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Home My WebLink About0108 RICHARDSON ROAD - Health (2) ago � �33 C � r( .j �+a�s�r��'x{�ss,�sara�� r�� V38 0i 4^ V��} 'ON I TTT v Z A T T'TT A9TVT') rTl 6'7 FRic C.2)................) .. ....... ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ ....................... ........................... Appliration for Dispasal Works Towitrurtion Prrmit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System ..........2P ;;Z� .. - ----- ...Z_ ................ ...... .. ..."' cation-..A ress or Lot No ........ ....... Owner Address ......... .. ......... ......... .................................................................................... staller Address Type of Building Size Lo :...........................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder ( Other—Type of Building ............................ No. of persons..._............._.......... Showers Cafeteria ( Otherfixtures ........................................................... .....................0................................................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. P4 Septic Tank—Liquid capacity ........gallons Length................ Width_.__............ Diameter.........__..... Depth.............._. 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. 1................minutes per inch Depth of Test Pit_.._................ Depth to ground water.._....___.......___.__. Test Pit No. 2................minutes per inch Depth of Test Pit_____._............. Depth to ground water......_._..___..__...__. P4 ------------40............................0................................................................................................................. 0 Description of Soil........................................................................................................................................................................ W ....................................................................................................................................................................................................... U ..................................................................................................................................... Nai�q of Re air U _vr Alterati,c)ds—,Answer when applicab!e-----------7--_ 7. .. ..... i7o...I.Q-4,r.............. ....... .. ...... ........................ . .... .. . .. 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) bged'�sued b the board of h alt ed. .. ......... ............. . ................. X/ Date Application Approved By........... - ; Date Application Disapproved for the following reasons:................................................................................................................ ....................................................................................................................................................0.............................................. Date PermitNo......................................................... Issued---.--- ........ a o.c... ........ FuE.. ..��.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for Disposal Works Toustnutiott Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (Individual Sewage Disposal System t� - ....... +"C ".v € !�7 »? yr •"`.. �' ' --•-••. ......---•............................... ,�"�. +'Location-Ac�lress -•.••._• .. -•--•-••._•--••.•••._--or. Lot No. ...................... ----•--•-•-•......-•-•----..............--- r t Owner ' Address C d ... staller Address d Type of Building Size Lot.............................Sq. feet V Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers — Cafeteria a YP g P ( ) ( ) p-' Other fixtures .........--•-•-.....-----•......- . W Design Flow............................................gallons per person per day. Total daily flow............................................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 Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................... a •------•---------•---------------•--•-----•--------------------••••----------------------.....••-••----------------------------- - -------- •-••••------- ODescription of Soil........................................................................................................................................................................ U -••----------------------------•---------------------------•-•--•----------------••-----••••••----•-•--••----•------•---•--••-••----•••----•---------••---•------••-------•-------..._...--•-•---•••---- W --------------------------------------------------------------------------------- ------------------------------ ----- UNa a of Repairs,-or Alterati s;Answer when applicable "" k °- ------ ----- Agreement: I/ 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 bbeeen ilsued by the boarda of health,� f-Signed. `---- C, r_ �. � ' .. , ,y Date Application Approved BY-----.... '` r a.._ t�`� .. ..i ------- ----- -•- '? "'� Date Application Disapproved for the following reasons:................................................................................................................ .......................•-•-•-----•----......----------------------------------------•-•------------------•------•------------•-••------•------•------•---------------------------•--------------------. -•Date Permit No..................................... •L Issued . - , ......•... D e THE COMMONWEALTH OF MASSACHUSETTS BOARD jO HEALTH 4.� ........OF.... ...?k, -L .. &xr?" - .........._. n (�rrtifiratr of Toutpliam T IYIS T0'` ER61�,/ hax th. Individual Se age Disposal System constructed ( ) or Repaired ( ) Italler � �ns at ......... _4077�tn/lu_ W 2".44. has been installed in accordance with the provisions of Ar, ,cle XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._' . . .�................ dated--- ................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM! WILL�FCT-ON SATISFACTORY.DATE t��l ................................. Inspector......................................•....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH--------------------------------•-•--"" .......OF FEE.. ..- Y--•.»— Permission is hereby granted .r ' , ........ . + wo Construct orRepair ( I D>sSstemt - zy at No... ,... y.. .......... .... _ - Street as shown on the application for Disposal Works Construction Per 4iit N d"'.. r_T ated... •!�... + . � 1wBd�of4HXahh BATE-- t FORM 1255 HOBBS & WARREN. INC., PUBLISHERS