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Home My WebLink About0052 GREENBRIER LANE - Healthr LOCATION SEWAGE PERMIT NO. 0 7pz, 1 l L A E -07$ - o/,6 INSTA L ER'S NAME S ADDRESS X12 iyz v nN-,1 I U I L 0 E R OR OWNER 026:LD 5). ?C 6-L- �4;-t�- DATE PERMIT ISSUED / ''/C9 � �c/+ DAT E COMPLIANCE ISSUED d UO W r � I I Y� - ,�'9��,( •�� - ��. Fria �.—. THE COMMONWEALTH OF MASSACHUSETTS BOAR® j HEALTH .------...ran......:..OF........ ....... . ., � ............................. App iratinn for Disposal Works Tnnitrnr#uan ramit Application is hereby made for a Permit to Construct 4�1 or Repair( ))' an Individual Sewage Disposal Sys at: �!,:•Li ................ ..� .r ----- ... ... --.... ------- ................ /� /]} Location- ddress o t No. /j C.�.QP9�l:'.t C✓. i!! E' ....... ....................................... .. •--..Yll/�...._._......... Owner, y� �pdddrAress�. j� a ...................... ff ............. yT/d.�Gr]f d..1� <fb4.� Inst er Address J� S feet d Type of Building Size Lot... _....._.. q. U Dwelling—No. of Bedrooms............... .....Expansion Attic ( ) Garbage Grinder ( ) Other—T e of BuildingNo. of persons............................ Showers — Cafeteria Ga ,Other fixtures -----•--•...............•--•-•......••-------- WDesign Flow...........................................gallons per person per day. Total daily flow...........�.3.0..........:.....gallons. WSeptic Tank—Liquid capacity Xgallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width..... Total Length.................... Total leaching area...................sq. ft. Seepage Pit No......../--------- Diameter...... 0......... Depth below inlet._.._---..... Total leaching area... e.sq. ft. Z Other Distribution box (� Dosing t ) `" LJ? Date----- / /' a Percolation Test Result Performed by-_.. .: .t / ✓�^� -/ _.7 .__l�f a Test Pit No. 1...._. .__..minutes per inch Depth of Test Pit......1/�/ _.__. Depth to ground w ter.___..... . (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Q+' •--•------•---------••--..../. •----------•-----------------•--.............••-•---•--------....................---------•-------••---•-...........------ O Description of Soil..............4g...:?r..-.......44e&XV. /&t;y W --------------------------------------- --/� A. ----------------------------------....--------------------------..._....-•---- UNature 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 TLITLE 5 of the State Sanitary Code The undersigne urtl:er agrees not to place the system in operation until a Certificate of Compliance has been ' ed by oard health. Signed... .... •_ --- = ......................... /z-z�-�� Date Application Approved By................................................... -------- •..................................... --------------------------------------- Date Application Disapproved for the following reasons-------------•--------------•-•--•----------------------•--------------------------------------------------------- .....................•---:..••-•--••--------•-•-----------------••------••-••---•••...-•----------......•---•-•---•-••••--------•-••-••----•-••---....----•----••------------------------•-•---•.....-- Date •..._ issued.....L.......Permit No....................... ---------._.._..:._..----------- M Date No..�? = v> Frm.........3.a.........._ THE COMMONWEALTH OF MASSACHUSETTS :BOARD OF HEALTH ..........0 F....... Il �.t� .............................. ApplirFa#ion for Dispogtai Works Tonstrnr#ion funfit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: f Location) ddress �y' or t No.a • �1.+�='-+ .t: '# . �� ar?lye '�/ v�Ji'r .... ............................... ............_. wner 11rress W ................... r= = r�'1 = ...... �". a 41�/. /r!` �� In Ier Address U Type of Building �.. Size Lot... �. 1„7.....Sq. feet Dwelling—No. of.Bedrooms............... ------------------Expansion Attic ( ) Garbage Grinder ( ) a'4 Other—T e of Building ... No. of persons............................ Showers YP g ------------------------- P ( ) — Cafeteria ( ) dOther fixtures ..---•--•----------------------------------•-----.................................................................................................... W Design Flow..............................................gallons per person per day. Total daily flow............ ____.--._--.gallons. W Septic Tank—Liquid ca acit - _ .gallons Length...._ Width................ Diameter....: ...__.._. Depth................ P q P x Disposal Pit Trench No _No Diameter Total Length.................... Total leaching area....................sq. ft. ter.... .. ........ Depth below inlet.... Total leaching area.....-_ s . ft. Z Other Distribution box "" Dosing to ) Percolation Test Results Performed by � ... ''2. t !may:` Date. .. ,f°_ ' / ----_ minutes per inch Depth of T t Pit......... Depth to ground w ter.._L ,�Art`.1 No. I..... ......Test Pit 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...................... P4 ....•---..-....... �t` .............................................................-•--•-------•-----........-•---------•-----••---....-- O Description of Soil.............. n --.___ ------------------------- ,. , > UNature 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 L I i' .;;:. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been 's ed by h oard health. Signed.._ .._ .. r �j l fir Date Application Approved By......................... a/ ..__._..... Date Application Disapproved for the following reasons:----•---------------------------------------------------------•---------•-----------...---...---.......---••_... ..................................................•---........--------•---••-•-----•--•---•--------.................................................................................................... Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , "1.............O F...... �............................. TntifirFa#le of Tomplinnr THIS IS CERTIF , That` the Individual Sewage Disposal System constructed (# 'or Repaired (" ) /ii.%' � I filer has been installed in accordance with the provisions of'fi F' 5 of The State SanitarCode as describe�'�n the application for Disposal Works Construction Permit N ."> _.....,8_/>......._... . dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHA NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTI N SATISFACTORY. DATE............. ......................... --• ....... Inspector.......1........................ cam_ THE COMMONWEALTH OF MASSACHUSETTS - - 1 .-• BOARD O HEAL H f!, ! ,l ................0 F....... ..... � ------....................... '' FEE.- ,�)............. Disposal Inork.5 Cho #r ion anti# Permission is hereby granted........ . . ..�..... �. 1 ' .�',?`o.e ,�....................................................... ................ to Constructor Rep�a' ) an di ir.ual Sewage Dispos System at No.................................:C ---- � ''�"- _ c" `'' ' •-- 1 =" • _. r .,. 'f tree as shown on the application for Disposal Works Construction Termit No...................... DaAed.......................................... Boar Health DATE--- ' J, ..---•...............•••-••--- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS