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Home My WebLink About0004 FOSTER ROAD - Health y roMa 301 ' a n a a o p O 0 - a " o e " r �I I 3 I � W o Iw I o - �, ? I 4 I iW w N u �I I col ? :2 �zI i r a WI cr � LW o o I a Iw W Ir Q ° I > I ? IcoIto 0 Q v � O 0 �I roJ Cl l� No.... _ FEE... ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............. ° ..�-....... ApphrFation -for 41-iipas al Works Cnoaastraartion Prrttait Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: L/ �- ,�oSreA /, ylywaz/s ----------------------------------------------------------------------------------------------•=. ••--•-•---------••---•-•--------••--•....--------------------------•---••--•--•-----•----•-----•. fLocation.Address or Lot No. Owner JL' Address •------•-- ...........X. - --- = � Installer Address UType of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms........................................Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) adOther fixtures ....................................................................................................: W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic 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------------------scl. It. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------•----------------------------------------------------------------------------------•------•---......................................................... 0 Description of Soil_-------_---------_--------------••-•---- -�` -----••--•-••--•-••-----------------..-__----...-..-..-----------.-...--..-.--------------------------------- -----------------------------------•-----------•------•--------••-•------------------. __--_----.--------•--•---------•----•--•-••-------- U Nature of Repairs or Alterations—Answer when:.applicable...... ...........a -..__-;__ ..:Z..e.w........................... .5' ....��ose�-- • ............................................................ 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 undersikni d,fur'ther agrees not to place the system in operation until a Certificate of Compliance has been issu by.,the dt'of.Fa i_I;fy. 7.3` Signed---- Application Approved By----- -- ----* ----------------- .............= ........................................... --•-•-•..._------.....t�:�.:.�. :? Date Application Disapproved for t ae following reasons:.'. -•...................................................................••-----._.......---•._....._•----- ..........--•--- --------------------------------•-----------•---••------••---------------•••----------••...•--•-..............--------••-------------------•-----•------------•-•--------------------•- �J?' ; Dete. Permit No. 0 Issued 7... ...... s ••�•--••------ Date ...•.....-•.......•.••...•..•..•....•.••.•••..••..•••••.••.••••••••.••••..•..••....•...•..•........•.• ... .........e•..........��... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.............. ...................................................................e... Wrtifiratr of Tomplinurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or aired ( ) by................ ---------•-...fJ .. ti.. v{p 3 u.f . tF�' /� / G l Installer �1� �� ../L.....�f ----------------------------------------------------------------------- has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described-in the application for Disposal Works Construction Permit No..______�_:� --................. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------......` -- 7-°-2-........................................ Inspector------- ............................................ No........ -•--- FEx............................ t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................. r,.i y..k...........OF. .� ,. orrs,-' . Applirtt#ion -for Difiliviittl Worka Tonstrur#ittn Vrrmi# Application is hereby made for a Permit to Construct ( ) or Repair ( �) an Individual Sewage Disposal System at: ............................. .......-, .................................................. L - . ...................................... -Addreess s or Lott N Noo. . .i.- O ne r" i �, d r•............... ....•-•••--•--••-••••------••-••-•-•••........•-•••--•-- Address :.... rF'� ' -----•-----•-------•---•-----•-•---•----------•-------------------------•---•-••-•-•---------•---- 'Installer Address 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 ( ) Otherfixtures ......................................................--------.....---....---------..........--------•-----.-•-- w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacitv---,--------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 ( ) Percolation Test Results Performed by.......................................................................... Date------------------------------------.... Test Pit No. 1----------------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........................ 9 .................. .......................................................................................................................................... 0 Description of Soil--------------------------------------------............................................................................................................................ . x w U Nature of Repairs or Alterations—Answer when applicable..--...............::..:...'._......--..... r 4 'r- ,_ Ag --�_ �- i-- --- Y... •. '-,s�.��•.�� =---------------•----------------------------------.......------------------..... --- --,r r, reemenN- •The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the The 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 the board of health. e?- ;r7. i ,Si ed------...- �r / ................................Application Approved BY °--- ................................................. --------•---•-•--••. •-••••--••-•-•----... .- 3 Date Application Disapproved for the following reasons:........................••------•--......................-----...........------•-------•--.....•--....._......-- ....-••--------------------------•--•-----•.-••--._......--•--------.......--•---•--••-•-----•--•-••........------...----•-------.•....-•------------••----•...........----•-...........-----..---•----•- ry _ Date PermitNo.. -�1 .......---•-------------•---.... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r/��<< ..........................................OF..................................................................................... (Irdif irtt#r of Tomphaurr THIS IS TO,CERTIFY That the Individual :Sewage. 1 Disposal System constructed ( ) or Repaired ( ) - s i by... ... --•--•-•-•-•--•---•--•--•------•-----•-•--......•••---•...............•-----•----------------------•---••---•--••-•-•-•••-••-----•------•-•••-••----•-•---•-•--•---•••- Installer at........................ .. - .has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No------------------------------;........-_. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE !�_.'?.= . ................................... Inspector..............................................................•-••--••-•-•........-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No °---•...---•-••---• FEE-1•.= =�• � �i��tt1 �rk� �>atts#r�tr#ittai �rrmi# Permission is hereby gran ted-.-..-.. -•........................................................ �.•....•. to Construct ( ) or Repair ' ) an Individual Sewage Disposal System Street �L. -- ?'7 as shown on the application for Disposal Works Construction Permit No.-- Dated..........:-`............................ Board of Health t, DATE................... ...--- ........... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS