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Home My WebLink About0291 STRAIGHTWAY - Health Ncwll A -70 No. ..... Fmc ............ THE COMMONWEALTH OF MASSACHUSETTS H a BOARD OF HEALTH j 1(4 ...... .................................. .T.0.&_-N................OF....... Apptiration for 11hipasal Works Tonstrurtion ramit Application is hereby made for a Permit to Construct /or Repair an Individual Sewage Disposal System at: 4/z"f'V&J' s... .......4�.E_5..................................................................... oca -Address or I N�........................ Owner Address ......GIQI'.Y..L...Iva -------------------------------------- ................... ............................................................ Installer Address Type of Building Size Lot./O.2/`2.....Sq. feet Dwelling—No. of Bd _ U erooms ...... .T.............................Expansion Attic (fJo) Garbage Grinder (V?) Other—Type of Building ............................ No. of persons........_............_..___. Showers Cafeteria Other fixtures .............................................;� ------------------------------------------------------------*---------------- I ily flow........:;;;U0...................gallons.Design Flow____.___..//"0......................gallons per4i4&;'Wper Ya�. Total da 04 Septic Tank—Liquid capacity-1 9Adgallons Length. ".. Width.KZ4."_ Diameter................ Depth..6..i6..P Disposal Trench—No..._...... ..... Width.....................Tot4l Length.................... Total leaching area....................sq. f t. Seepage Pit No-------/---------- 'ameter..47............ Depth below inlet...j6............ Total leaching areaZ- .......sq. ft. Z Other Distribution box Dosing tank ( ') RA. Percolation Test Results Performed by. ats)A�D..A,---T-11.020!0 Test Pit No. -.minutes per inch Depth of Test Pit.Z1............ Depth to ground water. Test Pit No. 2................minutes per inch Depth of Test Pit...._............... Depth to ground water.._................._... .....................................................*................. ............................................................................... 0 Description of Soil-----.... ......f Z.V.b........ ...... ;�.zvp............................. U W ............................. .......................................................................................................................................................................... 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'LIT1.JE,_ 5 of the State Sanitary Code—7 The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. --Sign ..... ...............T........................................................ ............Date............... Application Approved By........ . . -----------------------_---- ... ........... Date Application Disapproved for the following reasons:...............................................................................................................7'- ....................................................................................................................................................................................................... Date PermitNo......................................................... Issudd_....................................................... Date No.,U� Fim.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliratiaan for Disposal Works Tons rurtiaan Vrrtnit Application is hereby made for a Permit to Construct (y'') or' Repair ( ) an Individual Sewage Disposal System at: %!'!Q.!Sf-s'!JI ... ...... '_ / ... ....................•-----------------.....--•----•--.......-•-------- � Location-Address or Lot No. i owner _ Address Al Installer Address Type of Building Size Lott'_'0 _1`. ......Sq. feet �., Dwelling—No. of Bedrooms........ .............................Expansion Attic (00) Garbage Grinder (V4) a'4 Other—T e of Building ....._ No. of persons............................ Showers yP g ---------------------- - ........ ra ------ ( --->..— Cafeteria ( ) Other fixtures . -•---•--------------•-•-•-- ..... ---------- W Design Flow..... !' '`_°a_._......................gallons per�perg pey Total daily flow....... .......gallons. WSeptic Tank—Liquid capacity./AAp.gallons Length. `... Width3.-..k . . Diameter-_____ _--_-_- Depth.. .%,,I x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area:..........._....._.sq. ft. Seepage Pit No._.__. !'�._____.__. iameter.. `_'..._...._ Depth below inlet... Total leaching areal 7.10....sq. ft. Z Other Distribution box ( Dosing tank ( ' ) aPercolation Test Results Performed by oils)&$Z>.._/ ,__<F.?Z 0...fZ'S_,..... Date.A:tl_ Test Pit No. LZ..Zn...minutes per inch Depth of Test Pit.e 3... Depth to ground water.Al4A)..Fy....__ rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ .•. .... ... O Description of Soil _ l .. � .' :ram" !_.., 1 ----- / �.. 4-At.5`?....... !'�1v z-4..................... ''� '��r .��'t��'e!�S-le,_....--,70" W_...' -.----------•-------•----..... a UNature of Repairs*Oor'Alterations—Answer when applicable............................................................................................... .........................................--.................................................................................................................... Agreement: ; If The undersigned,.,-agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions oi, .;' 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. _ Sign . , .........••..................... } Date Application Approved By........... ._I lrt 1_ - -------------------------- - .. l- ...!°J... 3ti Gi Date Application Disapproved for the following reasons---------------•--•------------------------------------.._..------.....-------------------------------•--•-••--- -----•...-•-•-••---•----•----•-----•-•.....--•--------------••...........-------••---•••---•-----.......... Date Permit,No.................................. ........................ Issued..........................2�......................-:: Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH :.::...........0F......,✓.�`l1.0T rl <ge-If OK e.............................. Tn#ifirFatr of ToutpliFanrr THIS IS TO CERTIfY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by.............. ?/.;1..Z' .�'1.::�:_rlil --•---------------------------------------------•-----...----------------------------.........................-----...--------.... ,,�,�r ! y ,.. t Installer , at--••-r',..✓?r! ...... --•----•----`?C i ' 'ifr �F` '�!��r�'f`� _. _ - f' e4 ✓� .......................... has been installed in accordance with the provisions of TF07 ", 5 of The State Sanitary�Caode as described in the application for Disposal Works Construction Permit No. �7$7................. da.ted___P... . ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..---.... �2 q................... Inspector 4 �'? ,.� ... - '- f! ------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH N7%S 7� ...............OF.....s /i .: !!' !a!". .................... FEE * � Disposal Works Tonstrudian frrmit Permission is hereby granted.-` "-) =f f ..:.- L to Construct ( or Repair ) an Individual Sewage Disposal System 'i atNo..- ` - 9-•-•-----••-• % ?f`ra' . _ '... "'.} _/ !. r- -------------------•---------................. Street as shown on the application for Disposal Works Construction Pe No._.,____._._ Dated......................................... /j e' t- ......................... Board of Healthw/e DATE-----.,�"�±�_ ~..�.�_"'_ ------------------------------------ FORM 1255 HOBBS &.•.WARREN, INC.. 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