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HomeMy WebLinkAbout0035 MASTHEAD LANE - Health (2) A"asM ead" fq3 j d&3 *f N3— o & THE COMMONWEALTH .OF ASSACHUSETTS BOARD OF HE L ...._._..... GC.-.(.1..!'�-.....OF........ Appliration for Disposal Works Tonstrurtiun Prrutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal Sys�! '' �: ..:..... ... ... ...Q..... ......... ..............................----...... --------••------------------•----.....•-- Loca Addr ss AZ or Lot No. ........ _ .....r.................................................. ...................... ................... .............................................. ner --- .. -. - -•.Ad'ci,Ls a - -= Installer Address PQ UT of Building y Size Lot../_5y-z2-k.....Sq. feet Dwelling—No. of Bedrooms._._...................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures n`'- '` .-......................................................................................... Design Flow......... .:. ...........................gallons per person per day. Total daily flow..............2 G?._ ................gallons. WSeptic Tank—Liquid capacity/ lions Length................ Width_............. Diameter__.___________._ Depth................ x Disposal Trench—No_ ____________________ dth........ ._.... Total Length_. ........ .. Total leaching area....................sq. ft. Seepage Pit No....1A--'m'-----: v: .............._... -1 . To 1 leachingarea. d sq. ft. Z Other Distribution box ( Dosing tank ( ) U1p�- /©G � /Y.-�- ~' Percolation Test Results Performed by.. ?-_3,�c�ty2_ _.. 6................ Date- _f __"'.....'... ......... Test Pit No. 1.._ . _minutes per inch Dep h of Test Pit.................... Depth to ground water-------_................. .,� -_ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 •---•------------- --••-•---.... --•-•-•--•................•.........-•---- Description of Soil ...---�....._ fin?`6.�c�Y.._.... `z: x 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the boa d of he 1th. Sign Application Disapproved for the following reasons:. ............ Date Application Approved BY �!r —--------�....-•--•------ ...../-�--..�d- 7-7------ A Date ....................•------...------------------....--•-------•----------------•----------.........--.....-•-•-- •...................•--------•--------------•------•--------------------....-•------------•---....-----•-•----•••--•--••---•--•-•--•-••---•••--•------•-------•-------•-•----------------------- / �J� Date .. .. Permit No......................................................... Issued..--- ! t l ^ --- - -----••--••---- -------------- Date -. No.........FF.'.W...... FEs............................_ ,THE COMMONWEALTH OF MASSACHUSETTS BOAR®�OFHL.. .....O F...... ............................. ApplirFation for Disposal Works Tons rnrtiun Trani# k Application is hereby made for a.Permit to Construct ( or Repair ( ) an Individual Sewage Disposal Syst-.--..-:. ..c.... .�. ... r Location-Address f or t No. .... `�'"' ::' '�--"c:"• :_' - �'.' M' '� --..... --•-^.............l_.-"•d"'" •:......._..---•--•-----•----............_----- r Addkess W (f� --•--•--•--•-•- ' Installer / � Tess Type of Building Size Lot..4;.A�R __.Sq. feet Dwelling—No. of Bedrooms..... ..................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............. No, of ersons.......__.__................ Showers a YP g -----•--------- P ( ) — Cafeteria ( ) Otherfixtures ..e.... r`,. =------------------------•----.----•-------....------------•---------------------- ------...._.....---------.....---•-------- Design Flow•.... a........................... W g ' gallons per person per day. Total daily flow.............Asi._9................gallons. WSeptic Tank—Liquid capacityA llons Length................ Width................ Diameter................ Depth................ x Disposal Trench No ....................Width......... . Total Length Total leaching area....................sq. ft. Seepage Pit No. f '' '_. •a�t4eff.......... i 4 �. . ..._.._. Total leaching area. W ....sq. ft. Z Other Distribution box ( ).40 Dosing tank ( . ) v�j�. � - /40 � r '-' Percolation Test ResuZA-._minutes Performed b .r� ________________ Date.._f�`.......`_�_7......... Y-_.!n. � . 'c..... : Test Pit No. l... per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test'Pit..__.._._._...___... Depth to ground water........................ P4 Description of Soil..__"__ '__ :.--- _e� h _ �' ...::��'-- .... x •--•--_------ V -------------------------------------------•-----------------------------•••-----------••-•--------•-_---•- -------•------------------------................................................... W i. V 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 TITLZ 5 of the State Sanitary Code=The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the boa d of health. Sign ---- -- -- ...-- - Date. Application Approved BOKI f Date Application Disapproved for the following reasons:................................................................................................................ -•----•--------------------•-----•--•---...-----•--•-------------•--.:.-----------...------------•----------•--•-----•----•-•-••-•--•-•-•-•---•--•-••-••-••----••-•------•••--••--------•---•-------•--- Date PermitNo........................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL H �..�� OF... .... . .. (9rdif irFatr of Bunt litanrr THIS IS TO CERTIFY,,aThat,tye Individual Sewa_e Dis osal System constructed (04ror Repaired ( ) �,�' , � ' ' r , „ at. f .r 6r = r '7 ---------- -----•-----•------- Installer has been installed in accordance with the provisions of T LTE r of The State Sanitary Code as described in the application for Disposal Works Construction Permit N ________________ dated__./^+...ZFO.s`1.7.................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL NCTION SATISFACTORY. . >• DATE...............••/.....1/......7-----.................................. Inspector.__j; ----•---••-..... ----•----------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS k BOARD OF HEALT�1 �� �9 ............... . ......OF... ... ;...... ,. '. ....................•• " No.•-••._J 1-t1....._._ FEE........................ Disposat1 Works To, #r Wn p anit Permission is eby granted...... ,,/ �j ________________ to Construct ( r Repair ( an Ind-v1 r ual Se gsposal System at No...-• _140-. .... r -X" . . tTx Street as sho on the application for Disposal Works Construction , mit Dated..f�Z...a'®.._ 7 Board Health DATE................................................................................. FORM 1255 HOBBS & WARREN. INC., PUBLISHERS C 4' c c�i,Antl�r�- I 4.t l_`-! F tit c/ a t t C3 3 t 33 U G.P•U. } E 5-1-1 G T A*--1 V- = �`jO,t 1G�C PCffAL r-11T - us=_ I000 GAS. Q Su)rau ALL �AVG-A C� Irmo Sf=' T3vrrr.)/A CEO s.5= N TOTAL �ESIGt�I = �25 G.P.D. 'Z-1. S` � L� M t t:�!CGDI_,DTI(.>tJ CZlsTs= Cl" 2tit I tJ. 02 Y 1 � 27 \� v� . � , � � � : y S!lob• l% . ,• �;_- �. :.,, ��;�_� (; - I I q �, ter 1 -� ► k-t/�V,/J�irZ Tor 17.4 fir.,—,.%��: ', /�- ."f .�.iiin I til V.` •O AN 2 503sott Q'pac- 'Dis-r. IW 64L. 9Co'1 I r -Box qG l� Sepr,c laoo 95f t twv. GAL. C{G,� 9G 2 ; Lr Aca a ' MD. 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