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HomeMy WebLinkAbout0540 OLD STAGE ROAD - Health (2) suo old No.......7Y......... ........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD 9F HEALi ......OF........ Appfiration -for 14-4paiia1 Warkii Towilrurtion Vrrnfil Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: .............................. ------------------------------------------------------------------------------------------------- o;ati.on ss n ------------------- ---------- - ---------------- ..... -- ------------------------ ---------- -------- Address /':�_ .......... .......... .. ... Installer Address Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms._.-_7——------------------------------Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons__-____---________---__--_- Showers Cafeteria Aa Other fixtures ------------------------------------------------------------------------------ ------- --------------------------------------------------------------- W Design Flow.............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacitv7_6­6---gallons Length________________ Width__..___-_---- Diarneter---------------- Depth----------_--- Disposal Trench—No- --------------------- Width--_-_---____--_-____ Total Length--_-__-__--_.._-_--- Total leaching area--------------------sq. f t. Seepage Pit No./,O .0...... Diameter___________________ Depth below inlet......___....._._... Total leaching area------------------sq. f t. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by--_--------__........................................................ Date-------------------------------------- Test Pit No. I----------------minuiesperinch Depth,of Test Pit-.-_______________-- Depth to ground water------------------------ (i Test Pit No. 2................minutes per inch Depth of Test Pit-.-___--_______-___- Depth to ground water------------------------ P4 ­------------------------------------------------------------------------------m................. ......................................................... 0 Description of Soil.-- r01XA1&r- ----------- ------------------------------------------------------------------------------------------------------- U -------------------------­--- ........................................--------------------------------------------------------------------------------------------------------------------------------- -­----------------------........................................................................................... 0 Nature of R, ar ------- * s Alter ti?nk,—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 Sanitary Cod —The undersigned furtlpjer agrees not to place the system in the ,, operation until a Certificate of Compliance has een i ued y the�b�oaE)f heja&_-,� Sign ------ .. .............. ------ e............... 'te Application Approved By------- D,/e - Application Disapproved for the following reasons:...........................47------------------------------------------------------------------------------------------ .......... . . -----------------------------------------------------------------------------------.....................I-------------------------------------------------------- ------------------------------------- Permit No--------------------------------------------------------- Issued........�/_ at a-t-e---4--5--- � -------------------- - ------r AL. r ` No......./- ............ Fwic ..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - v^1..... OF.......&dt _:...... Applirtttintt -fox Uhiposttl Works Tottstrurtiott Urruld Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ------------------------------------ ocation.Address or Lot , f----- _,: -------------------------•------------- ... 4N aw r Address `I ..4-4l . --•-----•---..•-•--• /s/ ✓. 1- •- - Installer Address Type of Building Size Lot---------_-----------------Sq. feet U Dwelling—No. of Bedrooms------"�.c---------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Otherfixtures --------------------------------------------•-••--------------------------------------------•-•------------------------------ W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacitv'6.•.A-.gallons Length................ Width...-_..._-.._. Diameter-----_.......... Depth........_...... x Disposal Trench—No--------------------- Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No.Ap.l?.. ------ Diameter.................... Depth below inlet.................... Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by......... ----••------------------------------•------------•------•------. Date-----------------------•-------------- a Test Pit No. 1----------------minutes per inch Depth of Test Pit...----.--------_- Depth to ground water.........------.-------- f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.............-------.... ------•--- •--------------------------------------------•-----------------------------•.....----•---•------------------------------------------------------ D Description of Soil 16�_ eon,, ...................------------------------------•------------ x ------------- ----- - ----------- -----------------------------............................------------- - ... ;� 1 . V Nature of Re airs or Alter ti ns—Answer when applicable...--... .t...-.- `' '' +.- ._. .._ - •----- ' ----------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Cod —The undersigned furtlWr agrees not to place the system in operation until a Certificate of Compliance has been ued luy the boa f heal 0-1 Stgne.... Date Application Approved B -........ --/s `- PP PP Y--------- � -- -�-- -- 'j---�-• ---.+�r,.c•- ------------------ - ,.�" Date Application Disapproved for the following reasons:.... ----•----•--•----•..................••------..........--------- -----------•------. .........•..........................................................•--....---------.....--------•------... Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1...........OF........... ..u.Z. .r ............................................. QU-Irrtif irttte of Tomplittttrr THIS/IS TO' CERTY Y, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) L` I; 8 � = i : >� C j Installer �t .a ------ ---- --= �`---------/-- - -------------•---------------•--------------- has been. stal� in, accordance with the provisions of Article XI of The State Sanitary C d � _d c_•ibed-in the application for Disposal Works Construction Permit No----- _'-------7-f------------ dated._.-.�.-........�...................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................... ....................................... Inspector----------------------------------------------------...-----....................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTHY l ..................(l µ .....OF.......... .�•�''d'• ?eq.... . No..---•-------- ` FEE Permission is hereby g ranted_. _.. to Constr et (/ or Repair( ) an ndivid�ua age Disposal System j I� - _ r at No..... - ,_ -- ' , - ----------------------------------- Street as shown on the application for Disposal Works Construction emit N '�.:.....,-° ._. Dated--..-. ........................... :== v 41� t-/ Board of H'ealth'm— DATE.......... . OIL FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS -