HomeMy WebLinkAbout0065 JUNIPER ROAD - Health Li'3wwiGp+
No....... Finc � �.�............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA TH -
1 C1�' :..._....OF......../... !. .................................... ...
Appliratiou for Dhipviittl parks To-it,str�trtintt rrmit
Application is hereby'made for a Permit to Construct ( //"or Repair ( ) an Individual Sewage Disposal
Systemat: YU!........ ------•- --------------------------------------•-----____- ----•----------___--__
ocation-Address or Lot No.
, - N - -------------------
ner - ------------ ••••--------------------------•---•---•-___-Address_-_-•----•-------------•------••__---------
----- -- ----- l �C
Installer Address.............................................
-.•................................•..•---
UTy e of Building Size Lot----------------------------Sq: feet
.-, Dwelling-No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type
of Building ----------- ---------------- No. of persons.....................--..... Showers ( ) — Cafeteria ( )
d Other fixtures
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity------------gallons Length---------------- Width..------_-_--- Diameter---------------- ll----- Dept .____----------
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 ( )
aPercolation Test Results Performed by------- -----------------------•-••--------..._.....---...-----.....•---- Date.--------------------- -------------....
Test Pit No. 1................minutes per inch Depth of Test Pit...---.----......... Depth to ground water.._..___..__....-...___-
44 Test Pit No. 2................minutes per inch-
}Depth of Test Pit.-.---.--------.---- Depth to ground water........-.-.-.-.--.-:...
Description of Soil-----,?�7 - i�t�,u-!.... - -- - - -- - ,
x
---------- - - ------------ --- ----- ------- - ----------- - ------ --------- --------....- l
Nature of Repairs or Alteratio s Answer when a livable...._..... . .... . 1"^ (�C�Ca
�� ------....`�ram...-........ ----�� Zed --- ------------
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Cod The undersigned further agrees not to place the system in
operation until a'Certificate of Compliance has been s ed by the board
j/o�'heal f �J
i e /+...--�... d�'h-t��---�L ---- /
ateate /7
,�/� G /
Application Approved By__:-4 .... . �/I! ..... ..../....--1-.-....77------
Date
Application Disapproved for the following reasons:................................................................................................................
----------------------•-----•------------------------------------------------------------------------------------...-------------------------------•---------...--------------------------------------•-
Date
PermitNo.............. .~ •------- Issued-------------------------------------------•---•--._.--
Date
9'7
15
No....... S�"....... Ficu...t.�.'r�. ............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HE-
ALTH
Appliration -for INlipwittl Works C owitrurtiou Vrrmff
Application is s hereby'made for a Permit to Construct ( 1,,)or Repair ( } an Individual Sewage Disposal
System at:
�n \l,c/n✓•tit6 a 4.r,t, 1 f,
-...----•-'-'--t!-------- ---•--------------------•---•------------------•-•-------- ............---'-•-----------------------•-•------•-•----•--••-------'----••--•-----•-•--.._..--
t Location-Address or Lot No.
�t..
•.=-- .._ ....----.�,...---•-•-•-'�............. •---------•-----•-----------------•---.._..- ..
Owner Address
............
'' ::�•�� ......... ............
{ ��//,Jr//✓ter /1..+- �69
-- In sta
......... ----••...............
� nller Address
UType of Building Size Lot............................Sq. feet
Dwelling 47No. of Bedrooms._.........................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type
of Building _---.._-.---______________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
d 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--------------------------- ------------
W
Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water...------.---.-.-_..___.
!X Test Pit No. 2----------------minutes per inch Depth of Test Pit_----------------- Depth to ground water_---------------------
-----------------
O �.
Descriptionof Soil......::�f.. _ _ , ,,,` ............................................--------------------------------------------------------------------------
x
U -"-....-------•--'-....•-••.............•---•-•---•--•----•••---•---•----•--••---...--•-'-.... ----------- --------------------------------------------------------•--------------------- ------------
------------------------------ --------------- -------------- ----------------------------------------------------------------------------------------------- ------ �
U Nature of Repairs or Alterations Answer when applicable---------- _...1 ::._�!�!� _._......�G�_l!Cr /_1
- it4?-----••----•----------------------/J--jQor Il--W
Agreement:
-The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI 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.
i ed -•---•--•-----
-----------------------------•-.
Application Approved By.._. /! j t .:. �,/� ���Da�`
--------------------------------------- -
7
Date
Application Disapproved for the following reasons:_--------------------------- ---------------------------------------------------------------------------------
Date
PermitNo......................................................... Issued........................................................
Date
a
THE COMMONWEALTH OF MASSACHUSETTS.-..
BOARD OF HEALTH
.....................................OF.......
` T rrt f trade of fITAIutplialta
;.N
THIS IS TO CERTIFY, That/the Individual Sewage Disposal System constructed ( ) or Repaired
. / I � —Installer
has been installed-in acc rdance with the provisions of Ar XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.__._. ..... dated dated..... .._._�l_`'..7.7________________
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL UNCTI N SAT15 ACTORY.
DATE c -••--'-'-'•- -2---•--••-•---- Inspector.
THE COMMONWEALTH OF MASSACHUSETTS
_ BOARD OF HEALTH
FEE........................
R-ripalittl Works ( n trurtion Prrmit
Permission is hereby granted_____riA ___..r".__�C!__���`:: _ K_ ?__. ----
----•---------.•.•-----.•-----•-••-------------------•---
to Constrict ( ) oi- Repair ( ,)-an Indiviirdual Sewage Disposal System
� � Street
as shown-on the application for Disposal Worlds Construction Per /,s._'_. Dated 7 •---%•--...---•-•--
x
;. •_
DATE. " jJ------,(_ 7---•--- oard of IIealth
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
�7�7
LOCATION SEWAGE PERMIT NO.
GS j raz,C,
VILLAGE
INSTALLER'S NAME & ADDRESS
B U K D E R OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED // ��
y
�.
i
77 �
LOCATION SEWAGE PERMIT NO.
VILLAGE
INSTA LLER'S NAME & ADDRESS
i CLt' �ti
BUILDER OR OWNER
DATE PERMIT ISSUED71j
DATE COMPLIANCE ISSUED
i