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Home My WebLink About0052 THREE PONDS DRIVE - Health (2) h��o.�1 k r 1-073 No - FRX............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD 9F HEALTH A� OF........IrWW735'77.M_ 4'1�....................... ------- ----- -- --- - ------------------ ..... Appliration for UhqVooa' 1 Works Toutitrurtion Urrutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at, /_4rjjv,9S .... ............................................................. .................................................................................................. C_( lf4r4 rwx" ",A. ................................ . ......5 A 2 a........................ ----- Owner Var Address ifow' . ......... .....ir A.. �staller ------------------- ----- --------------------- Add dres;........ Type g Size Lot.............................Sq. feet U Garbage Grinder (Alp Dwelling—No. of Bedrooms............................................Expansion Attic Other—Type of Building ............................ No. of persons............................ Showers Cafeteria PL4Other fixtures ---------------------------------------------------------------------------------------------------------- Design. Flow______.______.` -0 .. .......................gallons per person per day. Total daily flow............................................gallons. P4 Septic TanV—Liquid capacity/ gallons Length_----_---_- Width................ Diameter---------------- Depth..._._.......... W x Disposal Tf ench—No. .................... Width.............__.__.. Total Length..................._ Total leaching area....................sq. ft. Seepage Pit No------ ------ Diameter....... "&------ Depth below inlet.......40*.......... Total leaching area- �.4.sq. ft. Z Other Distribution box Dosing tank ( ) — ... .. ........ Percolation Test Result Performed by............................ ............. Date_ Test Pit No I... X per inch Depth of Test P. .................... Depth to ground w ter................... Test Pit No. 2...............minutes per inch Depth of Test Pit._..._......_._..... Depth to ground water.___.._.__...........___ Pd ............................................. 7" ........ 0 Description of Soil---------- 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 TL I'i!�E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be is ... b e o d o. q .health ...... ..... .......................... ....... . .......V�...... ......i Date ..... Application Approved By... ------------------ Date Application Disapproved for the following reasons:............................................................................................................... ....................................................................................................................................................................................................... Date PermitNo........................................................ Is;U�........... .. ....................... lam; THE COMMONWEALTH OF MASSACHUSETTS BOARD QF HEALTH n� / `f oF....... - .. ................. ApplirFation for DhipaaFal Works Tonstraartion D[rrtni# Application is hereby made for a Permit to Construct ( ) or'Repair ( } an Individual Sewage Disposal Sys at L ati n Address f- . ,�+� _.. ................t--........ ...................... ...� � r. IfV Owner ,��f Address t � C��. Qi Installer Address Type of B dmg Size Lot----------------------=---Sq: feet° U Dwellin No. of Bedrooms............................................Expansion Attic Garbage Grinder aOther—Type of Building ............................ No. of persons...... .................... Showers ( ) — Cafeteria ( ) P I Other fixtures --------------•-----•-•••-----.- V--• - . ................. -------------- W Design Flow........._.. ..............................gallons per person per day. Total daily flow............. ..........................gallons. WSeptic Tany—Liquid capacity/D!*gallons Length................ Width................ Diameter.........:....... Depth..........._.... x Disposal Trench—No. ..................... Width.................... Total Length.............:_.... Total leaching'area..............._.__sq. ft. Seepage Pit No.....e............ Diameter......�4)__---- Depth below inlet......�-r..._.... Total leaching area..Z�.�*.sq. ft. Z Other Distributionx ( ) Dosing tank ( ) Percolation Test Result Performed by._-,..................... .. --- ------------- Date--�1 Test Pit No. 1.. .c...minutes per inch Depth of Test P t::.................. Depth to ground w ter........................ (14 Test Pit No. 2................minutes per inch Depth of Test Pit................:... Depth to ground water........................ _71 D Description of Soil........... '� � '4--_V ....'.... . -------------------------------------------------------••-•-•----------------•--••-•--•-•--•••--•-•----••-------------------------•--••-••--- -•---------•••--•---••••--•----- .................... 4, . U Nature of Repairs or Alterations—Answer when applicable..........:.................................................................................... ------------------------------------------••-•----......---•--•---------------••--•-••-•--•------ ........•----••••-----------••---••-••......••-•---•-•••......-•----•-------•------•--•-•---•-•----- 3 . Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System'in accordance with the provisions of TI,I.,. 5 of the State Sanitary Code—The uxid&signed further agrees not to place the system in operation until a Certificate of Compliance has be is -d'b e<. o . d of health . " _.... Sighed ••. tr ate Application Approved BY_.__/�`r .._ _-- ! ate Application.,Disapproved for the following,reasons-................................................................................................................ ..............•----------.....--------••-----.._.....------.....-•-•-•----...._..........---------------•----------------•-----••----•-------......----•-•--••••----•------••----•--••--••--••------- {. Date r' PermitNo..................................................:_..--- Issued.......................................................----...---•--------•-- ------• Date THE,-C,OM,MONWEALTH OF MASSACHUSETTS s l IN BOARD O HEALTH ✓' .........O F...... .... E�� ,.... f (9rdifirtttt of Toutpltuttrr THIS IS T C TIFY,, That the Inc,,.v, 1 Sewa D' p al constructed ( ) or Repaired ( ) b ----- J.__ ` ...e. �. �. ?!� _ ^.. _-.`t ...._ ........................ nstaller .... ......It. .-4. has been installed in accordance with the provisions of TIT 5 of The State Sanitary Code as describe in the application for Disposal Works Construction Permit"No.._'".___.__....Ay�'._7.._......_ flatted--___2.' ----- ........... THE ISSUANCE OF.-THIS CERTIFICATE.SHALL NOT BE CONSTRUED AS A:,GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Ins ector •--••- ....- ----------........... THE COMMONWEALTH OF.MASSACHUSETTS BOARD O HEALTH 7 O._._... R.x.... FEE........................ Bisiosal for onsr ion 7tt Permission i ereby granted._' ......... I..... l!. ._ ...................................... to Construct ) r Repair ( ) an Individ Sea, ge )isp al System at No " ---------.•-•-- •-- - --•••-•• .... _a -- /�- ' ` L S reet �► 'T�, as shown on the application for Disposal, Works Construction Per 't No. ..r__._.___: _. Dated.._." . ....... .�-:._.... +,. t Board of Healt� DATE.._`..-j-"�---�--��- --•�-�..................................... „-+, : . ;. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ' f � �� Ah'�y t�� Mr'liFS •• k74 .4 ��et-up17 �oN�+t,-nru• 14 - I f Iftv s.T wAO 60+tlW 1 Z as M;F 44 FAIL-{ Ft�.TN = 2 � �I D � �l�L�P t�• Sw-rw TmK - 4a.• t s gv 170►� I CPA 604" u�p•�►�lTY = -Iry .b x Io x 2•`�0 �ti X I•D o �'L• leis .au - / ' fir•. �' - - - - .... �11. l m Test } .1 1 p INS!• IrN• 5-7 17 - - - �00, 57. 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