HomeMy WebLinkAbout0030 WILLOW RUN DRIVE - Health (2) (IOLLUK) e,("Ln i�'.j Goy$- .
ai �/v7v
�Y
No.7C- ....... Fps.. .. ...............
THE COMMONWEALTH OF MASSACHUSETTS
I 101oBOARD O �EAT
� .._...------.OF.......... ....... ...... ...............----•-
Applirativart -fur 43iaiiauual Warkii Towitrurtion Perutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
......... ....... -•--•---------•---------------
-----
ocation-Add re or Lot No.
............__ ual _� ......... � _y_-__-.__--_ --.____--_____-:_
-----._...--
Own- Lam. Address
W ---------------- � '�t1f� y 1 y�l*.................... -------•------....----....----•--•--._..-. ...............---------------------•------
Installer Address
Q Type of Building Size Lot.. _ ........Sq. feet
U Dwelling—No. of Bedrooms_________________3____.___ ._ -___-Expansion Attic ( ) Garbage Grinder ( )
1:14 Other—Type of Building ............................ No. of persons.--------�-------------- Showers (1 ) — Cafeteria ( �,
04 Other fixtures --------------------------------------------------•--------------•--------------------------
W Design Flow...........
_.................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity------------gallons Length---------------- Width................ Diameter........_..----- Depth.___-_---..----
x Disposal 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.--------........------------------.....
Test Pit No. 1......_.........minutes per inch Depth of "Pest Pit-------------------- Depth to ground water...._._-_._-.__.._---...
�14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water._.-..-..___.-..--------
(� ._..._..:_._.._ -•- -- ---------------------------------•--•••........................................................
;47
O Description of Soil.____
J __. .__. � J. -----•------------------------------------------- ----------------•-----------------------------
x
x -------------------------- -- ---•••• --•--
U Nature of Repairs A er tions—Answer when a licable.-" ��.3�__ __ _._ ....
f
= � ----- � � --- --------------------- ----- ----------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee is ued by the board
' of he
WApproved By..
�
a`2e
Application Disapproved for the following reasons-------------------------------------------------------------------------------------------------=----•----------
-------------------------------------------------------•-------------------------------.._---------------------------...------------------------------------------------------------------------•-------
Date
PermitNo..................-•-------------------••-•------------- Issued.......................................................
Date
74,
No. A/........ .............. .. . .........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA TH
OF............6..rZ .................
Appliration -for Uttipoiial Works Towitrurtion Vrruift
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at:
................... .................................................................................................
Lc!,on S or..Ad., Lot.No............................... .................................................................................................
n r ' Address
----
J/e...........................,- ---_-_---------------------........... ......................................................
--PRa In alter Address
Type of Building Size Lot...... feet
Dwelling—No. of Bedrooms----------
--------------------------------Expansion Qttic Garbage Grinder ( )
Other—Type of Building ............................ No. of persons------- ............... Showers ( ) — Cafeteria ( )
Other fixtures -------------------------------------------
------------ -----------------------------------------------------------------------------------------
Design Flow....................:.......................gallons per person per day. Total daily flow............................................gallons.
Septic Tank—Liquid capacity------------gallons Length________________ Width........_..._.. Diameter_........-..._._ Depth...--_--_-------
Disposal Trench—No. .................... Width______-______--_--_- Total Length-------------------- Total leaching area-------------_-----sq. ft.
Seepage Pit No..................... Diameter-___--__---_..__---_ Depth below inlet_....._............_ Total leaching area------------------sq. it.
Other Distribution box ( ) Dosing tank ( ) I
Percolation Test Results Performed by-------------------------------------------------------------------------- Date----------------------------------------
Test Pit No. I................minutes 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------------------------
L�i -------------
.... .............................................................................................................
0 Description of Soil----------fir -7_�)�Q14FX_x--------S-1-4*1i—---------------------------------------------------------------- -_---_-------------------
X
U ----------------------------------------------r------------------------------------------------------------------------------------------------ ---------------- ---------- - ----------- --- ---
when a -.4
U Nature of Repairs r �to ations Answerh livable.-. ��j
---------------------------------------
---------- -_-----------------
Agreement 7
:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
Wl ca —
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 been iss (I by the board of S I
..........
Signed--;.......Z.10...q......Z� ---- ----- ----------
te
7
---- ----- ---- _,7
Application Approved By.--'/_�424. - - - -- ----- ...�Pl?x .. .... ----------
Date
Application Disapproved for the following reasons:----------------------------------------------------------------------------------------------------------------
............................................................................. ----------------------------------------------------------------------------------------------------------------------
Date
PermitNo......................................................... Issued--------------------------------------------------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD,,917
..........................................OF.....................................................................................
(IT
%:Patif iratr of TOmplitturr
_T C4�R Repaired
7 0 �FIFY4at th 1v idual Sewage Disposal System constructed or
by....... ........... ............... . ........ ............... --------- ---------- ........ ---------------------
------------------------------------
at.............----------------------------------------- .... In�j 41 --------------------
-----------------------------------------------------
d in the
has been installed in accordance with the provisions of t6 I. of��he State Sanitary Code as de
:2 ' 3-- .2 W -51e
application for Disposal Works Construction Permit No--------------- -- ---------------------- datecr_.......I.....................:0...............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE........... .......... ---V....................... Inspector---- . . ..............................
THE COMMONWEALTH OF MASSACHUSETTS
0-7,1 ;2 BOAR)X OF HE L./T
................................... ....OF .. ... ..........................................................................
No......................... FEE........................
'Dinvoml Nork_q )T trud-hin Frrutit
Permission !* ,hereby gran ----------------------------------
----------------------- .. ............. ..... .........................
Am 0 ffi/ 'S "I
to'constL ��ge jaal"&em
X
atNo---------------------------------------e....---------------------------------------------------------------------------------------------- ..........K.................------
as — 2
as shown on the application for Disposal Works Construction r it N>o _�_,�?_,4. ated ..............
. ... . ... ... .. ...... ..
-------------------------------------------------------------------- ----;.....................
Calif
Board of Health
... .... .. ----- ----
DATE..... ---------------------------------------
FORM 1255 HOB13S & WARREN. INC.. PUBLISHERS
,
,
+.Y t a
97-11
----- ----- ---- -- � -=-� =- ----- ---cam _ ._- z'� --- }
F
y
1 I
+
CsrsT;.S —
} '
i
I ,
,f ,
r r I
I F E I I I I I + I I I I I
-
`
I I I I I I I I
ice_ I I
o I I I !a�� I � I j
I Mi a, ,a I I I r i
I Et M
I _
r
I I j I I a i
I I I I l l i
r 7.79
Ilk
'i
-- ---- - - - ------- - -- - - -- El 1- _ --- - -- -- - -- -- - --- - - - __ - -_-