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Home My WebLink About0016 MASA'S PLACE - Health �qa ao �� . �_ I W 4 '� LOCATION SEWAGE PERMIT NO. VILLAGE 114ST LLER'S NAME & ADDRESS EGG/� �s'i�� • ��s� � . �. BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE' ISSUED _e � q �S e Fmc. i��...... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ®fin.............. Appliratiun for Eli-quiff al Works Tunitrurtiun ramit Application is hereby made for a Permit to Construct (�-j or Repair ( ) an Individual Sewage Disposal System at: ................_M 36 ...s.....Plane............................... ----••-•�o .107................................... .......----------.........---- Looation dd ess or No. -.-- »-•. ----.....-- �^ —� - _... . Owner - .-Addd ress �.......... ......................................... ---......................•..._..........._. Xlnsta er Address Type of Building Size Lot...1_Q,00d_......__.Sq. feet U Dwelling—No. of Bedrooms .......... ..........................Expansion Attic ( ) Garbage Grinder (Nd) Other—Type of Building No. of persons............................ Showers — Cafeteria 04 Other fixtures -----------------••----••-•••-••- Q lye Y'aor3ei°i ; W Design Flow-........1 0•--••......--••-•.......-•--gallons per pas=m per del —ay. Total daily lflow-------------- 3 30-------•------�g��s. WSeptic Tank—Liquid"capacity ...gallons Length._ -�.... Width. -10.._ Diameter................ Depth.- x Disposal Trench—No..................... Width s.•............... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------1------------ Diameter..1d_®C�...... Depth below inlet.._.(A 10...... Total leaching area...�62-1....sq. ft. Z Other Distribution box Dosing tank ( ) '-' Percolation Test Results Performed by.ape,. ...6-u rueg.6Cls�.Itant.S.... Date........1.�_50 - ............ �1� Test Pit No. 1� O!"Iminutes per inch Depth of Test Pit._�.�®�...___. Depth to ground _.420c. �w Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to gro �P�t61F'_bl�ss� ....----•--------------------------------- •. ...•. Descriptio of Soil a ... ••--........ ( •-_ ®-• . -•-•-•.. A-• R,• ... 7 V 1 �F Mtf(f8i FNIIE -��y, W 7 2 •. .. . . •.... .............. .................•-•-----•-••-•---..... •-A..�No-1470.4. . -•-�--- - --- UNature of Repairs or Alterations—Answer when applicable___________________________________________________ Po�F fS� �� •----------------------------------------------------------•-......---•---•-------........--•-••-•----•----------------------------------------•••• �tCQ� ........ Agreement: The undersigned agrees to install the aforedekribed Individual Sewage Disposal System in accordance with the provisions of iIT? 5 of the State Sanitary Code—The undersigned further agrees not to place the system in V operation until a Certificate of Compliance has been issued by the board of health. Signe .......... •••-•.........•---•........................•-••••...-••-••••-•.--••- .............Daatete...•••........ Application Approved By.-•--- . •-•-• --•- -• . .. . ... � Date------•---•-. C Application Disapproved for the following reasons:............ ............................................•.......-•---................--•--.....•..•......-------•---------•---------------------------•--......••-•••-•✓•--•--••----••-••-•-•-••......---••••••••- Date PermitNo......................................................... `,:, Issued-..... x /--H C�......................... Date r ({y No.. ....... `!!./..... J FEB..�..'.f.. ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .:..QW� .................OF.-1, fir'- t..5..��.��.�-_�14? �_t�.�t.�..�`�.� r ` ppliration for Disposal Works Tonstratrtion ar t #`'" Application is hereby made for a Permit to Construct (ti)` or Repair ( ) an Individual Sewage Disposal System at: ...................._ == : •--:1 f . ................................ ..........::... ._: 7....-------- ....._..... Location Ad ess or t No r ._.. .. . _._. . . eQ.41......................•----•------•----- -, :-...........' . t Owner Address .... ... Installer Address dType of Building Size Lot...10,00O______._..S feet U Dwelling—No. of Bedrooms............3�_.............._..........Expansion Attic ( ) Garbage Grinder(/V0 Other—Type of Building ............................ No. of persons..........._................. Showers — Cafeter• a . Other fixtures ___._....---•---------------------•- _.�. d !; ber. W Des gi �' gallons per perxt per day. Total edaily flow J------gallons. 134 Septic Tank—Liquid capacity.;��_.gallons Length Width.4_1 .... fi�._ Diameter__________f_ Depth_�:'o__ Disposal Trench—No._.__.._._.. __ Width-_ a, .-_.__ _ Total Length ................. Total leaching a sq. ft. Seepage Pit No.......I............ Diameter � "0 Depth below inlet.... Total leaching a,ea.:_.4..0.1....sq. ft. Other Distribution box (wl• Dosing tank ( ) aPercolation Test Results Performed-by_C2D40,0 1- iulrV 9rI�t�� .Pf.1b..... Date......... 5.0 .. Test Pit No. lUf_l�f:r��._minutes per inch Depth of Test Pit-�.9_. ._.___. Depth to ground water None._S.nc. ' (i, Test Pit No. 2................minutes per inch Depth of Test Pit_______.___________. Depth to ground �� _ Descriptionof Soil --- �L -1--- ......... '----• -------- Ica_::...DA�1A!_...... }n x ...........2- .~7 _V.:-_. ...._ "..... -. r.. .:.. - - -- .........w• -• � / KECHNIE ---•---------- p ----- 1 V., ...---•-No.14704__-..... . UNature of Repairs or Alterations—Answer when applicable_____________________________________________________ p�......... _a? /ST -------------------------------•--------------------•---•--•----------------------------•--•-------••---••--- •----•-----•----.... �. . Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITILE 5 of the State Sanitary.Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beeri issued by-the board of health. Signer ................................................... ................................ r,i'' `✓ �� Date Application, Approved By...... . ----'--- Date Application Disapproved for the following reasons: ............................. ----••-•----••••••••••••--•-•-••-••---•---•---••--•-•-••---••-•--------•--•- ......................................................................................................... --••••----•------------••••••-•••-•--•-•....•---•-••---••-••••--••••---•--•••••--•--------- i Date Permit No...:.......... - :r; Issued --------- •.... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD rOy WEALTH •� ...... .J` ' ' 4.....OF....... �"' a............................................... TH IS 0 RTI pa t n v dV� a e D osal ste consWicted Repaired n/ I staIler •. -- Y--- ----------- a een installed in accordance with'Ilie provisions"of T `�' 5,or The State Sanitary Code as described in the a lication for"Disposal Works-Construction Permit No.___"..._____---d__ ______. dated__.. _ ._. - ` P . THE ISSUANCE OIF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............ � -1'"'=-.�.......................•• Inspector... �4�1114lt..l� � THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH �p N ..:.....�`.�.......... FEE., . 5. .......... �i �a at1 x drudion .rranit Permission is hereby anted.....__.:. .. ..--••- Y �' to Const ct;(M—or •e air ( ) an Indivl ewage Di Street as shown on the application for Disposal Works Construction Permi No.:_:.. .......___.f ted..�_-.��_.��`.�"......_.. ------...... --` � f��/,ry /, � "�,r'. _.. ........-•-•--•--•--- a =// 9 Board of Health • DATE...... ...................................................... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS ' I Itop net 11, v IIt-III 141,IIlip IIIIIDIST'"'BOW NSA ' 86. 4, IIasmm Itoo U,10,A SEEP GE nee.Ioil 14 04-NiMUML 2!0 Tr: oil I711W. AMHEDNST NO 'S two -go- IIIK4 7 Piz, Ask 10' IAVAT ram g �c log--JE-S,TA48-Y- -y'. "j'_T0W:N,J9SPir&6 v,Y r IL.I `,TEST4 MADE,iION". .... ............ Z vow: II-4, I:k -4-six �7 wow x Ilip 74 I'lop IC lot 4t _f, Owl -a ow—IIIIIIIIOW I6 fl� IIFIT No , " — -, -0#i-A TERM ITA way jQ -ti yh IIIIsow" IIAll out IIIIIIIits 11 IIL Isop&,* Ste-;A INI r_rN V W E U U N N v Not 'lop, NOW iz��, �,B C lot I 15%TANK IIBPUMM NZMO W it,NTOMDIS�TRI g'via��,!A,V 6.u It, T�(JA 7 IN" AG1 'e-' 'CAPE G0Q'S.U!WVf -L NTS'— Y;,.- 'MIN.4. sit �ROUTE- 132 Iy TUREEN-CONSUL I'Iwo IIAll Yr. I17, Iwin