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Home My WebLink About0436 SOUTH MAIN STREET - Health (2) '3a-7 1 7 i i I' I �I �. �. i ��g u � � � / No..----- l j..... Fi$........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH /. . ..------.OF..... GTi ., p �dT7 -loo �D A.pplira#inaa -fair Biipwial 10orkii Tlaaw urtivn Vrrulil Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System --�° -'ram--- ---=� �' --- L atioal-Address��`/�f .. Lot No. Gv -- ------------------------ �st;aller ............................................Address Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) H aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures ----------------------------- ------------------------------------------------------------------------------------------------------------- W Design Flow--------------------------------------------gallons per person per day. Total daily flow--------------------------------------------gallons. 9 Septic Tank—Liquid capacity------------gallons Length................ Width................ Diameter---------------- Deptli--._---_.._.. xDisposal 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--------------------------------------- a Test Pit No. I................minutes per inch Depth of "lest Pit_.-___---.._--____-- Depth to ground water.--.-.------..-.--.-. - f� Test Pit No. 2----------------minutes per inch Depth of Test Pit................:... Depth to ground water------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------......................................................... 0 Description of Soil--------------------------------------------------------------------------------------------------------------------------------- -------------------------------------- x V ----------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------- W UNature of Repairs or ratio — nswer hen applica e.-.:_-_____________---_ 4 Agreement. The undersigned agrees to install the aforedescribed Individual wage 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 ee issued y the board of e"-alth. y Sin 6 .:1 ................. Date ApplicationApproved By.................................................................-------------------------------- ------------------------ --------------- Date Application Disapproved for the following reasons------------------------------------------------------------------------------=---------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Date PermitNo------------------------------------------------------- Issued.------Y---a'-- 7 j....................... Date 'No.........L;l..... a FED.. .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH ........ .......OF.... ...... ........................................................ Appliration -for Dispotial Works Totuitrurtion Vrrmit ' Application is hereby made for a Permit to Construct or Repair ) an Individual Sewage Disposal System AW101 11,3 .......................... ................... ................................................................................................ --------------—---- ---------------- Address ----------------Vatigh-Address or Lot No. --------------------------------------*---------------------------------- ni .....S4".P!......... . -----------------7--------------- ...................o......................................... 6w stalle r Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms______________________________ _____________Expansion Attic Garbage -Grinder Other—Type of Building -------------------------- No. of persons__'�'.................. Showers Cafeteria Other fixtures .........i -- ------------------------------------------------------------------------------------- -------------------------------------------------- Design Flow.......................... gallons per person per day. Total daily flow........................•...................gallons. Septic Tank—Liquid capacity--1,---__--gall', s Length_�_____,------- Width..._._....__.. Diameter---------- ----- Depth---------------- Disposal Trench—No.................._Wid,th-------------------- TotaVL'ength-------------------- Total leaching area...-----------------sq. f t. Seepage Pit No.....•--------------- Diameter_*.... Depth below inlet:._________________ Total leaching area---_-------------sq. It. Other Distribution box Dosing,tank Percolation Test Results Performed,by-'----------------------------------------------------------------------------- Date---------------------------------------- Test Pit No. I................minutes per inch Depth_Olf'"Tesj Depth to ground water.--_-__---_..__._... f� Test Pit No. 2................minutes per inch Depth of Test.Pit--------------------- Depth to ground water------------------------ -------------------------------- ------------ii,--------------------------------------------------------------------------------------------------------------- 0 Description of Soil.......................................................................... ---------------------------------------------------------------------------- U ...................................................................................................................................................................................................... -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or 6Jqration&.Vr_AnSwer hen ....................................... -7!2. - , , , , a, lira --- -- --------------0. .... .. ------------------- .....t&---- ------ - .... ......... . ---- ---------------------- ------------ Agreement: The undersigned agrees to install the aforedescribed Individual age 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 haasee h d of, , Ith. �#y the�bba Sign .. .. . ...... ��.Ao-------------------- r 90,f Date ApplicationApproved By................................................................................... .............. ......................................... Date Application Disapproved for the following reasons:...._...4�- ;------f-------------------------------------- .................................................... ............................................................................................................----------------------------------------------------------------------------------------- • 02 1 Date Permit No--------------------------------------------------------- Issued----- Y/----- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD 0)F) HEALTH ..........rilt.�.- .. .........OF--- .. ................ ........ OWrtifirate* of TOmptiana- I? That the Indio" ualpwa Disposal System constructed '�`,),.;onR.�paired TH�� .TO,fER I by.!t......Ct.. ...... .... .............. -- ----------- ------ ------- --I e--r------n------- IkSA ':---------------- at.'.--*.......JI(-a. ......... -Al--------- ........... I ....."__jr4--------- ................................... has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the applicati6n for Disposal Works Construction Permit No------------ ------------- dated.......... ........ THE ISSUANCE OF THIS.CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM W NXTIO. N SATISFACTORY. . ...... �• _.,DATE.... ...7... ....................................... ins' ector..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT .0 ........OF...... ....... ................a N9... FEE.-- .............. gr LIT trurti it it .. ---- ----- --a-- 11 -- to1 U,.............. 4 Permission is hereby grante ...... .................... ............. Cons ut (1j ) or ep ', ) anIn *v* ual SeXage isposa teem atNo.. ........... ........ A,-.714 /---------- - ------ ... . .............. ------ ----------------------- as shown on the a Street I ,V 0, application for Disposal Works Construction No. Dated------ a oUe ------ A-0 ........... Board of Health DATE._._.. ._.! *7 11-47 -------X.................................. FORM 1255 HOB13S & WARREN. INC.. PUBLISHERS