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Home My WebLink About0424 NYE ROAD - Health (3) i No.........J=� `� .. Fay.. ....................... THE COMMONWEALTH OF MASSACHUSETTS BOARD QF H EA �' —v� 1 .....I .. .. ..... ... .... ...........OF...... .................................................................................. Apphration -for UWVviittl Vurks "Mrurtiou Prrntit Application i hereby made for a Permit to Construct (- or Repair ( ) an Individual Sewage Disposal ystem at: 9 s � t- -----------------------•-----•---------------------------________--------------------- Locat.on-A ress or Lot o. ............. -••-••-- ..... .....___ Owner - 9d s a --_.._ . ---- --------- --------- -------------------- ......... --------•-----------••-----•-------------•--•--- Insta er Address Type of Building Size Lot------- CIO---Sq. feet .-, Dwelling—No. of Bedrooms-------------C2, ------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons.--------------------------- Showers ( ) — Cafeteria ( ) P4 Other fixtures ---------------- -------------- - - W Design Flow_......_.._______________________gallons per person per day. Total daily flow__._____ __ 4T_nc_)----- ..---.---gallons. WSeptic Tank—Liquid capac/�V_ _gallons Length___ ___________ Width------- .._..... Diameter_..-..---------- Depth....__-___.----- x Disposal Trench—No- No_ ____________________ VV ____-_ -____._ otal en h_______ ____._. otal leaching area......3®.: sq. ft. Seepage Pit No�.��_. __ ____ Total leachiug trea__________________sq. it. Z Other Distribution Dosing tank ( ) (3 inPC Percolation Test Results Performed by----------------------------------------------------------- ___ Date............--_-----------------------.. Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water.-_.---..-_-__.._..._... riq Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water__._-.-..--_----_-___- ------- -- x f "O Description of Soil__ J I_:_...w ._ - 7--------------------------------- V Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------__-----.--__--_----.__.....__._-_._.._.... -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------. Agreement: The undersigned agrees to install the afor escribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitar ode— The de geed further agrees not to plaXtheystemin operation until a Certificate of Compliance has een is ed e and of health. S (p Sig Application Approved By-------- •--•-- - 4-4 - ------------- ...... `-- �.. Date Application Disapproved for the following reasons:................................................................................................................ ...................•----•---•---•--.._..-•--••---•--•---------•-•-----------•---•---•--••-----••-•-------•-----•---._.._.___......__...._.....•.---•-----------•--...._----------------___-.------------ Date PermitNo......................................................... Issued........................................................ Date No......... l Fss.. ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH/ c �= _ .. ... ................0F....... .............................. ......................................-............ Apphration -for Biipmat Works Cnotugtrurfion Permit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: L Location-Address , / /C or Lot No. f�f C IiC�' -.liCf' ----•-----•---------•---------------------------------------------------------•-••••-•-----•-•-... ••--•-•-•-•••-••----•--••-••-•-•---•---•••-•••--•-•-•-••-•••--••-•-•-----••-•-----•-•.........•--- �,�*�� Ownekr ' � /-Address �i,lr� -7� Installer / Address UType of Building Size Lot__.....��.,_ ---Sq. feet Dwelling—No. of Bedrooms------------- ---------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------------------------------------ W Design Flow-------------- _)......................gallons per person per day. Total daily flow__.........I.,'e-)._._...............gallons. WSeptic Tank—Liquid capacoty� Vgallons Length...------------ Width................ Diameter___---.-_--...__ Depth................ x Disposal Trench No .................... Width.............. Total Length-------- ..... ,Total leaching ...sq. ft. Debelo`in et� G .. Total leaching area__________________sc ft. � Seepage Pit No�� ___cDtameterC!�.>�_._._� p g: 1. z Other Distribution box ( ) Dosing tank PPI - `�" et' 7 G Percolation Test Results Performed bY................................................ •-------• --- Date-_--.--•------------------------------- ,a Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ �Xq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water__.__.._____________..-- R,' ------ :... . O Description of Soil...71_0 .rr- - r �,c.� � �+ �1 x -------- fig..._ ...y -i�—'-�-----� - �. -, ... --------------------------------- 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 Article XI of the State Sanitar Code—The,nd igned further agrees not to place the system in operation until a Certificate of Compliance has een i ued } the oard of health. t / u 17 7(� Sig ----- --••-•••- ... ` D to Application Approved BY------- 'fir .. Lc,�1�-�- - ------------------ -----��----`---�-r---7-1---- Date Application Disapproved for the following reasons:.................................................................................................................. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Date PermitNo......................................................... Issued..................... .................................. Date 1 HE COMMONWEALTH OF MASSACHUSETTS BOARD 0 HEALT ........ G% �..�.....�.............OF... G ................................................... Tertif irate of Tilut hatter THIS IS TO CERTIFY' That the Indiv*d, I SeyVage Disposal System constructed ( or Repaired ( ) b `� C�c � � Y ----------------T--•---•••••-------------•--------------••--- j ^ --- is --- e In tiller at ` '.. /` •!---------v°,•-•--------------------- ------- ----------------•--•--------------.-------•--••-------•- has been installed in accordance with t1Se provisions of�.Article XI of The State Sanitary Code as described in the v application for Disposal Works Construction Permit �o 7 ' _1_._ .____,�.�1_`__.________ dated_.___ _ '... '� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. < DATE r^........ ------------------ Inspector -----------------.------- THE COMMONWEALTH OF MASSACHUSETTS BOARD 0'16V HEALTHY , 4 nn ;....� ` ...........of....... ........................'................................................. No........ z--•-••••-• FEE.,...................... Bi volial orkii L t�' rtion umit Permission is •ereby granted. ` ! --••--. =------ ,L ........ to Construct ( or I eair ( ),an Individual eyvage� o stem at No.. . Greet as shown on the application for Disposal Works Construction Permit No._ ...._.. fDated_.1�___:._I__�'_..r............. ............ ------------------ DATE------ ---------------•--------•------------------- Board of Health FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS t , � .�:" ; ..t• � `` .r 4 , e yr ,� i ,�, �'"`t..-� �',. } c ,. ,.,. }f } ,k r era `-A '{` 'p }rTM2 'r• p' /3 / y r ✓' �.x �i* V YY 'a a..:. � � n�✓� i t k r n»� 5 d 'r lit tE°u��3 tier��y}�6 jt PE + 4 Y2x y , ¢WV p//N -, aA 4Al lip z ;• t •p.. 11R 7 4' ��` F A C33 � 1 - fail r �-• ��,;--_a �A.4a .,� rap, e tea.i��. e.. 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