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Home My WebLink About0140 PATRIOT WAY - Health (2) 96 PQ4r(*6F as , (ho, 41 No. to � �,� �.. � Fs�. .. ..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH LJ - ow^c ..........OF...........�p.C'./� A..17.1 ....................... Appliration -fur Ui, voiial Works Tnnitrnrtiun Prrniit Application is hereby made for a Permit to Construct (V<'or Repair ( ) an Individual Sewage Disposal System at: ------l a..x �.,_nT- Jam. ------..o4AP-•L .. ......................................................... 1 1.....ocat��fl ei�M�ZS / lCwiei........_ �r .QA .... 2V---srY_t//4L.e............... � pp ner C a --..-� ..__T.il1l.�./............................ _..... ..._'.......................... .A!/L�lr.S/FaA,1s .................................... Installer Address i U Type gI�'o. of Bedrooms..______._14l��P.._Zeq1r#V.'>Ex anston Attic 'ay "_.Sq. feet e of Buildin � Size Lot.. � g YP g __.._---•--.....-•---....... persons ( ) (Garbage Grinder ( ) aOther—Type e of Building No. of ersons____________________________ Showers ) — Cafeteria ( ) dOther fixtures ---------------------------•--•---------------•----•----•--------------------------------------------•------ W Design Flow...........................................gallons per person per day. Total daily flow_______'7-3.3_Q-_____-_-_-_-.-_-_.gallons. WSeptic Tank—Liquid capacity_odVOgallons Length---------------- Width................ Diameter-----........... Depth...______._.... x Disposal Trench—No..................... Width-------------------- Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No.__�_PP ------- Diameter____________________ Depth below inlet.................... Total leaching area------------------sq. ft. z Other Distribution box ( Dosing tank ( ) Percolation Test Results Performed bY--------------------------------------------------------------------------- Date---------------------------------------- Test Pit No. I................minutes per inch Depth of "Pest Pit.................... Depth to ground water........-_--_-.-_.__.... �14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water__.__._.___.___-___-_--- W �A Description of Soil----- ---•-0 .-A-O-AEI ----------------•------•---•--•--- x V -----------•---------------•----------....._...._.•••------•------••---•--•-----...--------••••------•----•-•-•••••----•••--•-----••---........•-•-••---•--------------......._........------------ --- 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 \I of the State Sanitary Code—The undersigned further a rees not to placd the system in operation until a Certificate of Compliance has been issu 5 b,y the board f h alth. Signed. � Date ApplicationApproved BY -• . •�--••-----•••---•-•---------•-•--•---•-•-•--•--•.._....--•-•-----•----••--•---- ----------- 4-'_ 7 7 Date Application Disapproved for the following reasons--------------•-•--•-----••-----------•-•------.-.-._.....----------•-••-----------------.-----------------_-- ---. ..... --•-----•••-•••-------------•••--••-••---•----•-•- Date PermitNo......70t..l•..................................... Issued........................................................ Date ; No......................... Fnu.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 1 /I c.. JN ...--.OF............. ...._! _• -.1.. _...................... Appliratinn -far Uhipofitt1 Workii Ton,itrnrtinn Vrrmft Application is hereby*made for a Permit to Construct ( V)or Repair ( ) an Individual Sewage Disposal System at: a'J / �r- / i --...=---7--------------------------------------- ............- ----_- 1�........................................................ -P Address f _ or Lot Niq.� A , ��r. f' v r ...5.: !// �;v+ C /its c_._. L � % i � /r � i - l= ==' ................... '- �� i wner ddr;.s —.� -. Installer Address Q Type of Building Size Lot----- Uv-_-Sq. feet U Dwelling—No. of Bedrooms.-.__ _..-- 'C"✓=....4^<>A!.Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons-_--_-------_-__-_-__--.-_ Showers ( ) — Cafeteria ( ) Q' Other fixtures ---------- --------------------------------------- ---......................................................._ W Design Flow............................................gallons per person per day. Total daily flow........ C>----------------------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-----_--------.------------------.-..-.. Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water-------------------_-- 1:14 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ ---------------------------------------------------------------------------------------------•------------------------------------------- O Description of Soil-------'-f!' c._.._...._ "== =� ......`-..... --------------------------------------------------------------------------------- x V ---------•-----•--------------------- .............................................................................................................................................................. 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 has been is�s1uedlby the board o� health. Signed.-A/....,,,l.,.l'.:.:/z-a c.` �- .�� ') '. ��= ........7f 7-- Date Application Approved By. 1 ` / ' '- // . ,7 Date Application Disapproved for the following reasons:................................................................................................................ ........................ ------------------------------------•••-------------------•--•.....•--.---------•.•-_.._..-----.........._...---.-•---•--•---.....•-•------------------------.-----••......---- Date Permit No................. -------------------- Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................................O F.......'............................................................................ �prtifirtr of f�nmfianre THIS IS TO CERTIFY,.That the Individual Sewage Disposal System constructed or Repaired ( ) / cc-------------f Ll'C1 Installer G `i /l, . / r, r- has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No........ ...j:_4.................... dated......._f_____�/-......7._%............... THE ISSUANCE OF THIS CERTIFICATE SHALLAOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM IW L FUNCTION SATISFACTORY. DATE ------------•.//------/- --2�---------- Inspector .�1,d,.. - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................................... OF.......... ..----'---.........---................................................ , No............. ..-------- FEE_................. BinVaiial lVarkii Tomitrurtinn Vrrmit Permission is hereby granted----------- r_ !�_______________"_---:---` -- to Construct or Repair ( ) an Individual Sewage Disposal System at No.•----•......-- �-----------/= ................. -` ' ----------------------------------------------------------------------------- Street as shown on the application for Disposal Works Construction Permit No..................... Dated....f%-----. _ J r f !/ - ..........- i Board o ofHealth = .................................... f DATE............................................................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - 4i1�tzDoM QO C�AtZ}3AG� C�RI1J1� 1Z_ /fir to x 3 �3b G•PV `T� KEPT 1 G TA+,t tG = 3�0 ISG �fo = 4-9 USA- lOOU 6Q.t_, �15PUSAL PiT - uSE lovo Gam-. t�lc/at I Ae sue. . • C .o So C->.Rb. TOTAL �ESIGtJ = t�'Lrj G.f?D. 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