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Home My WebLink About0301 PINE STREET (HY - Health (2) aa�- eye - oo � No....... �..--- F$s.... .. THE COMMONWEALTH OF MASSACHUSETTS '10 BOAR® OF HEALTH �11/tt-s = - ------- OF................... ..../T�I,.JLG..................... Allp irati.ltt for Rapasal Works Tatuitrur#ion Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ............ ........5 .:............... �i� viL r .... .... ... ��........... ..... ............_.._........................_.. je..........t::.. ....Lo�cationsss2. �......... -__l.......... oLot No ........................................ Owner o Address ........ 'lG.. .T. / ...... L.G.r�1tS.............. ..........••••.......... ST5!ry l«. '................---......-----.....--- Installer Address UType of Building Size Lot............................Sq. feet P_wxLling—No. of Bedrooms........................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building .... No. of persons............................ Showers — Cafeteria Otherfixtures ----------•-... •-•----•------•-•-------••--••--•--•----------------•--....._............-••--------•••---•-----------...--•---•-------•--•---••---- W Design Flow.......... .............................gallons per person per day-., Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width---------------- Diameter................ Depth................ Disposal Trench—No..._.. . �... i h-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..f�---- ... �ame er ______________ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed bv.......................................................................... Date........................................ a Test Pit No. 1................minutes 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........................ -- - ------------------ ---�---------•-•••-•-••-•••---------------------------•--------•--- ......... ------- ............. -------- O Description of Soil...-__ :...... . ...�1Ut.�.................................................................................................... U •-•••----•••---••----•-------•-•----••-•--•••-•-•-•---••-•----------------•-••-----------------••----------------------•-----•----------•--•----•---•-------••--•--•------------•---•---• .............. -------------------------------------'------------•-----•-.............•-•--------•-•------••---•-•..........-----•------------••----•--------------••-. U Nature of Repairs or Alterati ns—Answer hen applicable....._.��Q. --C 1 G._�..._._l i Q -- -- -- ----------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 bee -sued by the boar of'.health. Signed c G � ! a; � �3 Date Application Approved By...---- f / - .......................................................... Date Application Disapproved for following re ons----- ------------------------------------------------------------------------•------------------------••---•••-- .................•------------------------------------.........-----------....------.....-----------......------------....--------------------------------------------•-----------------•---•-•••--•--•-- Date Permit No......... ..................................... Issued------... ::._ Date No...---- ........... F$E............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH -i ......._ OF_... �.�s...�` ,�... .................................. Applirativit for 43hipaiial 18orkli Toustrurtion Vantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ......:..... a.:...., f .c..:................................................ .. .1.2.1 ; err « Location ,dress or Lot No. ........................................................ f ./ :. .ft..............i... .0 ft` s. ....... �.:....... �-,Es a_t.......•................................ Owner Address (sa «� ...t4 l. :s. .. ,ri- ' ' /tf`.�3............ �. :.'.., ✓ G .......... Installer Address UType of Building f Size Lot............................Sq. feet Dmoli No. of Bedrooms._,....................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type. of Building .......::................... No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures -------•-----------•--------•-------•-•----•------------•----•---•-•••---•••----•-•.....•••.....--••-•'-•--•••'••••..................•--......-•-•_.. "'; .. W Design Flow.....,....:;__r�.........................gallons per person per day. Total daily flow............................................gallons. WSeptic "Tank—Liquid capacity..._...•.._gallons Length................ Width................ Diameter................ Depth........;................. x Disposal Trench—No. ......:............. vVie h_..._..._.._........ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..: '' %_ ameier`:'................. 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 Test Pit.................... Depth to ground water__--_______________.__.. f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water----,______-_-_--_-____. O Description of Soil ...-� ' �`--' ..__ '< G ,-. ------------------------------------------------------------•-----------------------------------------•----------- v .•••••-••••••-•-••...........................................• ....................................-..................................................................................................... VW ---- ------------'-- •-•' ......- ---- ------------------------------ - Nature of Repairs or Alterations Answehen applicable Xt Zl........... _-/!i✓i ."_._ ._.'_ Y.Ir l es.L_d" _'_'..._ -�.i.d..� iS` 4�✓ tj -... .. __---- _...__-•,,_ _._,. 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 bee4'- sued by the board of ealth. Signed_ . ,.`,,R.P '.. . ...........' t. "y Date 1 Application Approved By .._.._. ..:_ � f Application Disapproved for the following reasons:..........................::. i Date ---•••••••••••••-•••••••••-•••......................................•-•-----•-•••••••••••...................---•-----•••-••--•-•••••---••••-•'-••••-••••----.......................................... / Date Permit No..........;<....:...................::.... Issued------(_ .... ?a................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7l` ,I ......... ..OF........ 'x39. ` AT uEjer#if irate Lif Tantphattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed)( ) or Repaired by ........ `K' . . . r ..................•--•-------------...,...---••-------------------•-•--•------•----••----.......::. - ',ham Instatici� - 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 \o.._.___ . __, _____________ ________ dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT EE CONSTRUED AS A GUARANTEE THAT'THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.........................= -•--------................... -------••.••••-. Inspector--••--• --------.::..............-•------------•--.......................•..---•- Al Del �ry� " �� THE COMMONWEALTH OF MASSACHUSETTS , r/�r !'- G�`r-✓1 r G i BOARD OF HEALTH .� c v r ................... No.........':V� � ............. FE :'. Q.....---- Bispmrjal Works Tomitrurthin runfit Permission'is hereby granted.__._..'�.,k_._... _. .. . _.3i .:... ... .......... to Construct (A) or Repair ( ) Se«a e Disposal System P s at No:........ ,�. .....•--r� _ �. .... ::. . µ. me._. p° ..................:. --- ...... ,:.., ,. Street as showri on the application for Disposal Works Construct.ioti Permit No... ` ........ Dated... Boas dcalth DATE ! - :..:...... . ....:... FORM 1255 HORBS & WARREN, INC.. PUBLISHERS