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Home My WebLink About0020 OUTPOST LANE - Health (2) �o �1c�k-� as+- �.� � � . P � �, . a s3 a31� S4 a 2:� 'ON z 91e �'' No.......7;v.—.: Z ............... ` THE COMMONWEALTH OF MASSACHUSETTS /r BOARD QF HEALTH Ap 44 Amitirativit for Difivinial Worku Tiattstrurtion Vantit Application is hereby made for a Permit to Construct (/<or Repair ( ) an Individual Sewage Disposal Loca n�Add� or t No, *` Owner Address •......... ... .......�, = . ............... --•--------.....---.......----......................--•-••---...-••-•--•---------.....-.� Instal Address Type of Build' g Size Lot............................Sq. feet U Dwelling o. of Bedroom-----..-.---•. -Expansion Attic ( ) Garbage Grinder ( ) yp b ..__..._. No. of persons____________________________ Showers ( ) — Cafeteria ( ) Other—T e of Building .................... a Other fixtures -___-___•_........... W Design W Flow:..............\'.Pt_...� ...____ ons per person per day. Total daily flow........ ..`....gallons. Septic Tank 4-Liquid ca acit./ llons ' Length..........:..... Width__.__.__.__..___ Diameter._.._._......... Depth x Disposal Trench— o. ................... Wid ._....-_-- ------ T�l L 4�I. - otal leaching area....................sq. ft. Seepage Pit No......_._....... Diameter. Depth be Oinlel` .................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank Percolation Test Results Performed by------•------••-•----••-•-•-----------•••---....•----........•••-••.•.... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per ipch Depth of Test Pit.................... Depth to ground water........................ t ..........................---------- Description of So' L� a—� - � .. . . --- - x ... -�-�.� .....-- . •. .............................. w ------------------------------------------------------------------------------------------------------------------- ---------------------------------.................................................. U Nature of Repairs or Alterations—Answer when applicable................................................................................................ •--------------------------------------------------------------------------------------••••........•-••-•••------••------•------•••--•---••••••---•-•----•---•-•---------•-•--•-•-••-••---.....•••••••-- Agreeinent: The undersigned agrees to install the aforedescribed 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 ha issued by he U r f health. y� fined. •. - -........................7� Da Application Approved-By......... / � •-L%'°� -.. Date ` Application Disapproved for the following reasons:----•----------------------------•--• -----------------------••-•----------------• ----------- .........•---••••••-•......................••------•---•-••••----••------•----...•-••-•-•------•------------.......•--••-•••••-•-----••••---••..7-1 ... ..--------------------•--- ate 1�� , Permit No---••.....................................•----......... Issued.--• ---- -ate •---- ................ No ..f..O.—t Firm.-4.............. THE COMMONWEALTH OF MASSACHUSETTS u4 - BOAR F 1-I LT1--I 4 . pptirFaii u for Uhiv s ai larks (�aaaa raxrii n. [rranii Application is hereby made for a Permit to Construct ( or Repair an Individual Sewage DisposalAV... ` Sy oe' Loc on- dd/€' or t No. Owner Address W Instal Address . .� Type of Buildi g Size Lot............................Sq. feet aDwelling, o: of Bedroom-- ...... :Expansion Attic ( ) Garbage Grinder ( ) Q, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures W Design Flo*w_______________'' _:__ ___ ns per person per day. Total daily flow__.____ '`____gallons. t4 Septic Tank'T Liquid capacity " lions Length _____________ Width._................ Diameter________________ Depth................ W Disposal Trench o _______________ W>d fir_ 1 Total L ? otal.leaching area....................sq. ft. Seepage Pit No _ Diameter �r'_. Depth be ,��injell....... ......:.. otal leaching area..................sq. ft. Z Other Distribution box ( '") Dosing tank ( ) -� , - .Z x /fir'Yr. Percolation Test-Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (� Test Pit No. 2................minutes per ipc1 , Depth of Test Pit__ ________________ Depth to g nd water.................,....... - : •_.... Wit►` r O Description of So . '� j -- U ... � ............................ W -------------------------- --•-- - -----------------•------------------ --•----- -------- -------- �-------------------------------- -------- ------..._..---------------------- .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 Article XI of the State Sanitary Code— The undersigned,further agrees not to,place the system in operation until a Certificate of Compliance ha issued by he b •r health. gned--- �y? A licatwn..Approved By----••- ,_.. "/Date !, APp 'cation;Disapproved for the following reasons:.........................................--------- --------•------- ---------............................... ......... -----•---------------•---••-•----.....-----------------------._.........---•--------------------------_---- ---------------------------•----------------------------------•----_..... i Date Permit No......................................................... Issued._.... _ :. ... Date 8 THE COMMONWEALTH OF MASSACHUSETTS BOARD 95 HEALTH > a 1 F.!.... ••.................... . 'rdif irFair of Tom' iatta THIS IS TO.CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) b ......--• ---- nsta at 6., , Gic.�--- /!off has been installed in accordance Kit the provisions of Article X1 of The State Sanitary Co as described in the application for Disposal Works Construction Permit No......... ______------------_----- dated,%0'-.: ._ .-. ' ._______.__. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS AARA EE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.......................................................................................... THE COMMONWEALTH OF MASSACHUSETTS . BOARD QF HEALT No....... X"' FEE./. .......... Dispofi l Works (1111 itrurtion Prrmit Permission is reby granted -----------•--._...----••------------•----•-----------=------------'-----------..._............._... _:......... to Constr t or Rep - ,' Indivi al a Di sal. atNOI r--- ............................... •--•-••-•••-. Street. -`" Dated_ _`�.�� 7.as shown on the application for Disposal Works Construction it .cri.: . �. -. 440 ,.... Board of Health -DATE ....................................... = 'G� , -FORM 1255 HOBBS WARREN, INC.,_.PUBLISHERS -„` rw , _ ..■■■■ _ .■ he ■ .. ■ .■ ■..■■■tiiiiil.'31■■ p1Ill ONO MEN 0 NINE 0 41 mom mommomm . .!i �� ■■ . ■�... 11 �..■�ii� CNN. ONON MEN■■■ ■■■■■■■ .■■..■■ •■No ■ NONE .■■■■■�.■■■E.NN. ■..f...E■■...■. ■. ....■■■■■■ ■■■..■■ °.■■..�■. .■ NONE■■■.■■■■■■■. ■ �!■■..Ia. .. 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