code— The undersigned further agrees not to place the.system in operation until a Certificate of Compliance has been - sued by the board of health. 1 r Signed.--- z�`�" -----'Alog-4,0& -:.. ._..----_--•------------- ----- `/,�`° G Date Application Approved By.. .._..-- lsl .. —------- Application �' e .. Date Application Disapproved for the following reasons:----••-----•--------------------•-------•--•---•------------------------•--------------------------------------- ....................•--•-------------.....••-•--------------------...._...------------------------------....•------------------------•-------------------------=----------------------------------------- Date PermitNo......................................................... Issued........................................................ Date ••a+•��s��s��w��••e��s��rs�e��s��a��•-��ew�-��ws•��r��-•�ia��s��ew��s��•--��.s��-�-�� w THE COMMONWEALTH OF MASSACHUSETTS 1 ./ BOARD F HEALTH �iZ �a- g-2— �...........O F...... kZr,,.j � ` � �prtif ir�tr of tom I �tgcrr TH I TO CE. lI That, the Individual Sewage Disposal System constructed ( or. Repaired ( ) by------.. •a* f - ---=- 9 ----------------------------- Insta ler 1 _Q has been in alled in accordance with the provisions o Article XI of TI e State Sanitary Code a des ribed in the application for Disposal Works Construction Permit No.............�_ ____-_______._-- dated . _�r... ...7.4.............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GU RA TEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------------------------------------------------------------------- Inspector----------------------------------------------------------------------------------- ----- - -- - - - - - -- -------------------------------------- No... ---•-- _ �. F>�s............................ THE,:COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ` ;.e OF. .A. ................... . pphrtt#ion -fur M.5posal Worko Tomitrur#i n Prrutit . Application is hereby' made for a Permit to Construct ( ' ` or Repair O an Individual S aae Disposal System a �, s A j to � I ............................f� d or Lot o Locat on ,,rg Address - ------•.................. rr _.. 74e Installer Address d Type of Buildi> a Size Lot `� .Sq. feet U Dwelling-No, of Bedrooms.... ......... Expansion Attic ( ) Garbage Grinder ( )H _______________________ Other—Type of Building G� YP g __.,_....--"_---------_ No. of persons-------------- ---------- Showers ( ) —.Cafeteria ( ) Other fixtures _ d --•--------------- ..._...__._... Design Flow__ ______________`�� __:__.gallons per person per day. Total daily flow._...__.__._._.__- _ gallons. w - -- WSeptic Tank Liquid capacity gallons Length _._ Width.. Diameter......... ..... Depth. ..____-_ . x Disposal Trench Io........... _ Width o /�, 6. ota� 1" Total leaching area............ .....sq._ft. tA Seepage Pit No :--------- Diameter'' �....... .. Depth 11elow inlet.......... leaching are,i ----------------sq. it. z Other Distribution box ( ) Dosing tank ( ) ,c ,; •: . '�' o �? a 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 a water--.--.---_-..--:____---. " - x -- ---------------------------------- - --------------- ODescription of Soil----- ------------------------------------ ------------•---•----------------'----...-----._....---------=------ -------------------------------- - w UNature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------- ............---------------- --------------------------------------------------------------------------------------------------- ------------------------------------- ----- Agreement The undersigned agrees to install the afoi-edescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee5i sued by the board of health �: s 3 Ra C"�� •rt� "�'- .�� t��:tr£,�t�xx va'r�,wrF�e�$',e.'�r� �' Signed....„ r , Date Application Approved By....... �y�,'__�_ - 'd•--•---- � _ .. f ' Date Application Disapproved for the following reasons_________________________________________________________________________________________________________________ ---•----•--•--------•-------------------•--------'-._.---------------'-----------------...-- ............................................................................................................ Date PermitNo......................................................... Issued----------------------- ----•--••-•--•--•--•--••---- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH P °' o� OF , ............ .... _. ... c ... ;,�, err#ifirate Of lamp tatur THIS IS TO CER IF , That the Individual Sewage Disposal System constructed ( 4 or Repaired ( ) --- •--••'-•---•-•---- ---- - ......... InseT at_.� F4w-sr � .. r� �' � � *a ..-- has been msialled in accorce with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No:,,;;___.__...: � "?' -• •--•--_-.._._ dated.... - •-- '.. __.. •--- . . Aw, THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GSJARAPI EE THAT THE SYSTEM WILL FUNCTION SATISFACTORY., DATE..................................--•••----•-------------'---•------------•---- Inspector........................................................... ........................ THE COMMONWEALTH OF MASSACHUSETTS A BOARD OFF HEALTH / .......f ;.. o- W... ... .OF.... .. p t "! �5 ea ?C %s«.,E +� 'Au .._.... No. :.. FEE - %svolittl rr kq L�0,;n ion rrrmi# � Permission is hereby granted----- t -----�Y'� f p = to Construct ( 4Aeor Repair ) an''indivjaual sewage D•,posal System , t ti at No. ; sir ' a .. --'•-- as shown on the application for Di posal Works Construction Permit No __ ... Dated ' . w, art t, _ _._ r.'s x., Y oard of Wealt$ .ten . --- ' DATE............................................ •--•--•------'- .. FORM 1255 HOBBS & WARREN. INC:. PUBLISHERS ' ..•yam" - .. ' .