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Home My WebLink About0067 THOREAU DRIVE - Health (2) i Fic .............................. THE COMMONWEALTH OF mAsSACHUSETTS BOARD QF HEA6TH aag7.....V�.OF...... .................... Appliration' -for Dhi viral Worko Tvtw union Vrrmft Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal Syst W17 Z. ....... .. ... .Sgr------- ..................................... ................................................................................................ Locatio -Address or t NO. .......... . . ..... . ------------ W r Address ..... .. ..... ----------------------------------------- X. /..... ---------------------------------------- ...... . ..... ...... ........... - ------................................. w r Address .... .. ---------- ------------- ----- --*--------*--------------------------- ........... ... ... _L�r_s` Installer Type of Building Size Lot----------_---------------Sq. feet U Dwelling—No. of Bedrooms-------------------------------------------Expansion Attic Garbage Grinder ( ) -1 a4 Other—Type of Building ---------------------------- No. of persons----------------_-----_- Showers Cafeteria ( ) a4Other fixtures ---_----_-----------------4---------------------I------------------------------------------------------------ --------------------------------- Design Flow....................-$-------_-.-..gallons per person per day. Total daily flow--------- ..--........-.--.------gallons. R4 Septic Tank—Liquid capacity, gallons Length---------------- Width------.-..--.--. Diameter-----.....-----. Depth---._-_------. Disposal Trench—No. .................... _fidth......r-Al------- Total Length-----.----------.--- Total leaching area------------_------sq. f t. Seepage Pit No.........../----- Diameter -/,eon A ank OAV--We, th below iniq.... ------ Total leaching area--------------_-S( r4o It. Other Distribution box l5osing f /)h-- !%�/S—/711( - Percolation Test Results Performed by-------------------------------------------------------------------------- Date--------_----------------- ----------- Test Pit No. I..............-.nilnutes 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..-.....---------.------ ------------ 4............ ---------------------------------..................................................................................... 0 Description of Soil--------------------- -------------------------------------------------------------------------------------------------------------------------- x U ------------- ------------------------------------------------------------------I----------------------------------------------------------------------------------------------------------------------- ------------------ ...... ------------------- -------------------------------------I----------------------------------------------------------------------------------------- ------------------------ U Nature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- .............. Agreement: The undersigned agrees to install the aforcdescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigrie further agrees not to place the system in operation until a Certificate of Compliance has been-Issup,d by the>aT 34, o ealth. Signe ----T..................... A;� 1 4- . ............. ----------/------------------------------------------ _6------I te Application Approved By------------ ------ -- .... .... ... - ------------- v��-- -------------- ---P/wARX Application Disapproved for the following reasons:----------- ------------------------------------------------------................... ...................................................... .......................................................................................... Date Permit No......................................................... Issued---40 &e —-------------------—-------- ------------------------------------------------------------------------- NoFE/................... .................. THE COMMONWEALTH OF MASSACHUSETTS OF. -for Dispsal Works Tonstrurtion Vrrmit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal Syst ... .•-- ...................................... ................................................................................................. Locati. -Address Lot No. . ..... ...... ----- ......... ------- ---- ....... . .......................................... ........... r. ........�6; .0 i1c.,............................................... Ow w er Address .......... .... ... ...... ......... -- ---------------------- ..... ....................................... �_l -- -------------------------------------*------ ----_-_---------_�.- PQ Installer Address Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms---------------------_..........--------Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons...__:___._________._-__..__ Showers Cafeteria Otherfixtul= -------------------------------------------------------------------------------------------------------------------------------------------......... 6 U Design Flow----------------------------................gallons per person per day. Total daily flow____.__. ....... ...........................gallons. P4 Septic Tank—Liquid capacit gallons Length________________ Width.-._--.------_.- Diameter_----..._.._____ Depth----_---------- Disposal Trench—No. Width X/--------- Total Length-._-_____-________-- Total leaching area--------------------sq. f t. Total I I Seepage Pit N Diameter __ 'j&.Uqpth below ml ....�IW...... a eac ing area------------------s tank o---------- mel ----- t. Other Distribution box ( ) /�iing Percolation Test Results Performed by--------- ................................................................ Date........................................ Test Pit No. 1................minutesperinch Depth of Test Pit.__.._._______._____ Depth to ground water------------------------ L14 Test Pit No. 2................minutes per inch Depth of Test Pit_._.._.__.__________ Depth to ground water__._._____---__-__----- 0 Description_of Soil_________________________ ....................................... ----------------------------------------------------------------------------------------- ...............� A4064-- - ------------------------------- X U .................................................................................................................................................................--------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U 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 Article XI of the State Sanitary Code—The undersigne further agrees not to place the system in operation until a Certificate of Compliance has bee iss ed by th health.S. i1a;ig �... . 44, .............. ,o Sign . ............ ........e at e ..... ........... Application Approved By----------- ......... . ............. D e Y------------- ♦ a'Application Disapproved for the following reasons:............................. ................................................................................ ..................................................................................................................................................................................I...................... Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH ... ............ ...... .......................... . Trrtifiratr of Tompliatta T I I CEOFY, That the Individual Sewage Disposal System constructed (�r Repaired ------- - ------- ................. ...................04-- ----------------------- ----------- inst r _0� ..... ............................ has been installed in accordance with the provisions-of Article XI of The State Sanitary C.9de jas despribed in the application for Disposal Works Construction Permit No.____ ------------------ dated_._ tre-/ rT............... THE ISSUANCE OF'THIS CERTIFICATE SHALL NOT BE CONS UED AS A GUARANTEE THAT THE SYSTEM WIL U TION TISFACTORY. DATE _------ -------------------------- Inspector-------- ................................ ......................................... ............ .. THE COMMONWEALTH OF MASSACHUSETTS BOARD Pf HEALTH _Z ........OF..... , 0 ------ - No. FEE_ R-riposal Works Qlanstrurtion PrrvAit Perm.issloij is, reby granted---------------................................................................................................ ........................... to Co or Re i an Individ a ew e Disp I S' st t N Co 4t KrU, .0 .. ... ..6a ...... ...... ... . . ......................... as shown on the aConstruction Street ... Dated....... .. ........tdl........... application for Disposal Works � � �T Board of Health' ---------- /0,/ ........................... DATE..... .r/.. .....................r, ............. % FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS � -� ` :� �=. .�. -i I �, �� i / nn � �v W I� i �L J - � �'