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Home My WebLink About0017 HADRADA LANE - Health (2)�I TLW COMMONWEALTH OF MASSACHUSETTS ABOARDMF HEA ... Application. lWr!by made for a Permit to Construct or Repair an Individual Sewage Disposal Wystem at: Installer' Address Type of Building Size Lot.....I A"00�0.....Sq. feet Dwelling .... ................Expansion Attic Garbage Grinder W'd r&. ...... &t'a I e I Total leaching area--------------------sq. f t. Disposal Trench—No Other Distribution box Dosing tank 0 Description of Spil--:— The undersigned agrees to install the uforc6esc,ibcd Individual So.uXc Disposal System in accordance with the provisions of Article Xl of the State San ta ode — The undersigned further agrees not to place the system inoperation until a Certificate of Compliance ha ee-7 ed by t e boa f healthle) u~ � . - ate Application Approved By. x��—'1_.�� ---_-- _-�L Dat ----------------------'----------' —' ' ' -----''--- No..........Y12, ............. ............ TU9 COMMONWEALTH OF MASSACHUSETTS BO ARD �A ,y�'-/�� .........OF. ........... Appliration far 4iipoiial Morkii Tomitrurtion Prrutit Application i§-\hereby made for a, Permit to Construct or Repair an Individual Sewage Disposal System at: Lo ................. --------_--- ----- ----__-- ......... ..................Z�.............................................. Lo ation& or Lot No. ........... ......... ................ . ............ ................... ................. ............................... .. .......... "n' - -------- - ...... ..... .... ................... .. .- ...................A..d..�, -,---..... .. .... Installer ---- -------------------------- Address........... .............................. U Type of Building Size Lot...../---j 0---0-----------Sq. feet Dwelling=No. of Bedf'ooms------------- ----------------------------Expansion Attic Garbage Grinder Other—Type of Building ............................. No. of persons..-_____-_-_-_--_---___---- Showers Cafeteria Other_L41,tres ----------------- --------------------------------------------------------------------------*------------------------- :... - -------------------------- Design Flow....... ....0 .............................gallons per person per day. Total daily flow.............�_c_M_ ...................gallons. 9 Septic Tank—Liquid capacXi c.h�..gallons Length___ ---- Width....._......... Diameter-----_-_----- Depth----------_--- Le I Total leaching area....................sq. f t. Disposal Trench—No 7id - --------Depth ----- 1h Seepage Pit No------------/� 6i%& e ---ViarYter.................... �Vtli be o e 1 t>/,n ,.,* Total leaching area------------------sq. it. Z Other Distribution box Dosing tank ,0 Percolation Test Results Performed by------__................................................................. Date____-_-_------_.---_----_-..._.._....-.. Test Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water..---------------------- rZq Test Pit No. 2----------------minutes per inch Depth of Test Pit.._................. Depth to ground water-------------------- .. .......---------- ---- ---- ----------- ----------- �-/- -------7.... ..... •............... ............-*................ 0 Description of Soil----..,O 6;1� - ----------------............. ------ - --------------- ---------------11��Z........7:t'�....... ------- .. ....... U ------------------- ------------------------- ...... ...... S-- -- - --------------------------------------- ----------------------------------------------------------------------- U Nature 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 XI of the State Sanita -Code--The undersigned further agrees not to place the system in operation_until a Certificate off Compliance h been issued'by e boa of healtli,-, SiSi C ----- .... ..................... ......... ................. ...... .............. ... ...... Date Application Approved By---- - ---- - ------ ------- .................... ------- -- Date Application Disapproved for the following reasons: ...................(.....Z-------------------------------------------------------------------------------..... ........................... .......................................................................................................................................................................... Date PermitNo--------------------------------------------------------- Issued....------------------ ................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARrDF HEAL ................. .....OF......... .... ..... .......................................................... (Erdifirate of (11impliattre THIS-IS TO CER) FY, Th t the JndXidual Sewage Di Sal -stem eonstructed (,L. �6r Repaired by............... ...... ..... t,- ....... ......... --------- ......... / nstaller 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 FUNCTIO SATISFACTORY. ............. Inspector. DATE---------:3-----------/ -------------- THE COMMONWEALTH OF MASSACHUSETTS Izir, E30ARD�f HEAL to ........../ .......OF....................I........................11..................................... No......................... FEE.ZQ............. Binpaf)io lVjrki/i union Prrntit Permissionis granted---------- -bereby gra --- ................................................................. ............................................................. to Construct 0-1 U)air Di oralSystem .2j�R Ind' wage at No. f-1- ......._1deA_0LX—------------ ------91;;L ----50. Street a (�--------- ................................. as shown on the application for Disposal Works Construction mit ?p... ........ --- Dated.......................................... ....................... .,S'7'/' '�O Z� &oaof Health DATE ---------------------------------------------------------------- FORM 1255 HOBBS & WARREN. INC.. 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