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Home My WebLink About0638 MAIN STREET (CENT.) - Health (2) 63Y I an S1.) CeA4, Aor7 / 0 ( 1 4 Na "....... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEA . TH ............._) QlfrJ.J.).......OF....... .. .�,1 ' .6:C�...-•--••..................... Appliration for Uiipoiittl Vorkg Tontitrur#ion rumit Application is hereby made for a Permit to Construct ( ) or Repair (4—yan Individual Sewage Disposal System at: c:S rc� r..............• ........... ....0 ............--------- Locati dress or, t No. ........--- 1',?.....__...- Q.Y�.. �YU �': ....................................•-----.. �'l Owner Ad r s w - pox x_f. . .... �. ,�'eYU.. .a ......................................•... Installer Ad ress dType of Building Size Lot............................Sq. feet U Dwelling-No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers Pa YP g --------•------- P ( ) — Cafeteria ( ) Q' Other fixtures --------------------------------- - W Design 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........................................ 1.4 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water..................... Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ODescription of Soil.............................. L-mil , ............................---------•---•............................... V -•••••••-•-••-••-••----...•--•------•-•-----•-------•-----•-•••......--•---•••...................•-.......--------•--------•---•--- -------------------------------------------------------------------•----------------------••---....---•-------•------------------------------------_-•-• -- U Nature of Repairs or Alterations—Answer when applicable................/_=_�.40p.�...9 ........................ ......._..._......... --------------------------------•--..............-•----------------•-----------•--•-•--......._.....••-•••------•••-•---•-•-....•-••-•-•••-••-••-••--•--••••---••-•••••-•••••-••-•••--•.._..----•_-----• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be n issued by the boar4 pf Health. ....ou#�.. ,;K Application App;0. --• ... ••. ........... -------•--.:....---•---•..........................•--•-.......... ...... ../.� -------- Date Application Disa r the ollowing reasons:---•..........................................................••-----------••--•--------._...---•--------....... ............................ ...............•-...............---••--•----.................--'---•-•--•------•-----..............................-•------------•-•-......Date........----- ermit --•-•............... ..------........... Issued...----••--••-------•-------•------••-•................. Date .............. ............................................................. ................... THE COMMONWEALTH OF MASSACHUSETTS j BOARD OF HEALTH ............... I?......OF..... .6)e........................ (9rdif irate of Toutphalarr THIS T�CERTIFY That the Individu 1 Sewage D' osal System constructed ( ) or Repaired (L� by t......:.. �� .m, r .�t ?C. has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated...................:............................ THE ISS NCE OF THIS CERTIFICATE SHALL NOT BE CONSTRJVED AS A GUARANTEE THAT THE SYSTEM W L F CTION SATISFACTORY. DATE---1�.. ®.. ....................................................... Inspector.-- -•----•-------•••-----•---•-------------•-----._.......----••......•--........ THE COMMONWEALTH OF MASSACHUSETTS . BOARD OF HEALTH . ..............)0/ '3 - .....OF....... bk............................. A �.�� «��o�mwu� �x�� ou�ou� q� �. Workii Tonstrurtion rumKt Application is hereby made.for u Permit to Construct ( ) or Repair ( 4--�~uo Individual Sewage Disposal Sx"="^ __ ____ .............. Installer Address Type of Building Size feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other--Type of Building ............................ No. of persons Showers ( ) -- Cafeteria ( ) Other fixtures ~� ----._._--------__--__----_'-'-_-'------_----_------___-- Design Flow............................................ per person per day. Total daily flow Septic Tank—Liquid ............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench--Nv. .................... Width.................... Total LcuQtb---------' Total leaching ure�---.----'-�� 8. :� Seepage Pb 2�o----_-- D�mrccr--.----- Depth leaching �ur� --------'ag. b. �� Other DistrQhotioobox ( ) Dosing tank ( ) ~~ Percolation Test Bcmlm Performed by.......................................................................... Date........................................ Test Pit No. l................mioutcupeciuc6 Depth of Test Pit.................... Depth toground water........................ �14 Test Pit No. 2................minutes per inch Depth of Test Pit-----_--. Depth ro ground water........................ P4 ................... '-_ __' �� ucr��n� c� .1--'-_-_-'---__-'..-__-_--___-- _--._---..--...--'---__----'---_--_------_.---_---'___-'__--_-__---_-_'_'_____'-_----- '--'_-'--.-'-----.--.'--'-'-__--.---_--._-_--- �� Nature of orA1t�udoox--Auowerwhen ---.-.. .-`__'._____ . . -'--.-'—'_'_--'--'-.--'-'-,--.__--..-___-----__.—.----'--'--___-'_--.--''--_-____.- � /*grrro`eot: The undersigned agrees to install the aforedescribed. Individual Sewage Disposal System in accordance with the provisions of TIT 1,E 5 of the State Sanitary Code The undersigned further agrees not to place the system in operation until a Certificate of Cvozyuaoco has be n issued by the boar�hpf health. ale � Application u ____________._____________________`___________ ................................ --__---.---_-___-_--'_..._--'_-_---_--_-'---___' Date reruurmu-_--___-__.___'___ --- � --- ` | THE COMMONWEALTH orMASsAoHUssrrs � BOARD OF HEALTH � .----' -'OF..... . -''----'-. Tntifiratr of THIS T CERTIFY That. the Individual Sewage DiRsal System constructed or Repaired Q'�� by..by.. _� ��_ � has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... duted-'.----------------. THE B SHALL NOT BE CONSTPED AS A GUARANTEE THAT THE ^ SYSTEM - -- SATISFACTORY. ` DATE ~ r*s cowwomvvEALrn OF mAssxCHussrrs BOARD OF HEALTH -.x�F--. ------� �vm��-'�-.z--�'- Fou-_-�"�� / ~Permission is granted.......~� ----- � PP --- Street as shown on ' Board of u"*m D��T7the .+x--_. ronw /zss x. w. suLx/w. /mC.. 00yrow | - - |