The URL can be used to link to this page

Home My WebLink About0039 SHUBAEL GORHAM ROAD - Health I LOkAT-10N SEWAGE PERMIT NO VILLAGE INSTA LLER'S NAME & ADDRESS BUILDER OR OWNER X)4NN E . s��•1�.� �. DATE PERMIT ISSUED DATE COMPLIANCCI ISSUED_ -_ 7 r �� , %��„_ � . \� — � `_�' I�► �F _ �� 1 � �/n �� alf f1 K)P No........... .. Fmc......y................ THE COMMONWEALTH OF 3Go0w, MASSACHUSETTS BOA!R® F �HE L H - -------- - --- ...................OF..... _. . . . ..........------------ ...... ....................... h&lA liration for Dig .4 al lVarks T antrnrtion ramit Application is hereby made for a Permit to Construct (( - )�-or Repair ( ) an Individual Sewage Disposal Q System at: --------�-�• t��-�!JS..----•.......................... ..�l- � 3� ...---�-�ttL� �,tr'�i?��.G�C�c-Rr'1 -. Location ..... ....................................... W vGner � A Address Installer ........._. Address v� t � !/�° S feet Type of Building Size Lot__ _. _.f._.._____ ._ q. Dwelling—No. of Bedrooms.............�".''�-_.........................Expansion Attic ( ) Garbage Grinder (/1,/9 a'_l Other—T e of Building ............... No. of ersons...._................--.---. Showers YP g -------------------------•-•--------------.P Cafeteria ( ) d Other fixtures - -----------•----•-.----- W Design Flow............. ._.3-Q_............gallons per person per day. Total daily flow......... ... .............gallons. WSeptic Tank—Liquid capacity. QA-b.gallons Length................ Width................ Diameter...--.--........ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No... � Diameter...............----- Depth below jn1et- ... --_... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing to �rS�-7r Percolation Test Results Performed by .. ..___ ��...:5.... .��...:........... alA Date.= Test Pit No. 1................minutes per inch Depth of Tes Pit.................... Depth to ground water........---............. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ V............ Description of Soil........'....` — -4........ W UNature 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 SIT .;;. p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by thejoarcVof health. / Q,p /p o Signed.. -- --- '..... -- '`' . l6 .. . D to Application Approved By...=----� -- . .-- •-•-- . Cam-Z` 7............ Date Application Disapproved for the following reasons: ----------------------------•--------------- ..................................... ---------••-----------••---•---------------•----•-••-----------•----....---------•-----------...-•----------•--------------------••------•----------------•-•----•---•---------•-----.................. Date Permit No......_.................................................. Issued---. ?Y IIate " • m I .-Y. No: ..... � - Fss............ ............. THE COMMONWEALTH OF MASSACHUSETTS .,�..-. BOARD �HEAL ,tom Applirtttion for Disposal Works Tonotrnrtion .unit Application is hereby made for a Permit to Construct' ( ) -,or Repair ( ) an Individual Sewage Disposal System at: P e 44' 4447-' ........................ ...-----••. ................................ ... - -......__ Locatio ddress g.N..ww or o. er Address a ....................: .... .<� .... Installer I � Address d Type of Building Size ...Sq. feet Dwelling—No. of Bedrooms............Q'�..........................Expansion Attic ( ) Garbage Grinder ,( Other—Type e of Building ................. .._._ No. of ersons.....................__..... Showers yp g ------ p ( ) — Cafeteria ( ) Otherfixtures -•-•-••--•--... --••--••-•••-••----- •-•....... . •-•••.-----Q , ------------------------ Design W Flow.:.............. - ..Q................gallons per person per day. Total daily flow...........................N.--............gallons. Septic Tank—Liquid'ca.pacity(A .gallons Length................ Width................ Diameter................ Depth................ . x Disposal Trench'No. .................... Width.................... Total Length....................Total leaching area....................sq. ft. Seepage Pit No. ___. Diameter.................... Depth below nlet ___.. -__ --- Total leachi g area..................sq. ft. Z Other Distribution box ( ) Dosing to *iof' '* �"' . '-' Percolation Test'Results Performed by..__.�_ ... -._. a A... Date... ''. '^7 ".............. Test Pit No. 1................mmutes per inch Dept Tesf Pit.................... Depth to ground water................. fr Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... O ,� Description of Soil ... -�- ) � i '� ----- -•-- ---� :--- ... V ..................................... W UNature of Repairs or Alterations—Answer when applicable.............................................................................. ---------------------•----••---------•----------------••---•--•---...._... ----•--• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Dispo§al-System in accordance, with the provisions of TITLE; 5 of the State Sanitary Code— The undersigned further agrees notNto A, ce the system in operation until a Certificate of Compliance has been issued by4he oard of health. Signed.. . ..... -- ........................ Dite Application Approved By..—-.-- •_ ` �f i �'/�M---------------- ..... ............ Date F: Application Disapproved for the following 'reasons:.......................................................------•-- - ....................••-------•-------...-----------....--•-------•-......------------•----------....-----:_......•..---------------------------------------------------------------•---•-•...-----•-•--•- .C': Date PermitNo......................................................... Issued....................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH ....... .......OF.... ! i ........................................... Tn#ifirate oaf (��amplianrr TH I 'TO That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) .. by..~` .---- ---- ---.. y,, ---.- r p l Installer -• --- has been installed in accordance with t provisions of ZT, r of The State a.nitary ode as described in the application for Disposal Works Construction Permit N ............... da ...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A ,A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. � DATE.............. .. .'� �' Inspector ... THE COMMONWEALTH OF MASSACHUSETTS '' BOARD HEALTH f ..... ....O F. .. 4.-X p.. ............................ FEE....................... Disposal _ks n ' n prrmit Permissioq is hereby --ranted.......... •-- �......... -a.. to Con tru ( or Repaii �} an dlvi ual w.. isposal Sy at No.- I ... Street as shown on the application for Disposal Works Construction Permit No. _._ Dated..-.Z.._7j......?S ...... . ..------•---- • --• --------------••----•-•-................_ _ of Health DATE................. ------------•�-•----- --. ..-•------•..-------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - .. r d:. � 7� • 4. �€ -f c_ TA~i►� _ =�o,. lam._ nio = 49 ra 6.1 .L7. { :1 POSAL P1T - t .)Sly IOtDCC, GAL.. - SMe"/At-L AM GA - lSc> t SF 2.S 7� G.Rt7. �Jcla r S� CE�o f#5=. x 1 .C> _ So C>.Rv. ,��r TOTAL z 425 ToTA L -CI0&t L�-f l=LAD W = 33D b.1?u. / � r►t.+ -N K�L,��` �►/�T i t 14 ,r TEST �J�X�7 Tor ruo =too.c, ~%"A ,%. ��iin IFJK` { 10 LcAri Q F;v$ i000 1w. -Box - S�eprK 2 +►ry t000 go Iwv. 1w. LsAr-A 'A P�T A. V./I rw WASN1lrU ry Mom, 'STOWS- CE(ZTtF1aC7 PLOT" PiZ.p�"1 L� LoCATtd" �2 N SGAL (t� I +ATIF=- GG.IZTIt=-{ Ts4AT TIdG TouUvaTtof.1 5"0%41 1 Pt-At.1 u> lz 1. 06-j cCAAPL.-eG WIT- -A L c9- 13� Awv SETL-,,AC-V- VC-QUIQP-ME'- -tT'; of TNT -TGWU of -fSAV-41TA4U& 14TE.r✓t Lc C3 +If t ! tzcGls l-�lzl�� t..a.►.�a 5uevi+:�of• Ti-1t5 C7L.Ah-1 t5 ►-tOT LA�yEC� tag•-3 AW O�'1'E2V1l.i_L': o MASS, I if.fst's;tJMCWT ��tJC:./ram Tiac-- APPL-1 CAf-JT t CeMttiJ� LOT l_t�.t, ( C}`!,r 4,OAS ' �_�