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Home My WebLink About0089 HORSESHOE LANE - Health (2) db� � loa • No...... FIc$....>. .:........... THE COMMONWEALTH OF MASSACHUSETTS � pL BOARD OF HEA TH ......... .10:a1Ar..............O F......4 .....---............................................. Allp irtttiun for Biupuual Works Tunitrurtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair (f-�an Individual Sewage Disposal System at: /.6-----..&.....----------------------------------------- � Location-Address -•-----•-----or Lot No. ------------•--.----- --•---••--------------------------------- ...-------- . ........-------- ............................. Owned-�-� Address Installer Address dType of Building Size Lot............................Sq. feet U Dwelling Ko. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria P, Other fixtures .-------•--••..................... . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth_............. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ........... ............ ....-------------..........---•----- --------.-•--•----•-------- 0 Description of Soil-----... -----------------------•---••-----••--•-----------------------....--------------...-------•----•--------------------•••-••••••-_.. --------------------------------------------------------------------------------------------•-----•------------------------------- -- .............................................. U Nature of Repairs or Alterations—Answer when applicable___ ../..6� _..: ��//�� ._A$IX...................•......... ---------------------------------------------------------------------------------------•-•-•------•--..... - a . ...e� e� 'a Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has betaZb �the ar f health. 1. f:---••-. •..._y Signed- - ...... -h-- - ----- ...... ApplicationApproved BY----•---------------------------------- - ---�•---•---•-•---•--...---•-- ..._._........... Date.............. Date Application Disapproved for the following reason ------•---•----•----•-••••--•-•-------•---••---•--•----•-••-•----------••----------------------•--- ---••----...---•--•......-•------•-------....•••••---•-•-....---•------------•-•--•-.-•-•••----•.......... •------•-•-------- Date PermitNo........................................................ Issued_....................................................... I ' Date ----- -- -- -- ------ ---------- `._ ' No................_....... Fss... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,�°..............OF....A�/�:� s /.............................................. Appliratinn 'fur Disposal Murks Tonstrttrtiun rrrmit Application is hereby made for a Permit to Construct ( ) or Repair (L-` an Individual Sewage Disposal Systems at: ---......4.....:. � Cst :. �:'.r.. :% :a fad.....» �.Efi: •'r:+%%:.--•---....----.•...............•----• --........•••............---•-------•-•-- �� • Location--Address or Lot No. ......................».<;f.s}:!r~ 1�� . ............................. .......... . ............................................. ......................................_..... r. ess Own Ad rt ...Installer Address Type of Building Size Lot................ Sq. feet Dwelling—'No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) P4 Other—T e of Building No. of persons............................ Showers_ — Cafeteria 44 Other fixtures ............................................... W Design Flow........................:...................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. --------:•--..------ Width.................... Total Length.................... Total leaching area...................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth, below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a ..a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_..................._.. Test Pit No. 2....:...........minutes per inch Depth 'of Test Pit.................... Depth to ground water........................ 04 .................. ............. " ..........._..... - - •---- - D Description of Soil...........Y_11 ,�. :. I V pl -----•---------------------- ------ --....... •--------------------- •------ .--------- ••----- ---------- ------ ......----------- •----.------------------------.... --------•------ W ........--•-......•--•-•-•--••---•••••.............••••---•••-----•---••---...-•--•----...----••---••••-•------•••----•-•••••...••.... .�.�.__...:....; ,.......•--................. . - V Nature of Repairs or Alterations—Answer when applicable -l.................r �r '' '�J.............................. y,} r ........................................................................................................... �...C�AC ..Y..«Y iJ_ _.(.rf'.!f1��1- •_-.r ...................................... Agreement: The undersigned agrees.to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIME 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 card of health' Signed �S?" �l of r a/tr' ?o5 ..../ �✓.. . .... gri ...... --- T -..., ......... ...-..... ..... Date Application Approved By......................... r T.................................. .... .............................. Date Application Disapproved for the following reasons:......................................................................................................».-_ ........----•-•--------------•---•-•----.................-----................----------•----.............-•••-• --•--•.................--•--•• - -•--•----..» Date PermitNo......................................................... Issued..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS �d-- BOARD OF HEALTH f Tntifutttr of Toutphana b Tga ST��C{E�..fT � 'at the Individual Sewage Disposal System constructed- (-. ) or Repaired (. Y-....= .............................. ,r Instar. at. /J /�+ cF' �f aid vG� . . ...... -----... ... = ......------•-• -•.•-•... ......... ...•... ---••••• •..---•.. ....... ------. has been installed in accordance with the provisions of TITIF 5 of The State Sanitary Code al described in the application for Disposal Works Construction Permit No........� . '7......... dated...........q, z_* ............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTE14 WILL FUNCTI N S TISFACTORY. DATE.................................. ..` G?........................... Inspector........---•--•-------=-------•---.................--••------...---..............-- THE COMMONWEALTH OF MASSACHUSETTS y �� ... BOARD OF HEALTH No... . ..��. �......... .......................... .. ........ .... ...... FsE ..:.. .: <,.✓. Ropusol VuOs Tonotnu ton1 rrmit Permission is hereby granted..... to Construct,(-� or pair,,,(kra Individual Sewage Dispo System at No........... ' ' .%" �' � . .�s�' ...._.. . d�1' � 1141 ' ty-........................................... e!�... ...t..- ----•- Street y as shown on the application for Disposal Works Construction Permit No..�6�.... -i_ Dated......`��.._'_ �............ ,7 .................................................. . _i;o -• ................_ Board o e th DATE............ .� FORM 1255 A. M. SULKIN. INC.. BOSTON