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Home My WebLink About0110 BEARSE'S WAY - Health 31) Z70 4` LOCATION : SEWaCxE PERMIT MO. VILLAGE '. j o37o Ill TALLE E t ADDRESS k7l BUILDER 5 Nl ADORE 5511�e�� DINE PERKA T ISSUED '— 2 — — -- D b.TE COkAPLi bt�ICE ISSUED : S 7� No.. Fizz ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........OF ............ .. . .... ................... ............................. Appliratiun -for Dhiposal Works Tongtrnrtimn-Vrrniit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ----- ••.�.. ---------------------- J 15----------------------....----...---------------------------------------- Location-Address ._or Lot No. Q---------------------------- 1��.�1�. s------. (�_�............................................................ �0 ner � Address �._........C�n_�j(.-------------- --•-------...--------------------------- Installer Address U. Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) pi Other-Type of Bt' ........................ No. of persons............................ Showers_ ( ) — Cafeteria ( ) Q' O r fixtttres .......... d W Design T lo/...... -•---------------------------- ----gallons per person per day. Total daily flow............................................gallons. W Septic '1'a ik—Li uid capacit ._.__._.__._gallons Lengtlt�ab _.... Width................ Diameter................ Depth................ x Disposal rench— o. .. .................Width-_----_____ ....... ength.................... Total leaching area.-.--.-._---_-_--_sq. ft. Seepage P No-------- ---------- D' r-- ------ _j epw inlet..................... Total leaching area------------------sq. ft. z Other Distri tion b ( ) � sing tank ( ) Percolation Te Res is orm y-------------------------------------------------------------------------- Date........................................ Test Pit No. minutes per inch Depth of "Pest Pit.................... Depth to ground water........................ f14 Test Pit No. 2................minutes per inch Depth of Test Pit...,...:...........,: Depth to ground water........................ W ...................... -- ODescription of Soil.......................••...- -- --- j•--••-......---•-------------•--------••---••-------••••----•-•••••-•--•••-•........._...----•••--•--... x W 4�5;Aitx-. G!.0 F ... !�L). ....��. U Nature of Repairs or Alterations—Answer when applicable_ � ....... vp =5� ---...................................-------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with :I the provisions of Article \I of the State Sanitary Code— The undersigned further agrees o place the/syste in operation until a Certificate of Compliance has been iss b Sign - - --- .. �... D Application Approved By------ � - 5........76••---------------- -- Date Application Disapproved for the following reasons:............................................. ................................................... " ----------------------------------------------------•---•••-•--•--------•............-•--•-••••......•••... ------------------ Date PermitNo........................................................ Issued......................................................... Date 4 Fss..-... ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �'D Gr L1........OF.............. .. 4..,.. I!/ .....................-•----. Appliratiun -fur Utgpuuttl Works Tonutrurtiun Vrrniit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: � .....!t/ I -•-----------•--••---/�! � N�` �� ................................................................. y - Location-Address y or Lot No. r 1 Owner Address Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOtl;rer fixtures ........... ...................... W Design Floes.��___________________________7 .gallons per person per day. Total daily flow............................................gallons: 9 Septic Tali k—Liq lid capacity�_______gallons Length��............. Width................ Diameter................ Depth................ Disposal Trench— o. ..._ ......... Width - 41 tal Length____-_____-_-_-_-_-_ Total leaching area....................sq. ft. Seepage Pit, o........ Diameter............ .��D�pth b�Iow inlet.................... Total leaching area------------------sq. ft. z Other Distribution bo� ( ) �D sing tank ( ) `~ Percolation Test Results--} erformed y.. Date------------------------------------- Test Pit No _.1...........minutes per inch Depth of "Pest Pit.................... Depth to ground water........................ LT. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 .......................... ....... .. .......... ................................•----------------•......................................................... ODescription of Soil................................. /�✓ -----------------------------------------------------------------------._..........._......--•••----- U ----------------------------------------------------------------------------------•------------------------------------------------------------------------------------- W -------------------------------------------------------•------------------•-•--------------•--------------------------------------••-••......= •--•••-••--..•-----•--•-------------------------------- U Nature of Repairs or Alterations—Answer when applicable._.:Fi�t z< G. �jL... !-?.t.CZ..__ Iy- L �•.�....... --------------------------------------------------------••.......--•----•--•-----------------------------------------------._.......------. 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 undersigned further agrees not-to place the system in operation until a Certificate of Compliance has been issued by"`t-lie'b�0 d of health `j ,y Signed ...... -_._ ----... .... .. Dae Application Approved By..... �r ,�l-_.- j- / ��l� � ,r':. . / .- Date ��... Application Disapproved for the following reasons:................................._........__..._._______.____._..._._____.___._....._......._._.................. ...................................••-----•-...•-•--.._..-•-•-•••-•-----•---••-••-•----•-•--•-...---.._.....----•--------•-•-•----...----••---------------------------------------••---•••---...---..---- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS nY... BOARD OF HEALTH 1Yl-..........OF........... .. / .l .................... Qlrrtifirutp of frkomplinurr THIS IS�TO C�ERTI T, That the Individual Sewage Disposal System constructed ( ;) or Repaired b /�(_r_/.ram _...�1'``�-=-------------------------------------- ------------------------------•--------- ---------•--...........-----------------••-•---------•--- Installer. at-. .-.J.. .!"k!.:... 0.. ... ....._ G�li1 LI.ezk(fic-le' A�>.: r G -------•---••---._....-•--•--••----•------ ��_. -- _ .has been installed in accordance with the provisions XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit . .`'_ 3•t"_ __________________ dated-.. ...-.5'.-.7.C._..__.__........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE---- -------------•---•--------------------------------------------------•-•---- Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS _ 1 BOARD OF HEALTH J . ,Y ...........OF........X%.0 1/1� !.fie •.............•---.. 1` v—t/ No.---- ...... FEE....-----............... �i��u,�tt� urk;� C��n�tr�t�rtivat �rrutit Permission is hereby granted j... to Constrict ( ) or-,Repair ( ) an Individual Sewage Disposal System --- . . _ .............................................. Street as shown on the application for Disposal Works Construction P r it No... �� Dated---- .............. �� ✓ /i�i �i .,�- � `- 7G ------------------•------- /+ (� / Board of Health /• DATE • ............................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS I