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Home My WebLink About0025 FOREST STREET - Health�5 FDresE 5+. , 4wmfs 8b(c � 0i3 F 'BA NSTABLE TOWN O R LOCATION 'T SEWAGE VILLAGE 4tt ASSESCR'S MAP 6t LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY f"T r y� 1` . LEACHING FACILITY:(type) F'1GC (size) `` AQ NO. OF BEDROOMS 3 PRI"LATE WELL U BUILDER OR OWNER DATE PERMIT ISSUED: �'— DATE CObIPLIANCE ISSUED: VARIANCE GRANTED: Yes No I c izt�' 6A �k Finc THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........0 F...1?V06Q ...................................... Appliration for Disposal Warks Tanstrurtion rrrutd Application is hereby made for a Permit to Construct or Repair Vj"an Individual Sewage Disposal System at: ......... ................................ .......... C....................................... r Location-AddressLot No. .......... ...........C.Q.0--jr V......... ......................................................... . ........................ ................ Owner �A . 1 dress .............. ......................... ....... .....\ ........ ........... .. ......... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder 04 04 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria 04 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. f t. -------------0........I............ Diameter......&------- ... Depth below inlet....L2.!Seepage Pit N ....... Total leaching area..................sq. ft. Z Other Distribution box Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0:4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....---....._-.-.-..--.. N ...*-----*--------------------------....*'****.......*---------------*.......*'*"***...*------------------------....*-----------------*....."...... 0 Description of Soil......................................................................................................................................................................... �4 1 --------------------- --------------*------------------------------------------------------------------------------------*-----------*---------------------***---------------*--------*------ ........................................................................................................................................... ...............................4 . ........... U Nature of Repairs or Alterations—Answer when applicable- . .......... ........t..... ............ VIT.......... .. ... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI ITI U 5 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 the board of health. Signed....... .. ...... ....�'_-::_ .... ................................. ... Date Application Approved By............. .. .................................. - ---------- 0 Date Application Disapproved for the following reasons:.............................................................................................................. ................................................................................................................................................................7...................... ................. Date PermitNo------ • .................... Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r0. .C_LJ..N--.........OF �A- .! .! ....................................... Appl ration for Disposal Works Tonstrudion jImA t Application is hereby made for a Permit to Construct ( ) or Repair ( (i)an Individual Sewage Disposal System at: . �-•............................. ....•.... �!_rA_ L�.V i_Gtf)��(? ...................................... -- ..- - Location-Address r or Lot No. ....... :.......» ......................... �51 -•(/. ............................ Owner Address ........ ........................... ^........ . Installer�•--•.•-,--•....... ..................... Address Type of Building Size Lot............................Sq. feet �-. Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures ----------•-... ......•••...•-•-----•-----•-•••---•-.....----•---•••••••-•...••••-•-•--•.............•------•-•-----•-•....._...--•--......--------- W Design Flow........ ... . ......................gallons per person per day. Total daily flow.......... K-1 ................gallons. WSeptic Tank—Liquid'capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No........I............ Diameter......L.,.......... Depth below inlet....1.2..t....... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) � Percolation Test Results Performed by.......................................................................... Date...._____........._.._...._.._...:--.... Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water....................... AG --- ------...................... ----...... --..... ---------------------- ------------ :.......................................................................... ODescription of Soil........................................................................................................................................IF—-------------•----......... V ---------------•--------•--------------•--------..... ------- --............ -------------------------------------------- -------------- •••---....... ••...... ...... .. W UNature of Repairs or Alterations—Answer when applicable......757.7._0ti �_..K...AA............. ....... ............ --------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I T U 5 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 the board of health. g l = ll Date Application Approved BY . �.` ..._ Lr'- Date Application Disapproved for the following reasons-------------------------------------------------------------------=----------------------------------------...» Date Permit No......tis�.�1.'l` ..............».... Issued._..................................................... Date THE COMMONWEALTH OF'MASSACHUSETTS J BOARD OF HEALTH -'T'{�. A•�(!�/..........OF.. �� ................... Trrtif irall of Tomplianu THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (L)/ by :.-- ••----...... ... r s:'.c. ...---••-•-•-------------------•-•--._........--•-•••---•-•....._...-••-••-••....._ Installer at............................. lc"' .................................... �— has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit. No,......... �G''-•:lye dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--•--•-----•--•-•-....--y C,� = Inspector............. -.._...._.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,............:....... ....... S FEE. �........ Disposal Works Tnnstrurtion "rrmit Permission is hereby granted........ jz4_(- :! t --•- -=-- -'-'-= ``-`.................................................................. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System - atNo -----•----------------------------------- Street I as shown on the application for Disposal Works Construction Permit No.--2-� ____ Dated.......................................... -----------------•----------...... ..._,= ................................................. 7 r r' Board of Health DATE............... --------------------- .----- `J - ,i _