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Home My WebLink About0033 GENERAL PATTON DRIVE - Health �3:3 jG�r►cr �- iat44m, D �r . - r• i 1 ` R R ` is C.v a�s7�-y'��- �l ss, r i �D r O G C � O � T� t 4 f No. FEs. ........... THE COMMONWEALTH OF MASSACHUSETTS _BOARD O HEALT .......OF.......... - ....................... ....... - r Apptiration -for Dhipmal Works Tvtu urtivtt rrntit Application is hereby made for a Permit to Construct ( r Repair ( an Individua Sewage Disposal Syst at 3-•- ----- -- ----_�= � - --------------- -t . ��_�_. ....---•-- --- ------------ - ----- - - - L cation•Addr ell, or o. -------------------------------------------------------- Owner ^ Address ............................ Ins er Address UType of Buildi Size Lot............................Sq. feet Dwelling—r No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building .........................:.. No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Other fixtures ----------------- --------------- - d W Design Flow_ __ _ ______________________ tllons per person per day. Total daily flow--------------------------------------------gallons. W Septic Tank Liquid capacit` illons Length---------------- Width................ llia eter..........------ Dejnh---------------- "~ x Disposal Trench— 0_ ____________________ W dtly____..._.._._._ gth._ ... ..._...._.- t aching area- •---•--••----._.sq. ft. 3 Seepage Pit No _._ Diameter._.. ._C�� e 1 leading area-----------'=___.sq. it. -- 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..-____--___--_-__----.. fZ4 Test Pit No. 2________________minutes per ch Depth of Test Pit_-_______._________- Depth to and water........................ 7 Description of Soil //�' x U. ....__.....-------------------------•---••------•-••••--•-••-•-•--••----•---••------•--•------.•------------------ -------•-•-----------•--•--•---•--.:...••---•--._..------------•-•-------------------- ••-••-•••-------------------•-••---• --••-•-----•--•---•-••-•-------•-------=--------•••------------ - - U Natfire 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 Article YI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee sued th o rd of health. �� Signed ° � Application Approved By.__ �� ••• -•- ----- ---- ----- ----=L ----- --- -- �,/.- ' to � Application Disapproved for the following reasons:-•--------•------••----••...-•-..... 7........................................................... --•••-•••-----•-•--•••___._-•--•-••--••••-•--•-•-•-•••-•-•--•-------•---••--•••-•---•--._._._•---••-•••-•'•--------•---••___________________•-•••----_--.-•-•------------•-•--•-......------------------- Date ----- Permit No......................................................... Issued.--��.��- -- - --•--- Date r No....1. "-----• Fas. ✓.........r..ZJ1.. THE COMMONWEALTH OF MASSACHUSETTS J BOARD O HBALT 4 .0 . .......OF........... . ......... Applirtttinn fur` 43i vugtt1 Works Tonstrurtion Prniit. Application is hereby made for a Permif6to Construct r Repair an Individua _Sewage Disposal osal Sys at: . cation.Addr or o .. --- ----- . .•---• - --- --- - --------•----•- .--------••-- - - - ----------.�-------------------------------------------------------- Owner Address W4 •......... i+ Ins er Address d Type of Buildin Size Lot............................Sq. feet U Dwelling— o. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building -----------------•_____.___• No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------------------------------------ W Design Flow-- -------------•-_---------.A.— lions per person per day. Total daily flow___.____.___..______._______._____...._.....gallons. WSeptic Tank Liquid capacitIllons Length................ Width................ Di. Disposal Del�tll................ x Disposal Trench- --__ -__-.__• Width•............. h to Ching arca....................sq. ft. Seepage Pit'No..____ ___ Diameter,. �e 1 _______________/."i' 1 leaclziug area.................. it. Z Other Distribution box ( Dosing tank ( ) aPercolation Test Results Performed bY........................................................................... Date-.--•----------------------------------- ,a Test Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ L14 Test Pit No. 2----------------minutes per ' h Depjofest Pit.................... Depth to nd water--.-_._____--__----_---- � •...................... ...•-----•----•------ .. ... ----------------.------ •. ---•--•--•--......_._..------••------...... ODescription of Soil.......................... .. .... __. _. x --....J----------- -- U P" PP -------- ------------------------------------------ Nature of Repairs or Alterations—Answer when applicable ---- ----------------------------••---------------------------------------------_.--•.---•----•-------•----_-_--------•------------•--••--••--••---•--- .............................................. Agreement: _,,,14 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 beery sued o d of health.. Signed.•.. . .'........................................................ Application Approved By---- ----- � ---• •. --- •--- ---... .• e �� Application Disapproved for tJze'f ollowing reasons:.................... .. ^' ................•----.•--•-•----•---•---.•--•---••-----------.................._.........--•------------...............................---•-•------------......................._..-•----•---.......----- 1 Date { PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS 0ARD OF1,44EALTH f1T tifi tP of 'Tomplinurr T 1 TO CE ' IF hat the I vidual Sewage Disposal System constructed ( or Repaired bY-...... . ..• •------•----- -• ----- ....... ............ .. ........ ..------•-•-------•- nIler .at............�. ....... ---. ....... .--- -•-- .--- -- .. !" ".._. .. .••• ......•...........:..•••.......... has been installed in accordance with e provisions of Article XL of�TI State Sanitary a 16/crib �h application for Disposal Works Construction Permit No-------------l--S:.__. d .. __ ... ___ ..... -- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUN TION, SATISFACTORY. DATE....... 7 A . Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH �. ..... /,. FEE........................ rk To , strurtiui Prmit Permission is hereby granted ............. ------ ---- ........ ••... =' ••-•-•-•-••-• •-- .................... �;---....... to Cons y�'�'( epair an Indivi a e i posal s em �.�.� atNo._. . •-- ---- >.... . .... .. . ....... ... . ir ....... . ......... ---•-----•-••-----•-•- .s as shown on the application for Disposal Works Constructio No._.__ _ '�F_ .............. .. ......J . --- ..... ..�.�c. ._.... .. --------.- �r.. oard of Healt DATE ... ................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS