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Home My WebLink About0122 POINT OF PINES AVENUE - Health (2) ° . r e rF P o c I e r o ° , o.. a , o r C3•-:a- ' a 0 0 ° No....... -- FER............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH }, Appliration -for Bhipolitt1 Works Tonotrnrtion Vrrnt t ' tcation is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewag isposal S Systep atr ---------- ------- /� Location•Address ......... ----•-• or Lot No. C Owner h ess •_.._�G---- ------ `C'.ee ------•-••----------•------=------- ------------ ` �• �� ` -•----•--•---•------••----------•-----•--••-•-- {" Installer Address UType of Building Size Lot__--------------------------Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building .........::...`..__________.. No. of persons._______._._..._........... Showers ( ) — Cafeteria ( ) P Other fixtures ------------------------------------------------------ -- W Design Flow.............................................gallons per person per day. Total daily flow--------------------------------------------gallons., WSeptic Tank—Liquid capacity-__________gallons Length................ Widt................. 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 ( ) aPercolation Test Results Performed by------- --------------------•---•---..................................... Date-----•----•-•-----•-----------------.-.. W Test Pit No. 1................minutes per inch Depth of "Pest Pit-------------------- Depth to ground waV r__--_-___-__-._.___-___. f� Test Pit No. 2________________minutes.per inch Depth of Test Pit.................... Depth to ground water-_--------------------- P4 -•--- -------------------------------------------••-•--------•---------•-•-•------------ ------------- O Description of $oil ��z-►_�j..._. °�-: ,��' '�z-tl�i `= -- - ... U ._____________---------___.___________--_____________._________..._.__.. ................................................ W x atiorts.;� Answ w _...--•--------•-------------------- -• -••-•-�----------------- I U N ure of Pe at s or Alm — h ap lica.ble. �' 'rF=`�'`�" ci ------ ------------ � _.. .._ L � �---•-------------•__--------------------------•-•-•-•----------------------------••---------------------- Agreeemen The undersigned agrees to.install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has W11 issue y the board of health. Signe G!: - --�'� -••-- •-- � { ---7 -- Date Application Approved By______________::______ •-----•-------•-------•--------------•--------- Date Application Disapproved for the following reasons:--•-`' ---______•_---••-----------•--•----------------------------=------=.................................. --.___...-•--•--•--•--..._••-•--.----------•---------••--------------------•-•--•-•..-.----•-••------•-----•----•----------__....__..__..-.-•--•-----------•-••--•-----------...-------.._.----------•--- Date PermitNo......................................................... Issued.------ -- 7_�_..---•------• Date -" - - ---- ------------ ----- --I r No. "....._.... --� � Flc$............................ _ THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALT ,� ........................... �" .� Itr�a ilatt -for Uiiipooal Workii TI wstrurtion V.erutit Ajp, lication is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal syst at Loc ion Address or Lot No. i� - Ownerress .................................. ---------••----•-•-•------•----•---•---- ...............'��_.._. f.�r.............................................. nstaller Address U Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type T e of Building a, YP g --------•---•----•----- ---- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) - P-1 Other fixtures ----- .......................-_--_----------------............................ --------------------------------------------------------•--_------ W Design Flow..........................................._gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width-y.............. 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 ( ) aPercolation Test Results Performed by Date.. Test Pit No. L__-------------minutes per inch Depth of Test Pit-------------------- Depth to ground water"------._-_-_.-_-..-... �14 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water_-.-_.-_______-___-_.... Sotl ' �'------------------------- --------------- ------- - - -------------------------------------- O Description of U141.0--------------------- ------------------------------------------------------------------------------------------------------ W VNature of Rep•t s or A ations—Answ who ap Itcable ''" + " !' . ......... f-------�1--44 -. .. �'.. -•-- -------- -------- -------• •-•- Agreemen 1, ' 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 helh issue y the board of health. Sig - � 7 .-•---------------•---- 'Date Application Approved BY----- -----------------------------------------------------------=---------- -----------------•-- Date Application Disapproved for the following reasons:.............................................................••----------_--------•----------------------------- -----------•--••-•---------------------------------------•------------- .._:.-•------•-------••---------------•--...._..--•-•-------•-----..._......----•------•----•----.....--------------.....-•---•. Date PermitNo...............................................-•-_..... Issued.........-----•-----------------------------•---.:------ Date THE COMMONWEALTH OF MASSACHUSETTS t� ' BOARD OF HEALTH C . err#ilirateof fuInmpliaurr IS I TO CERTIFY, That the Individual Sewage Disposal System constructed ( } or Repairedy ry ;; ------------------------------- - --------------•- - b +�OM r Installer has been installed in accordance with the provisions of cle XI of The State Sanitary Cosieasdesutbed`in the application for Disposal Works Construction Permit No.__:_ 0-7....................... dated.........._ _f_` _ ►............... l THE ISSUANCE OF THIS CERTIFECATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE. SYSTEM WILL FUNCTION SATISFACTORY. :. DATE............................................... ...... Ins ector..._... ---_----•----- J. THE COMMONWEALTH OF MASSACHUSETTS BOARZ F HE-ACTH ...... .. OF... . . :.:.:... ��. .--.::. .................. s No.°`0. x FEE... •--""- ...... :. Permtssion is hereby granted_....._.. _ ' to Construe ( �).or-Re1! parorDisT Individual Sew e Di oral tem ' at No. .. `r'�tJ"��' = ' + .=- -t�?`-`--_------t----------------------------- -------------------- as shown on"the applicationosal Works Construction P t No. _= _____ Dated------- _ '7! _-_•_.-: ! " B rd of Health ' DATE. `"� ------- -------------------•------------- 7,7 FORM 1255- HOBBS & WARREN. INC.. PUBLISHERS - w