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Home My WebLink About0048 SHUBAEL GORHAM ROAD - Health (2) (7 -76, 1-71 THE COMMONWEALTH OF MASSACHUSETTS ri BOARD / F HEALTH �0c OF......1. ... . 1 � -i% `�-... . Appliration for Bii#nsFal Norkii Tonstrnrtinn frrutit Application is hereby made for a Permit to Construc/tr ( ) or a ai ( ) an Individual Sewage Disposal 1� - - 0^4--------------------- ------------- -------- ------ ----------- ........------ -......... .. Lo tion•Address er► t ........*ofuilding ... ................................. .......•••... -- Owner ��/� w ress-. - 4 a •....... � � ............. ...........�..�1..�if .-.. ................. Installer Address Type Size Lot_le'f° +_----Sq. feet U Dwelling—No. of Bedrooms.......Z...............................Expansion Attic ( ) Garbage Grinder `4 Other—Type e of Building ..... No. of persons............................ Showers a YP g ----------------------- P ( ) — Cafeteria ( ) Q' Other fixtures -----•-••-•-•-- -•--•-•----•... - Qr - ------ --------.-•---------•-•-------•-•-------•4'--------•-•-•------------•-•------------------•------------- W Design Flow.......5.7.j;........................gallons per person per day. Total daily flow.....7..X.°..........................gallons. WSeptic Tank—Liquid capacity/.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No........... ........ Wi th................... Total Length............._..... Total leaching area....................sq. ft. Seepage Pit No./.... Diameter..4.X..Y.. Depth below inlet_...`/27 . tal leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank (Percolation Test Results Performed by......—" ti............. .. ...... Date-•- .Test Pit No. 1................minutes per inch Dept of Test Pit.-............... Depth to ground water...........f......... GT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ - .........•-•.............. ................ O Description of Soil----...... - ®.., ...-. .`... ��•• -•••-•• --. . ................................................... �., UW `----------------------------------------•---•-•--•---•••-•-•-- 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 iITU 5 of the State Sanitary Code—The undersign d further agrees not to la the system in operation until a Certificate of ComplianceI n ' s ed by thig ,.....Ll.` ....................... _ ate Application Approved BY 7C-------- ate Application Disapproved for the following reasons:-------•••-----•••• ............... ..... .......................... ....................................... ---••-•••--•--•-••-•-•-•--------•---....-----•------•••••-....----••--•--...•••-••--•--......•-----------••----•-----•--------•-----••-•--•--••-----•-•-•••--••--••••....--------••--•-••-••••-••------. Permit No......................................................... Issued..... Date a^ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t. :5...... OF......I :.. !" ...................................... Appliratilan lnr Dispas al Works Tonotrnr#inn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal y at ,..:. Lo ation Address ... t ►t.S +!' •Yc. w "................................... ........... V _ .!a✓ 2.1J Y W Owner, Address 4 ......................a .••...-- _.... Y¢ 1 ............................... ......•.. ....._..... Installer Address UType of;,,eBuilding Size Lot. .,. '.....Sq. feet .., Dwelling—No. of Bedrooms......ft-7................................Expansion Attic ( ) Garbage Grinder (4-1)x Other—T e of Building ............... No. of ersons...._................_.._... Showers a YP g --------•---- P ( ) — Cafeteria ( ) Other fixtures -•---•-------------------------------•-----••--------.. W Design Flow.......... . .........................gallons per person per day. Total daily flow.... _. _ .__..------------ ..........gallons. WSeptic-Tank—Liquid capacity jO..gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No..................... Width.................... Total Length ... Total leaching area....................sq. ft. Seepage Pit No. A.._... ..... Diameter ._ _..��_-.... Depth below inle .._..... .... tal leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( � • 1.4 Percolation Test Results Performed by..... .......... , •. ...... Date_-�l_7t_f-. *.7�......_.. �-7 Test Pit No. I................minutes per inch Deptlf of Test Pit.................... Depth to ground water........................ (4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to'ground water..._._.................. Chi O Description of Soil........... ... ....�- .-" .... _-... V .................................................... «„ ---•.- ----- W .....-----'•.............. , �Z•---••. -- "- - -.---•- ---.- •-•----••--••-•-- M _....---•--••------•--------•---•------•........-•----...---....w---•----•....._..................... ............................................................... U Nature of Repairs or Alterations—Answer when applicable._....................................................` :. ................................ I - Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE; 5 of the State Sanitary Code— The undersig�d further agrees not to pla the system in operation until a Certificate of Compliance has en ' s ed by the board,of health. ..... 9 ' X' ....................................igne Application Approved B ; iDate PP PP Y-, - �� ........... ' ate Application Disapproved for t e f ollowirg reasons:------•------•---•----=--- . -----------------••------••---------------•-----.......................... .........-•--•----•........................••-----••-•-•----•••-----•----•...-•------••--•-•-•-•-•-•---•-'-----------......•---••---------•••--------•-•--•--•-----•--•----•-••-------------••---•.•••--- Date PermitNo.........................=-•-----•-•--•----•-----••••---- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF LTHg ...............:.. .Li OF....... ... (....................................... Tertiflrttfp lit ToutoliFanrr THIS C IF. at the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by .......... -•-•-•......... ......... In taller ''has been installed in accordance with the provisions of T 5 of The State SanitaryCode as described in the application for Disposal Works Construction Permit No. ;_. ...._._��d ...r......._ da.ted .... _-" . _ - -- . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A,GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE:............................................................................... Inspector--••---••.....-•---•.....•--------•••---•---•-•••-•...... THE COMMONWEALTH OF MASSACHUSETTS �s - - BOARD OF EALTH f' 3: L ...OF...:::....:.�1 '�e�r! ....................................... L FEE..... :..` No.. :.rT1. �t��n�atl k� r� aimrn Fl`lltt� . Permission. s reb e ante ..... -• . -----.�...._ •-- •-----. .................... .............. ......•- to Const c or �ir ( n I dividual. Sew e ispo Sys at No. .---- • n.� Gt'1 Street } as shown'on the application for Disposal Works Construction Permit N I ` ...... ........ ed... ^2._M�...J........... .......----- -----• �. ........ Board of. 6 Health / y DATE--------- ------....----�-•--•--��'--•---....--•-•--•----•--.:....--•---- FORM 1255 HOSES &'WARREN, INC., PUBLISHERS - x- �•�i�..1GLE �L1J�/�Il..� - � �St�7T•CL�C.h. L�4 vz Low I t o 3 = s3co 4, r-'�• d�1-1 A F1�t --EEF-t-r U S A f - = S30,f G L.t ram► f-o�,aL pt-r - usr= t oc>o (=-aL. . -c, ors - 3 45arWAL.L AA2r✓A. . 15o s.�. t .o SO S.PD. TOTA L. 't7 C.Sl6w = 425 -&.P ID 3 - - coTAt- �dt��( Fc.o� = 330 6.FD. � ......,..�,. �3�t � Pr--rZGDLQTIOL.l tZh,rE IQ I-MIu- 02 LF-%. .u4 AA,y�i f 4CNI4t° ) ' t A is t = z e•ng,c TdJ rxP "' g.. n A. �Y i MrN ��* kp ) t3AXTER O Q !�l Tl.' TeST 9 Top F.w ioo.o ,.. Low •• J"Pine t�tv• q7 Q 000 1Nd 94.7 r �v orL. 4'p,PP rw. CO �. "box 9G•9 S�ric-r r o 1 000 qs 8 t,►,v. uw. 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